Dr. Summit Shah
For those with food allergies, eating out can be anxiety-provoking, as it is difficult to control what ends up on your plate. Even if the problematic ingredient is not purposefully included in a dish, cross-contamination can occur in the kitchen. The result is that people with food allergies can still come into contact with food allergens at restaurants, even if they don’t order something containing that allergen.
To complicate matters further, allergens can get into the air during cooking, so simply cooking certain foods can put restaurants at risk for exposing allergic individuals to dangerous allergens. Given the safety risks, it is important for restaurant staff to be knowledgeable about food allergies to the extent that they can minimize harmful exposure to their customers.
A recent study in Germany, published in PLOS One, evaluated 295 people working in restaurants to determine how well they understood food allergies. Over the course of 3 months, researchers conducted face-to-face interviews with restaurant staff, about half of whom were servers.
Nearly 90% of those interviewed said that they were confident that they could provide meal information related to allergies, and 46% had completed training in food allergies. Nonetheless, not even half of the restaurant staffers could correctly answer a 5-question quiz on food allergies. Only 30% could name 3 food allergens, and 35% believed the common misconception that water alleviates food allergy reactions.
Also concerning was that individuals working in restaurants demonstrated negative views towards patrons with food allergies. While nearly 20% of those interviewed said that they would rather not serve those with food allergies, 42% said that they don’t believe customers who declare allergies. Interestingly, female servers were more likely than male servers to believe those who said that they were allergic to certain foods.
These data demonstrate that there is no correlation between food allergy training and food allergy knowledge, as those who have undergone training do not appear to be more knowledgeable about food allergies than the general population. These results suggest that new training programs may need to be developed if restaurant workers are to understand food allergies. Until then, people with food allergies should be extra cautious when dining at restaurants.
Both omega-3s and omega-6, which are found in a variety of foods, appear to impact asthma symptoms in children. Interestingly though, they seem to have opposite effects on asthma symptom severity. Specifically, new evidence suggests that omega-3 intake is associated with milder asthma symptoms in children, whereas omega-6 intake is associated with more severe symptoms.
The study, published in the American Journal of Respiratory and Critical Care Medicine, involved following 135 children who live in Baltimore. The children ranged in age from 5 to 12. The researchers evaluated what the children ate and the level of air pollutants in their homes, as well as their asthma symptoms and their use of asthma medications. The children were assessed at 3 separate times: at the start of the study, after 3 months, and after 6 months.
Data from the study demonstrated that children whose blood samples had higher levels of omega-3s were more likely to have milder signs and symptoms of asthma. In contrast, the children with higher levels of omega-6s were at higher risk for more severe asthma symptoms and more severe asthmatic responses to certain pollutants in the air that are known to trigger asthma.
In addition to the correlation between omega intake and asthma symptom severity, the researchers also found that higher levels of omega-3 and omega-6 was also associated with physiological markers of asthma. Indeed, children with higher levels of omega-6s also had higher levels of immune cells associated with inflammation in their blood, whereas those with higher levels of omega-3s had lower levels of these cells.
Foods like fish, nuts, and seeds contain high levels of omega-3s, whereas omega-6s are more easily found in vegetable oils. These new data indicate that omega-3s may help to mitigate asthma symptom severity. Though the details on how omega-3s may confer their benefits to those with asthma is not yet clear, omega-3s are known to have other health benefits and are found in healthy foods. It is therefore reasonable for those with asthma to increase their intake of omega-3s, as they may enjoy benefits from more omega-3 consumption.
Over 6 million children in the U.S. suffer from asthma, according to the Centers of Disease Control and Prevention (CDC), which is approximately 12% of all children in our country. However, the prevalence of asthma amongst children is not evenly distributed between distinct demographics. Instead, minority children, those who are obese, and those who reside in urban locations are more likely to suffer from the condition.
New research, funded by the National Institute of Environmental Health and conducted by scientists at Johns Hopkins University, has focused on how to protect children in urban environments from asthma. The study, published in the Journal of Allergy and Clinical Immunology: In Practice, specifically investigated the potential of vitamin D - which has been increasingly recognized as a vitamin in which people across the U.S. are deficient - to affect these children’s susceptibility to asthma and asthma symptoms.
The researchers studied 120 children in Baltimore who had been diagnosed with asthma, about 40 of whom were also obese. The scientists evaluated the children 4 separate times over a 9-month period, looking at the children’s asthma symptoms, the level of air pollution in their homes, and the amount of vitamin D in their blood.
The results of the study showed that for obese children with asthma, low vitamin D levels were associated with higher risks of being impacted by indoor air pollution. In other words, obese children who lived in homes that had the highest levels of air pollution had fewer asthma symptoms if their vitamin D levels were higher.
