kokoro
03-30-2008, 09:38 PM
Someone who went to the 2008 Baltimore FAAN conference took these excellent and very interesting notes. I can 'translate' any abbreviations that are confusing if anyone asks.
Food allergy prevalence 6 to 8% of young children; 3 to 4% of adolescents and adults; prevalence is rising and food allergies may be twice as common as they were just 10 years ago.
Sesame is a common allergen, probably number 4 on the list of common allergens but there arent any studies done to prove this yet.
Milk allergy is the most common allergy in kids. It is twice as common as egg allergy, three times more common than peanut allergy.
Food allergy and hives: food allergy is rarely the cause of chronic hives. Hives can be caused by many things. But sudden hives developing within 2-3 minutes of eating or within 2 hours of eating are most likely related to food allergy.
Hives caused by food MUST be considered a risk for future anaphylaxis. If your child broke out in "just" hives from eating a food make sure you get an epi pen - they are at risk for future anaphylaxis.
40-50% of patients with severe eczema have food allergy as a major trigger; 20-25% of those with less severe eczema have food allergy as a trigger. Egg is the most common cause of food allergy related eczema followed by milk, peanut, soy, wheat, and fish.
Allergic eosiniphillic esophagitis, gastritis, and gastroenteritis may or may not involve IgE.
Eosiniphilic Esophagitis appears to be rising in prevalence.
Allergy testing: There is a high rate of false positives with skin tests and RASTS. They are poor tools for predicting positive food allergies but they have a high negative predictive value for IgE mediated syndromes. They are 50% accurate for predicting food allergies but very good at proving there is not a food allergy if you have a negative test. They must be interpreted in the context of the persons history of reactions. Oral challenges are the only definitive tests. There is no role for intradermal skin tests and no role for IgG antibody tests.
A reaction is highly probably (90% chance of reaction) if CAP-RAST is:
>15 for milk; >7 for egg; >14 for peanut; >10-15 for tree nuts; > 60 for soy; >80 for wheat.
In children under 2 years old these numbers are different and a reaction is highly probably if milk is >5; egg >2; peanut >5.
The challenge level for milk, egg, and peanut is a CAP RAST of 2; for tree nuts it is 2-5; for soy 10-20; wheat 10-30. Challenge level is where you have a 50/50 chance of passing the challenge.
Less than 50% of milk, egg, soy, and wheat allergy currently outgrown by age 6.
Outgrowing of food allergy may be helped by strict avoidance in the very early development of food allergies (through first 6 to 8 months of life). As child gets older you are avoiding the food to avoid the reaction.
You may continue to test postive for 25 years to a food allergy that has been outgrown. Food challenge is only definitive way to know for sure.
Skin tests give yes/no answer for allergy. Blood tests (RAST) give level of allergy and let you follow numbers to see if child may be outgrowing.
Breast feeding does not prevent food allergies.
If child is showing early signs of food allergy, get them tested. They can test as early as signs and symptoms appear, at 2 to 3 weeks of age.
Early intervention/removal of allergic foods at this early stage when child is still an infant may promote outgrowing.
Can food allergies be prevented? There may be a possilbe role for, but there is there is very little evidence ,to support food avoidance during pregnancy or breastfeeding, delaying the introduction of solid or allergenic foods; or using probiotics. Still, Dr. Wood currently recommends avoiding peanuts and tree nuts in pregnancy and breastfeeding (some studies show the small exposures like those from eating food in small amounts or not often or from may contains might sensitize the baby to develop food allergies); supplement breast feeding with a hypoallergenic formula in the first 3-4 months of life if you are going to use a formula; delay solid foods until 6 months of age; delay milk until age 1 and peanut and tree nut until age 3; early intervention when signs of food allergy appear (this is most important).
Unlabled foods are ALWAYS an accident waiting to happen.
Anaphylactic shock is rare in children. Anapylactic shock is when the blood pressure is affected and children have strong cardiovascular systems. Problems in children from anaphylaxis are usually due to airway constriction (respiratory), not blood pressure (shock).
Mouth itching almost always happens in anaphylaxis.
Approximately 20% of anaphylaxis cases do NOT present with hives or other skin symptoms.
80% of fatal, food-induced anaphylaxis cases were NOT associated with hives or other skin symptoms. Do NOT rely on hives to determine if its a serious reaction, there very well may not be any hives. Just because you dont see hives, dont assume its not that bad.
Do NOT wait until child has stopped breathing to give epi.
