House CallFeb/Mar 2015 Issue

Research Roundup: Nannies and Food Allergies & More

The latest medical news for people with allergies and food sensitivities.

nanny with kids

Photo by Thinkstock/istock/sbytova mn

Nannies and Food Allergy

Almost all nannies who took part in an online survey about food allergy recognized the condition as potentially life-threatening. However, only 58 percent of nannies who cared for food-allergic children had self-injectable epinephrine with them at all times and 46 percent felt uncomfortable using epinephrine in an emergency. In addition, 30 percent of nannies thought it was acceptable to pick an allergen out of a prepared meal before giving it to an allergic child and 19 percent didn’t always wash their hands after touching food allergens.

Results underscore the importance of food-allergy training, as well as communication between parents, physicians, nannies and other caregivers.

The study was published in September in the Journal of Allergy and Clinical Immunology: In Practice.

See a Specialist

Don’t skip a trip to the allergist after an episode of anaphylaxis! According to a new Mayo Clinic study, just a third of patients who visited the emergency room with anaphylaxis followed up with an allergist or immunologist. Of those who did see a specialist, 35 percent had an alteration in the suspected allergy trigger or in the diagnosis of anaphylaxis. In some cases, anaphylaxis was ruled out.

Current medical guidelines recommend follow-up care with an allergist or immunologist after an emergency department visit for anaphylaxis. Actual follow-up rates were largely unknown until now.

The study was published in September 2014 in The Journal of Allergy and Clinical Immunology: In Practice.

EoE Linked to Allergy Treatment

Eosinophilic esophagitis (EoE) is an allergic disease of the esophagus that can cause heartburn, swallowing difficulties and persistent burping. Sometimes specific foods can be identified as EoE triggers and avoiding them relieves symptoms.

Recently, a number of studies have linked EoE with oral immunotherapy (OIT), a treatment aimed at tamping down food allergy. According to a new report published in September in the Annals of Allergy, Asthma and Immunology, EoE developed in up to 2.7 percent of patients as a result of OIT. Importantly, the same food that caused the initial food allergy—and the target of OIT—also triggered EoE. In many cases, EoE remitted when OIT was stopped and patients gave up the trigger food.

Researchers don’t know how OIT triggers EoE, which they call a “very recent disease.”

Worm Therapy

Hookworms may help people with celiac disease and other inflammatory conditions. According to a small clinical trial published in September in the Journal of Allergy and Clinical Immunology, study participants with celiac disease who were deliberately infected with hookworm larvae had tamped-down immune responses to gluten. Trial participants, with worms on board, were given gradually increasing doses of gluten over the course of a year. By the end of the trial, markers of celiac inflammation remained stable or improved and participants were able to tolerate the equivalent of a medium-size bowl of spaghetti with no ill effects, say the Australian researchers.

The key to the hookworm’s anti-inflammatory effects may lie in proteins that the worms secrete. Scientists hope to home in on these proteins and bottle their anti-inflammatory properties in pill form one day, rather than dose patients with worms.

This isn’t the first time hookworms have been studied—and shown promise—in celiac disease. In both past and current trials, participants have opted to “keep” their worms at the end of the study, i.e., they declined deworming medication. Researchers say these trial participants remain in good health, although they were instructed to resume a gluten-free diet.

No Magic Window

There’s no perfect time to introduce gluten to babies at risk for celiac disease. Parents and parents-to-be with a family history of celiac disease may have heard they should start gluten-containing cereals between 4 and 6 months of age. But two new clinical trials debunk this advice, which was based on earlier, less rigorous study data.

The two new trials, published in October in the New England Journal of Medicine, tracked large numbers of children at risk for celiac disease to ages 3 and 10, respectively. Rates of celiac disease were similar across all study groups, regardless of when children were introduced to gluten. Breastfeeding didn’t help stave off celiac disease, either. Only genetics—carrying the markers HLA DQ2 and/or DQ8—were identified as an important risk factor for developing celiac disease later in life.

Photo of man reading food label

Photo by Thinkstock/fuse

Gluten-Free Claims

An investigation led by the U.S. group Gluten Free Watchdog showed most—but not all—foods labeled gluten-free test below 20 ppm. About 5 percent of the 158 foods that were sampled missed the mark, including a small number of certified gluten-free foods. These items included a wide range of products, from bread and breadcrumbs to hot cereal, tortillas and a hot beverage.

Gluten Free Watchdog measured these gluten levels before the FDA’s less-than-20 ppm labeling rule went into effect in August 2014. It’s hoped that all food labeled gluten-free will soon test below 20 ppm, although FDA regulations don’t specifically require manufacturers to test food for gluten.

The study was published in October 2014 in the European Journal of Clinical Nutrition. For more on Gluten Free Watchdog, visit glutenfreewatchdog.org.

Milk Allergy and Vitamin D

Another study has found milk-allergic children are at risk of falling behind on growth charts. This latest study, published in October in the Journal of Allergy and Clinical Immunology, looked at growth and nutrition patterns in a large sample of U.S. kids. Results showed milk-allergic children took in fewer calories and had lower average height, weight and vitamin D levels than their non-allergic peers. Interestingly, these findings weren’t seen in children with other food allergies.

In related research, published in October in the Canadian Medical Association Journal, scientists found tots who exclusively drank milk substitutes—such as soy, rice, almond or goat’s milk—had significantly lower vitamin D levels. Although most cow’s milk in the United States is fortified, not all milk substitutes are fortified—or fortified at the same level. Targeted vitamin D supplementation may be necessary in these kids, researchers say.

Senior medical correspondent Christine Boyd lives in Baltimore.

 

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