Future research should help to clarify how exactly vitamin D may confer its respiratory benefits, but experts agree that it is likely to work through its antioxidant properties and to thereby affect pathways of the immune system. For now, they argue that our growing knowledge of the link between vitamin D and asthma amongst obese children in urban communities justifies higher levels of vitamin D intake. While vitamin D levels can be improved through sunlight, consuming dietary supplements and food high in vitamin D, such as fatty fish and milk, may be a more reliable way to increase vitamin D levels.
In attempts to develop therapies for seasonal allergies, researchers in Austria are using animals not often associated with scientific research: camels.
There are currently about 800 million people worldwide suffering from seasonal allergies induced by pollen, and though there are several treatment options on the market, seasonal allergy sufferers often struggle to control their symptoms and see their symptoms worsen over time. New treatments are therefore continuously sought, and research into seasonal allergies remains a robust line of investigation.
Camels provide a unique opportunity for allergy treatment because, unlike other animals, who tend to produce antibodies containing what are referred to as two “heavy” and two “light” chains, camels are able to produce single-chained antibodies that are more capable of binding strongly to allergens and thereby preventing their problematic impact on the immune system.
Normally, upon exposure to an allergen like pollen, those who develop allergies will begin to produce antibodies against that allergen. The next time they are exposed to the allergen, those antibodies will bind to the allergen and set off a chain reaction in the immune system that leads to inflammation and allergy symptoms.
If we can produce allergen-specific antibodies that more readily bind allergens like pollen, we can prevent our own antibodies from binding to those allergens and thus prevent the resulting allergy symptoms. This logic is driving the high-performance nanobody technology project taking place in Vienna, where researchers are injecting allergens into camels and obtaining antibodies from their blood.
The hope is that these antibodies will enable us to protect against seasonal allergies through the development of treatments that will be used locally, in the nose or in the eyes. The researchers expect that it will take between 8 and 10 years to develop these therapies, and further investigation will help determine the feasibility and timeline for such treatments.
The U.S. Food and Drug Administration (FDA) has approved the first generic version of an asthma inhaler, Advair Diskus. The generic inhaler is referred to as the Wixela Inhub. In addition to asthma, the inhaler is also used for patients with chronic obstructive pulmonary disease (COPD). The FDA has made this approval as part of its efforts to increase access to inhalers for those who need them and to reduce the costs of those inhalers in the hopes that more patients who need the inhalers will purchase them and use them before their conditions get worse.
The inhaler comes with some side effects, which differ for asthma and COPD patients. All patients using the inhaler may experience hoarseness, respiratory infections, and headaches. However, asthma patients using the inhaler are more likely to experience oral thrush, bronchitis, throat swelling, cough, nausea, or vomiting, while those with COPD are more likely to experience musculoskeletal pain or pneumonia as a result of the inhaler.
The new generic inhaler comes in 3 different strengths:
- Fluticasone propionate 100 mcg/salmeterol 50 mcg
- Fluticasone propionate 250 mcg/salmeterol 50 mcg
- Fluticasone propionate 500 mcg/salmeterol 50 mcg
The inhaler is meant to be used two times each day to treat asthma patients who are at least 4 years old and as a maintenance treatment for COPD patients to reduce COPD exacerbations. Unlike some other inhalers, Wixela Inhub is not meant to be used to relieve acute asthma attacks.
As part of their research and development efforts, Mylan, the company that has produced the generic inhaler, did a 28-day study with over 1,000 asthma patients to compare the effects of the 100 mcg/50 mcg Advair Diskus inhaler with those of the 100 mcg/50 mcg Wixela Inhub inhaler. Through this study, which was randomized, double-blind, and placebo-controlled, the researchers found that the treatments were equally effective and that both inhalers were well-tolerated.
Asthma has long been linked to obesity, and researchers have shown over the years that not only does obesity increase the chances of developing asthma, but asthma also increases the chances of developing obesity. According to the U.S. Centers for Disease Control and Prevention (CDC), nearly 40% of adults who suffer from asthma are also obese. The relationship between these two conditions is therefore complex but deep.
A new study conducted by researchers at Johns Hopkins University has shown that a low-calorie diet can prevent asthma symptoms. Interestingly, low calorie diets appear able to improve asthma symptoms regardless of the fat content or sugar content included in the diets. This study was published in Scientific Reports.