1/3 of reactions are bi-phasic.
Most peanut allergy does get worse with time; i.e. as you get older the allergy gets worse.
Four well defined risk factors for fatal food induced anaphylaxis are: having peanut and tree nut allergy, having asthma, having experienced prior anaphylaxis, and failure to treat promptly with epinephrine.
Steroids are given in ER to help block a bi-phasic reaction.
MOST people only need a single dose in the ER, usually no call for sending patient home with prednisone for several days. ER docs tend to treat food allergy reactions like asthma and asthma patients are often sent home with a several day course of steroids. But most food allergy reactions are totally resolved after several hours and extended steroids are not needed. Protracted anaphylaxis (happening/continuing hours or days after initial anaphylaxis) is extremely rare.
Do not fear or hesitate to give epinephrine. Use the trainer, practice with expired pens on oranges. Talk to your doctor if you are not sure when or how to give the epi pen. Teach family and friends how to administer epinephrine so you will have back-up if needed. Remember that YOU are in charge, act the part! A reaction is no time for negotiation. If you think the person needs it, give it to them, dont ask them what they think. You know what to do, DO IT.
Important quote from a parent who had the epi pen but was afraid to use it. He drove his child to hospital instead of giving child the epi pen. The ER doctor had to administer the epinephrine: The momentary discomfort my child experienced getting the shot was nothing compared to the agony he went through waiting for it. I will never again be afraid of using the auto-injector.
IEPs are for students with documented learning disabilities. If a child has a documented learning disability AND food allergies then health goals relating to food allergies can be incorporated into the childs IEP.
Kids with a history of anaphylaxis and who carry an epi pen may qualify for a 504 plan. If no history of anaphylaxis, child might not qualify for a 504 plan.
Important question to ask when child is starting school: Does the school have school supplied epi pens as back up?
Many students in middle school cannot tell the difference between their asthma reactions and their food allergy reactions. Make sure your child knows the signs and symptoms of a food allergy reaction.
Before child grows and leaves your home they need to be able to eat, read a label, order a meal in a restaurant, feed themselves (plan, shop and cook meals), plan an event that involves planning for meals (travel); initiate an emergency treatment plan.
Eating out is a HIGH RISK behavior. Risk is greatest for those with multiple food allergies. Peanut and tree nut allergies are easier to accommodate. Children with multiple food allergies, epecially those with milk allergy, are more likely to be unable to eat safely in any restaurant.
Food allergy is like a third child. It goes everywhere you go, it affects everything you do, it cannot be forgotten or ignored, must always be accounted for and accommodated, everyday.
Research shows that 69% of fatal food induced reactions occurred in teens aged 11-21.
It is never too early to start teaching child about food allergies and how to handle them. You need to know your childs personality and what they are capable of. By pre-K you should be enforcing no sharing foods rule. As child gets older, friends are very important and will look out for them. Teach friends about the food allergy, how to spot a reaction and how use epi pen and how to get help.
Dr. Wood would not hesitate to give a child of 15 pounds an epi pen jr. Under 12 pounds and he might do vial with syringe instead.
Anti IgE therapy (like Xolair) the medicine can cause anaphylaxis in as many as 1 out of every 200 patients.
Chinese herbal formula looks promising, they dont know how it works, dont know if it suppresses immune system, promotes tolerance, etc only know bottom line in that it was working on the mice and the first clinical trials for people were recently initiated.
One thing learned in the milk oral immunotherapy trials is that a patient could be doing fine on a particular dose for several weeks and then one day have a reaction on that same dose they seemed to be tolerating.
Present and future initiatives for food allergy research include: Three studies underway with a 4th in development: observational study of infants with eczema and food allergy; oral egg immunotherapy, sublingual peanut immunotherapy study, recombinant peanut vaccine safety study (2008).
Future initiatives include a second Hopkins/Duke milk study beginning later in 2008, studies on Xolair may resume; Human studies on the Chinese Herbal formula have begun.
Expect that treatment for severe, persistant food allergy will be developed in the next 10-20 years. May be able to shorten this timeline with increased funding for more research. Donate to FAAN, donate directly to the investigators doing these studies.
Go to the FAAN website. There are buttons there where you can vote for Trace Atkins to win the CMT Music Awards. Trace and CMT have promised donations to FAAN if Trace wins the CMT Music Awards. Also, if you download his song (Youre Gonna Miss This) from iTunes, the proceeds go to FAAN. Money they raise goes directly to research and education.
