Adventures of an Allergist Mommy

I had an excellent time talking to my colleague, Dr. Phil Boucher, about the topic of Food Allergy Prevention. The podcast episode is live now, just in time for Asthma and Allergy Awareness month! 🎙️ If you haven't already subscribed to his podcast (Raising Good Parents), please take a listen. I think you'll find it both educational and enjoyable. ⠀ 🔗 Here's the link: https://drphilboucher.libsyn.com/139-food-allergy-prevention-with-allergistmommy-dr-sakina-bajowala ⠀

Son #2 woke up this morning looking like a streetfighter! Dramatic swelling of the eye(s) such as this can occur for a variety of reasons: 1. Allergic reaction to ingested food or drug (generally affects both eyes) 2. Direct contact with environmental allergen or food allergen (can affect one or both eyes) 3. Hereditary or acquired angioedema (can affect one or both eyes) 4. Injury (usually affects one eye) 5. Low protein levels (generally affects both eyes) 6. Infection (generally affects one eye) 7. Insect bite (can affect one or both eyes) In this case, my little one endured a mosquito bite at the outer corner of his left eye yesterday afternoon.  It was mildly swollen at the time, and became progressively worse as the night wore on. Does this mean he has a mosquito allergy? Actually, no more than anyone else.  Certain areas of skin, such as around the eyes and on the lips, are more loosely attached to underlying tissues and muscles than skin elsewhere on the b...

The dangers of environmental tobacco smoke (ETS) have been well-documented. Environmental tobacco smoke has been associated with increased risk for not only asthma and ear infections, but also with meningitis and sudden infant death syndrome. Young children are particularly susceptible to these ill-effects. The risk is not limited to second-hand smoke, however. Third-hand smoking occurs when an individual is exposed to an environment in which someone has been, but is not currently, smoking. Quoting from the Pediatrics article "Beliefs About the Health Effects of 'Thirdhand' Smoke and Home Smoking Bans" by Jonathan P. Winickoff, MD, MPH et al: " Research has documented the association between smoking in the home and persistently high levels of tobacco toxins well beyond the period of active smoking. These toxins take the form of particulate matter deposited in a layer onto every surface within the home; in loose household dust; and as volatile toxic comp...

A recent article in the Wall Street Journal ( Is Your Kid Truly Allergic? Tests Add to Food Confusion) recently highlighted the inherent problems with over-calling food allergy in children on the basis of serum IgE testing. I was impressed with the article, and encourage parents of allergic children to read it: http://tinyurl.com/yb5fw5s This is an issue that most allergists run into on a fairly frequent basis- a parent walks into the office with bloodwork ordered by another physician. Tests returned as "positive" for multiple foods, so for the past 3 months, parents have restricted all these foods (generally there's always something that's a pain in the butt to eliminate, like soy or wheat). Now we have a child who is still as symptomatic as ever, and cranky to boot. When I tell the parents that their child in all likelihood is not allergic to all of the eliminated foods, the reactions are a mixture of relief and annoyance: "That's great news, but why di...

OK- both boys have a barky cough, Son #2 has been having some mild stridor (that whistling noise you hear after a croupy child is crying and takes a deep breath), and just yesterday, the daycare informed me that my musical little one need albuterol during the day, and felt "so much better" afterwards. I think the respiratory goblins have arrived at my home. Serves me right. Although I always tell my patients to resume their child's respiratory controller medicine around one month before their "bad season" is due to begin, I deliberately ignored my own advice and tried to hold out for as long as I could before resuming Baby's inhaled steroid this fall/winter. This I did despite knowing better than anyone that my child is probably destined to become asthmatic. Why did I make such a ridiculous decision? Am I concerned about medication side effects? At the low doses of controller medication that my 16-month old requires, hardly. Is the medication too expensi...

Image by Getty Images via Daylife In this season of influenza pandemics, our vaccine-naive little ones were scheduled to be subjected to not one, but 2 separate influenza vaccines, in a total of 4 doses! Ouch! Well, here's some good news from GlaxoSmithKline, the makers of Pandemrix, one of the H1N1 vaccines currently being distributed and administered around the world. A single shot may be sufficient to confer protective immunity! The study is not yet complete, but preliminary results look promising... Son #2, who was none to happy with me when I gave him seasonal influenza vaccine 1 of 2 on Wednesday, would be pleased (if he had any idea what any of the fuss was about)! http://www.medscape.com/viewarticle/711241_print

Image via Wikipedia Epinephrine is the first-line medication for the immediate treatment of anaphylaxis (sometimes referred to as "killer allergy"). Intramuscular injection of epinephrine is superior to subcutaneous injection in terms of how fast peak plasma levels of the life-saving drug are achieved. Consequently, epinephrine auto-injectors are deigned to deliver the medication to the large muscle of the anterior thigh (called the vastus lateralis). A recent study published in the July issue of the Journal of Pediatrics, however, suggests that intramuscular injection may not be achieved in a significant percentage of children with the current needle lengths of epinephrine auto-injectors (EpiPen and TwinJect). Ultrasound measurements of the thickness of subcutaneous tissue in children indicated that the needle lengths of the auto-injectors may be too short to penetrate into the muscle. When the outcome that one is attempting to prevent is death, this is no small issue. ...