To delve deeper into the link between calories and asthma symptoms, the researchers looked not only at the impact of low-calorie diets on asthma symptoms but also on the impact of high-calorie diets. Consistent with their findings on low-calorie diets, the researchers observed that high-calorie diets were associated with asthma symptoms and that these symptoms were mediated by increased lung inflammation. When a drug that blocks the lung inflammation was implemented, the asthma symptoms associated with high-calorie diets were avoided.
To test their questions about the impact of calories on asthma symptoms, the scientists provided mice with 1 of 4 separate diets: a low-calorie diet, a high-calorie diet with more calories and fat per gram, a high-calorie diet with more calories and sugar per gram, or a high calorie diet that was high in transfat and also supplemented with sugar. After 8 weeks of this feeding schedule, the mice on each of the 3 high-calorie diets had gained at least 7 grams more weight than the mice on low-calorie diets. In addition, the mice on high-calorie diets experienced higher rates of airway constriction than did those on low-calorie diets. This constriction, however, was reduced if anti-inflammatory drugs were administered.
These results show the potential for high-calorie diets to exacerbate asthma symptoms. Future research will need to further clarify the links between obesity, diet, inflammation, and asthma. Given findings that traditional therapies like steroid inhalers do not work as well in asthma sufferers who are also obese, it will be important to determine the factors that contribute to therapy responsiveness and to develop evidence-based protocols for specific populations of asthma patients in order to optimize their outcomes.
Leading allergy organizations around the world – including the American Academy of Allergy, Asthma, and Immunology, the European Academy of Allergy and Clinical Immunology, and the Canadian Society of Allergy and Clinical Immunology - have recommended that IgG tests not be used in the diagnosis of food allergies, intolerances, or sensitivities. Nonetheless, companies continue to push their food IgG tests on unsuspecting patients. At best, these tests are a waste of time and money. At worst, they result in misinformed patients who lack an understanding of their body’s reactions to certain foods and how best to manage potentially problematic reactions.
What is wrong with using the IgG test to identify adverse reactions to foods? Unfortunately, there is no scientific evidence that strongly suggests that IgG is predictive of one’s reaction to foods. According to expert allergists and immunologists, high IgG levels likely reflect a perfectly normal immune response to food, and a particularly high IgG level may indicate that someone has a good tolerance for the food in question. Nonetheless, someone administering a food IgG test who found high levels of IgG in response to the consumption of a certain food would tell the patient that the food had caused an adverse reaction.
Another significant problem with clinics using the IgG test to help patients make decisions about their diets is that these clinics often use the concepts of food allergies and food sensitivities interchangeably, though food allergies and food sensitivities represent vastly different bodily responses to food. A food allergy poses a potentially life-threatening situation wherein the immune system reacts to what could potentially be a very small portion of the food allergen. A food sensitivity, on the other hand, tends to refer to a reaction in the gastrointestinal (GI) system that is dose dependent, meaning that the more of the substance one consumes, the more affected they are.
In practical terms, when someone has a food allergy, they tend to have to avoid that food altogether. With food sensitivities, there is often no reason to avoid the food, but the patient may want to reduce the amount of that food they consume so that it does not cause them discomfort. Whereas a food allergy may lead to tongue swelling and difficulty breathing, a food sensitivity is more likely to cause bloating, stomach pain, and diarrhea.
Given that food allergies are much more serious than food sensitivities and should be dealt with in a more urgent manner, people who are concerned that they may adversely react to certain foods but are unsure if they have an allergy or sensitivity should consult a licensed allergist or immunologist so that they can be properly screened for allergies. These physicians can help to navigate symptoms and food reactions and determine the best course of action to ensure patients’ safety and comfort.
Allergies are on the rise in the United States, but a new study published in JAMA Network Open reveals that the reported increase in food allergies may be overblown. According to their data, the researchers who published the study concluded that almost 50% of people who believe they have a food allergy do not qualify for a food allergy diagnosis.
To determine the validity of people’s beliefs about their food allergy status, the scientists surveyed over 40,000 adults in the U.S. Nearly one in five of those surveyed believed that they had a food allergy. However, once details of their history and symptoms were evaluated, it was discovered that only about one in ten of those people truly suffer from a food allergy.
Allergy and immunology experts have pondered why this discrepancy exists and have posed two ideas. One idea is that those who falsely believe that they have a food allergy suffer instead from another type of allergy, such as seasonal allergies and do not recognize the true cause for their allergy symptoms. Another idea is that these people mistake food intolerance for food allergies. While food intolerance can make people feel unwell, an important distinction between food intolerance and food allergy is that only a food allergy engages the immune system.
What this means in a practical sense is that those with a food intolerance can still eat the food to which they are intolerant. Indeed, food intolerance works in a dose-dependent way, so small amounts of the food may be well-tolerated and larger amounts may lead to symptoms. Allergic reactions to food, on the other hand, can be life threatening even at incredibly small doses.