The above notes are really just the tip of the iceberg in terms of what was presented at the conference.
Food allergy prevalence 6 to 8% of young children; 3 to 4% of adolescents and adults; prevalence is rising and food allergies may be twice as common as they were just 10 years ago.
Sesame is a common allergen, probably number 4 on the list of common allergens but there arent any studies done to prove this yet.
Milk allergy is the most common allergy in kids. It is twice as common as egg allergy, three times more common than peanut allergy.
Food allergy and hives: food allergy is rarely the cause of chronic hives. Hives can be caused by many things. But sudden hives developing within 2-3 minutes of eating or within 2 hours of eating are most likely related to food allergy.
Hives caused by food MUST be considered a risk for future anaphylaxis. If your child broke out in "just" hives from eating a food make sure you get an epi pen - they are at risk for future anaphylaxis.
40-50% of patients with severe eczema have food allergy as a major trigger; 20-25% of those with less severe eczema have food allergy as a trigger. Egg is the most common cause of food allergy related eczema followed by milk, peanut, soy, wheat, and fish.
Allergic eosiniphillic esophagitis, gastritis, and gastroenteritis may or may not involve IgE.
Eosiniphilic Esophagitis appears to be rising in prevalence.
Allergy testing: There is a high rate of false positives with skin tests and RASTS. They are poor tools for predicting positive food allergies but they have a high negative predictive value for IgE mediated syndromes. They are 50% accurate for predicting food allergies but very good at proving there is not a food allergy if you have a negative test. They must be interpreted in the context of the persons history of reactions. Oral challenges are the only definitive tests. There is no role for intradermal skin tests and no role for IgG antibody tests.
A reaction is highly probably (90% chance of reaction) if CAP-RAST is:
>15 for milk; >7 for egg; >14 for peanut; >10-15 for tree nuts; > 60 for soy; >80 for wheat.
In children under 2 years old these numbers are different and a reaction is highly probably if milk is >5; egg >2; peanut >5.
The challenge level for milk, egg, and peanut is a CAP RAST of 2; for tree nuts it is 2-5; for soy 10-20; wheat 10-30. Challenge level is where you have a 50/50 chance of passing the challenge.
Less than 50% of milk, egg, soy, and wheat allergy currently outgrown by age 6.
Outgrowing of food allergy may be helped by strict avoidance in the very early development of food allergies (through first 6 to 8 months of life). As child gets older you are avoiding the food to avoid the reaction.
You may continue to test postive for 25 years to a food allergy that has been outgrown. Food challenge is only definitive way to know for sure.
Skin tests give yes/no answer for allergy. Blood tests (RAST) give level of allergy and let you follow numbers to see if child may be outgrowing.
Breast feeding does not prevent food allergies.
If child is showing early signs of food allergy, get them tested. They can test as early as signs and symptoms appear, at 2 to 3 weeks of age.
Early intervention/removal of allergic foods at this early stage when child is still an infant may promote outgrowing.
Can food allergies be prevented? There may be a possilbe role for, but there is there is very little evidence ,to support food avoidance during pregnancy or breastfeeding, delaying the introduction of solid or allergenic foods; or using probiotics. Still, Dr. Wood currently recommends avoiding peanuts and tree nuts in pregnancy and breastfeeding (some studies show the small exposures like those from eating food in small amounts or not often or from may contains might sensitize the baby to develop food allergies); supplement breast feeding with a hypoallergenic formula in the first 3-4 months of life if you are going to use a formula; delay solid foods until 6 months of age; delay milk until age 1 and peanut and tree nut until age 3; early intervention when signs of food allergy appear (this is most important).
Unlabled foods are ALWAYS an accident waiting to happen.
Anaphylactic shock is rare in children. Anapylactic shock is when the blood pressure is affected and children have strong cardiovascular systems. Problems in children from anaphylaxis are usually due to airway constriction (respiratory), not blood pressure (shock).
Mouth itching almost always happens in anaphylaxis.
Approximately 20% of anaphylaxis cases do NOT present with hives or other skin symptoms.
80% of fatal, food-induced anaphylaxis cases were NOT associated with hives or other skin symptoms. Do NOT rely on hives to determine if its a serious reaction, there very well may not be any hives. Just because you dont see hives, dont assume its not that bad.
Do NOT wait until child has stopped breathing to give epi.
1/3 of reactions are bi-phasic.
Most peanut allergy does get worse with time; i.e. as you get older the allergy gets worse.