Just received the following update from the American Academy of Allergy, Asthma & Immunology: This morning, The Food and Drug Administration (FDA) held a news conference warning physicians and consumers about Zicam Cold Remedy intranasal products, indicating “these products may pose a serious risk to consumers who use them.” Specifically, the FDA has received more than 130 reports of anosmia (loss of sense of smell, which in some cases can be long-lasting or permanent), associated with use of these products. Some individuals also report loss of sense of taste. Included in the warning are: Zicam Cold Remedy Nasal Gel, Zicam Cold Remedy Gel Swabs, and Zicam Cold Remedy Swabs, Kids Size. All are administered by direct application to the nasal cavity, and as described in the labeling, are intended for use in “adults and children 3 years of age and older (with adult supervision). These products are available without a prescription, and they contain zinc gluconate (identified as zincu...

President Obama addressed the American Medical Association in Chicago on Monday June 15th, aggressively pushing his plan for health care reform. During his speech, he stated, "That starts with each of us taking more responsibility for our health and the health of our children. It means quitting smoking, going in for that mammogram or colon cancer screening." OK, I can agree with that. However, on Friday, June 12, an exchange between reporters and White House press secretary Robert Gibbs made it clear that the President has not yet kicked the habit. http://blogs.suntimes.com/sweet/2009/06/obama_may_still_be_smoking_war.html C'mon now, Mr. President! Your daughter is asthmatic- and you're still puffing away? From the sounds of it, it seems that his sole aid in the fight to quit is Nicorette gum. Really? The leader of the free world, and all he can come up with is Nicorette? OK, maybe mood-altering medications like Zyban and Chantix are not the most appropriate fo...

Two recent studies find interesting associations between lower levels of folic acid and vitamin D and increased allergy/asthma symptoms... #1) A retrospective study performed at Johns Hopkins and recently published in the Journal of Allergy and Clinical Immunology tracked the effect of folate levels on respiratory and allergic symptoms, as well as levels of the allergic antibody IgE. They reviewed the medical records of over 8000 patients ranging from toddlers to octogenarians. The researchers found that patients with serum folate levels at the higher range of normal had lower rates of high IgE, atopy, and wheeze than those patients with lower levels, even though some of the patients with lower levels were technically within the normal range for serum folate. Bottom line? Folate levels on the high side of normal may be protective against some allergic disease, but blinded prospective studies are needed before we begin recommending supplementation for this purpose alone. #2) A cross...

So, returned from a trip to Son #1's dentist this morning... At our last visit ~6 months ago, he was found to have areas of decalcification ("almost-cavities") between his molars. At that point, he was still not the best at cooperating with tooth-brushing and used to swallow the toothpaste, which meant that we couldn't use fluoride-based toothpaste. We were instructed to optimize the brushing, start flossing, and switch to fluoride toothpaste. We did great! Well, the flossing could have been a little better, but otherwise, we did great! Twice a day, without fail, spending plenty of time focusing on the molars. Very limited juice, candy only on Halloween and birthdays... our only weakness was ice cream, but he always drank water afterwards. Despite our best efforts, half of the areas of decalcification have progressed to cavities, and now we're facing having the teeth fixed with a pulpotomy and the placement of ugly stainless steel crowns, which will remain un...

Researchers from the Netherlands have reported in the March issue of Allergy that supplementation with a mixture of short-chain galacto-oligosaccharides (GOS) and long-chain fructo-oligosaccharides (FOS) appears to decrease total levels of the allergic antibody IgE, as well as IgG subclasses 1, 2 & 3, while increase levels of the "blocking" antibody IgG4. These oligosaccharides are known as "prebiotics", and they supply a nutrition source for the "good bacteria" (probiotics) that colonize our gastrointestinal tracts shortly after birth. The microbial environment in the gut may be an important factor in the risk of developing allergic disease, such as atopic dermatitis (eczema). The interesting thing about this study is that it demonstrated that despite the overall decrease in antibody levels, the immune response to vaccinations was preserved. This is important, because antibodies are essential to protecting us from infection, and a decrease in allerg...

A study in the April issue of the Journal of Allergy and Clinical Immunology reveals that prenatal maternal anxiety, especially late in pregnancy, is associated with higher rates of asthma in children at approximately 7 years of age. Why might this be the case? Maternal stress hormones, such as cortisol, may have a negative-feedback effect on the developing fetal adrenal glands, leading to relatively low levels of anti-inflammatory hormone production in the child. Makes one wonder... knowing that women tend to display higher levels of anxiety than men during times of economic downturns... will the current economic crisis result in increased pediatric asthma rates a few years down the road? One can only speculate, but it certainly makes the case for prenatal yoga!

Just returned from Son #2's 6 month check-up, where he received a couple of jabs to his chubby little thighs. (brave boy- hardly even cried!) I am often asked about the safety of vaccines by concerned parents who are frightened that they are putting their children at risk of adverse reactions by following the recommended immunization schedule. I fully understand the sentiment behind not wanting to take a risk (even if it is only a perceived risk) when the diseases we vaccinate against seem like ancient history. Let me put it plainly- the fact that these illnesses: polio, mumps, measles, diphtheria... seem like history is testament to the enormous public health success of immunizing children. Immunizations are the reason that we don't lose our precious children to horrible diseases like epiglottitis, meningitis, and measles at the alarming rates seen in previous generations. Let me use measles as an example, as the U.S. Court of Federal Claims recently delivered decisions on t...