The researchers found that the symptoms reported by many of those who incorrectly believed they had food allergies were more consistent with seasonal allergies and food intolerance, corroborating experts’ suspicions that seasonal allergies and food intolerance could account for at least some cases where people erroneously believe they have a food allergy. Perpetuating the confusion about the distinctions between food allergy and food intolerance may be the rise in clinics that claim that they can identify adverse reactions with a single test – despite the inability of these tests to do so - and that use the concepts of food allergy and food insensitivity interchangeably. Educating patients on what food allergies are and how they can identify the symptoms of food allergies may help to improve people’s understanding of these allergies and how to manage them.
A new study published in Thorax suggests that a couple’s fertility may impact the likelihood that their children develop asthma. Previous research had shown that children who are conceived with the help of fertility treatments, known as assisted reproductive technologies (ARTs), may be at heightened risk for asthma. However, existing data have made it hard to determine if fertility treatments themselves lead to increased asthma risk, if the culprit could instead be whatever factor led to the couple’s reduced fertility, or if some other factor or combination of factors was to blame.
To help clarify the relationship between fertility and asthma risk in offspring, a research group leveraged data from national Norwegian health registries that included information on nearly 475,000 children who were born between 1998 and 2009. Included in these data were information on the use of fertility treatments, the time to conception, details of previous miscarriages, and maternal factors such as age, asthma status, weight, and smoking habits.
The researchers’ results corroborated previous findings that children conceived with the aid of ARTs are at a higher risk for developing asthma. Indeed, the researchers found that those conceived through fertility treatments were 42 percent more likely to develop childhood asthma – defined as the use of asthma medications during the previous year when children were seven – than those conceived in the absence of fertility treatments.
However, asthma risk also correlated with other factors indicative of fertility. For instance, children of those who took more than a year to conceive were more likely to develop asthma, as were those whose mothers had previously suffered first trimester miscarriages. The risk amongst children of mothers who had miscarried increased with the number of miscarriages. While the risk for asthma was seven percent higher in children whose mothers had experienced one miscarriage than in those who had experienced no miscarriages, the risk increased 24 percent for those whose mothers had had three or more miscarriages.
The increased risk amongst children of mothers with three or more miscarriages was comparable to the increased risk observed in those whose parents took over a year to conceive. The increased risk in the latter group was 22 percent. While these data point to a relationship between fertility and asthma in offspring, the increased risk of asthma observed in children who were conceived with the help of fertility treatments was much higher. These children experienced a heightened asthma risk of 42 percent
Parental fertility appears to play a role in children’s asthma risk, but something about fertility treatments or those who undergo those treatments may contribute more significantly to this risk than does low fertility itself. According to experts, ART procedures—including the modification of the hormonal environment—may affect fetal development and may account for some of the increased risk for asthma that is observed in children conceived through these methods. Future research will help to clarify the specific link between parental fertility and children’s asthma risk and hopefully provide insights into how we can intervene to reduce asthma risk in these children.
The pharmaceutical company Sanofi, in collaboration with Sema4—a predictive health company that spun out of Mount Sinai Health System—just launched a major study to help improve our understanding of asthma, as well as our ability to provide better treatments and recommendations to those who suffer from asthma.
This new longitudinal study, which will take place over five years and involve nearly 1,200 asthma patients, is unique in that it is employing cutting-edge digital and analytical methods to gain enormous amounts of data related to asthma in real-time and to produce valuable, actionable insights from these data.
Using assets like connected inhalers, sensor data from mobile devices, and environmental, genomic, and immunological information, the researchers will track and analyze how asthma affects individuals – and how it affects certain people differently than it affects others. They will also track what triggers asthma attacks, the mechanisms by which asthma occurs, and which patients are most likely to respond to specific therapeutic interventions.
Given that approximately 235 million people suffer from asthma across the globe and that roughly 400,000 people die each year as a result of the disease, there are significant opportunities to gather information about the disease, make sense of that information, and then use it to improve the global state of asthma and asthma care.
With the help of sophisticated machine learning techniques, Sanofi and Sema4 will not only be able to collect huge amounts of data on asthma and asthma patients, but they will also be able to process those data efficiently and translate the data into meaningful information that should allow clinicians and researchers to make better predictions about the course of asthma in individual patients
This information should also improve clinical decision making related to providing patients with the best therapeutic options that are currently available to them. In addition, this new information is likely to help the research community identify new drug targets to improve and expand the tools we currently have to address asthma and improve quality of life for those with the condition.