Four well defined risk factors for fatal food induced anaphylaxis are: having peanut and tree nut allergy, having asthma, having experienced prior anaphylaxis, and failure to treat promptly with epinephrine.
Steroids are given in ER to help block a bi-phasic reaction.
MOST people only need a single dose in the ER, usually no call for sending patient home with prednisone for several days. ER docs tend to treat food allergy reactions like asthma and asthma patients are often sent home with a several day course of steroids. But most food allergy reactions are totally resolved after several hours and extended steroids are not needed. Protracted anaphylaxis (happening/continuing hours or days after initial anaphylaxis) is extremely rare.
Do not fear or hesitate to give epinephrine. Use the trainer, practice with expired pens on oranges. Talk to your doctor if you are not sure when or how to give the epi pen. Teach family and friends how to administer epinephrine so you will have back-up if needed. Remember that YOU are in charge, act the part! A reaction is no time for negotiation. If you think the person needs it, give it to them, dont ask them what they think. You know what to do, DO IT.
Important quote from a parent who had the epi pen but was afraid to use it. He drove his child to hospital instead of giving child the epi pen. The ER doctor had to administer the epinephrine: The momentary discomfort my child experienced getting the shot was nothing compared to the agony he went through waiting for it. I will never again be afraid of using the auto-injector.
IEPs are for students with documented learning disabilities. If a child has a documented learning disability AND food allergies then health goals relating to food allergies can be incorporated into the childs IEP.
Kids with a history of anaphylaxis and who carry an epi pen may qualify for a 504 plan. If no history of anaphylaxis, child might not qualify for a 504 plan.
Important question to ask when child is starting school: Does the school have school supplied epi pens as back up?
Many students in middle school cannot tell the difference between their asthma reactions and their food allergy reactions. Make sure your child knows the signs and symptoms of a food allergy reaction.
Before child grows and leaves your home they need to be able to eat, read a label, order a meal in a restaurant, feed themselves (plan, shop and cook meals), plan an event that involves planning for meals (travel); initiate an emergency treatment plan.
Eating out is a HIGH RISK behavior. Risk is greatest for those with multiple food allergies. Peanut and tree nut allergies are easier to accommodate. Children with multiple food allergies, epecially those with milk allergy, are more likely to be unable to eat safely in any restaurant.
Food allergy is like a third child. It goes everywhere you go, it affects everything you do, it cannot be forgotten or ignored, must always be accounted for and accommodated, everyday.
Research shows that 69% of fatal food induced reactions occurred in teens aged 11-21.
It is never too early to start teaching child about food allergies and how to handle them. You need to know your childs personality and what they are capable of. By pre-K you should be enforcing no sharing foods rule. As child gets older, friends are very important and will look out for them. Teach friends about the food allergy, how to spot a reaction and how use epi pen and how to get help.
Dr. Wood would not hesitate to give a child of 15 pounds an epi pen jr. Under 12 pounds and he might do vial with syringe instead.
Anti IgE therapy (like Xolair) the medicine can cause anaphylaxis in as many as 1 out of every 200 patients.
Chinese herbal formula looks promising, they dont know how it works, dont know if it suppresses immune system, promotes tolerance, etc only know bottom line in that it was working on the mice and the first clinical trials for people were recently initiated.
One thing learned in the milk oral immunotherapy trials is that a patient could be doing fine on a particular dose for several weeks and then one day have a reaction on that same dose they seemed to be tolerating.
Present and future initiatives for food allergy research include: Three studies underway with a 4th in development: observational study of infants with eczema and food allergy; oral egg immunotherapy, sublingual peanut immunotherapy study, recombinant peanut vaccine safety study (2008).
Future initiatives include a second Hopkins/Duke milk study beginning later in 2008, studies on Xolair may resume; Human studies on the Chinese Herbal formula have begun.
Expect that treatment for severe, persistant food allergy will be developed in the next 10-20 years. May be able to shorten this timeline with increased funding for more research. Donate to FAAN, donate directly to the investigators doing these studies.
Go to the FAAN website. There are buttons there where you can vote for Trace Atkins to win the CMT Music Awards. Trace and CMT have promised donations to FAAN if Trace wins the CMT Music Awards. Also, if you download his song (Youre Gonna Miss This) from iTunes, the proceeds go to FAAN. Money they raise goes directly to research and education.
The above notes are really just the tip of the iceberg in terms of what was presented at the conference.