House CallFeb/Mar 2010 Issue

Pediatric Allergies Q & A - Egg Allergy and More!

Easter Egg Hunt

We’d like to dye Easter eggs but our child is allergic to eggs. Any suggestions?

Dr. Leo‌ My recommendation is that severely egg-allergic children strictly avoid eggs in all forms. However, we all want children to participate in life’s good experiences as much as possible. There are options: Parents and children can decorate wooden eggs using kid-friendly paints. This is a fun project that creates holiday memories and nice keepsakes. Another idea is to fill colorful plastic egg shells with surprises, a quick and inexpensive project that parents can do in a pinch.

Warm Weather Itch

My child has had eczema since infancy. It’s always been worse during the winter months but recently it’s gotten bad in warm weather, too. What’s going on?

Dr. Jain It is not unusual for eczema to worsen during certain seasons, particularly during the winter as dry, cold air can make the skin even more scaly and itchy. Some people have eczema only during the winter. As kids with eczema grow older, they can develop sensitivity to certain allergens found outdoors. Exposed skin that comes in contact with molds or pollens, for example, can set off an allergic reaction on the skin that has your child scratching. Other culprits might also contribute to skin problems—sweat in combination with perfumes, detergents or cosmetics can irritate sensitive skin. Be alert to any new products you’re using on your child’s towels, sheets or clothing or a different soap, shampoo or cleaning item that might be contributing to the problem. Consider having your youngster tested for environmental allergies. That way you know what items are prompting the irritation and you may be able to lessen exposure.

Keeping Epinephrine

We mistakenly left our child’s EpiPen in the car for the afternoon on a freezing day. Do we need to replace it?

Dr. Leo Yes, you should replace it. Epinephrine, the primary ingredient in self-injected devices like EpiPen and Twinject, is very sensitive to rapid temperature change and should be kept at stable room temperature (between 40 and 100 degrees) for maximum potency. Dr. Estelle Simons at Children’s Hospital of Winnepeg in Canada has studied how time and temperature can decrease effectiveness of this drug. One study revealed that an EpiPen over six months past its expiration date can lose from 25 to 50 percent of its efficacy—a life-threatening problem should there be a medical emergency! This is why most self-injected epinephrine devices have one- to two-year expiration dates and should be replaced frequently. For specific details on the proper care of your self-injected epinephrine device, read the instructions that come with the medication.

Egg-Free Vaccine

My child has been unable to receive either the seasonal flu vaccine or the H1N1 vaccine because she’s allergic to eggs. Why can’t they make a flu vaccine that doesn't contain eggs?

Dr. Jain The influenza vaccine is actually produced in hen’s eggs—that’s where the flu virus grows very well. The virus is injected into fertilized eggs, where it multiplies for two to three days and is then harvested. Although the virus is separated from the egg whites before it’s chemically inactivated, a small amount of egg protein can still exist in the final vaccine. A few companies are developing an influenza vaccine that’s grown in cell cultures, rather than in eggs. Initial studies suggest this egg-free vaccine is safe and effective. Pending FDA approval, it should be available for next year’s flu season.

Stick It to Me

Is there another way to administer epinephrine aside from a shot?

Dr. Leo EpiPens, Twinjects and self-drawing epinephrine kits (Ana-Kits) have been around for about 20 years. Researchers are now working on giving us more choices. Several groups are attempting to deliver epinephrine sublingually (under the tongue). Others are looking at inhaled versions using an MDI (puffer). Some researchers are working to create injectors that are less cumbersome and more portable. These newer devices and delivery methods are still in the research phase and aren’t likely to be on the U.S. market any time soon.

Pucker Up, Carefully

Our teenage son with a milk allergy has started dating. Could he have an anaphylactic reaction by kissing someone or holding hands? Should we approach him about personal safety and dating?

Dr. Leo Nothing terrifies the parents of an allergic teen more than the idea of their child beginning to date. No matter the food allergy, good hygiene in all daily interactions, including dating, is a must. Teens should be aware of two things: (1) Allergens can be detected in mouth saliva for several hours after ingestion and (2) kissing can transmit allergens across mucous membranes, leading to allergic symptoms. I tell my teen patients that dates should brush their teeth after eating and that my patients should know what their date has ingested before they consider kissing. Also, allergic teens must carry an EpiPen or Twinject and an antihistamine with them at all times when away from home.

Parents may find that talking about dating, kissing and other issues related to their child’s budding sexuality is difficult and embarrassing. Nevertheless, the discussion is critically important and having a food allergy makes it even more so. Parents should be firm in instilling the importance of medical safety, proper hygiene and responsible personal conduct. (For more about teens and food allergies, go to (Adolescence and Anaphylaxis). LW

 

Harvey L. Leo, MD, is a pediatric allergist with Allergy and Immunology Associates of Ann Arbor and an assistant research scientist with the Center for Managing Chronic Disease at the University of Michigan.
Neal Jain, MD, is a pediatric allergist with Dean Health System in Madison, Wisconsin, and an assistant clinical professor of medicine at the University of Wisconsin School of Medicine and Public Health.

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