House CallFeb/Mar 2009 Issue

Pediatric Questions & Answers - Allergic to Dogs and More!

Pediatric allergist Harvey L. Leo, M.D., answers questions about allergies and food sensitivities

Q The Obamas are bringing a new puppy into the White House even though daughter Malia is allergic to dogs. Is there such a thing as a hypoallergenic canine breed?
A Not really. A person who is highly allergic to dogs will react to any breed. The culprit is a protein found on the dog’s skin, dander and in the saliva. This allergen is trapped in carpeting, bedding and upholstery and can become airborne, contaminating the entire house.

Allergic sensitivity varies (symptoms include watery eyes, runny nose, coughing, sneezing) and you can choose a breed that’s less problematic. Canines that shed less, like poodles, or one of the hairless breeds have less impact. Obviously, small dogs produce less hair and, therefore, less allergenic protein. A Bichon Frisé, for example, would be less allergenic than a St. Bernard. Bathing the animal weekly can reduce the overall allergen burden, as can regular grooming. Many people can develop a partial tolerance to an animal that they’ve lived with for a prolonged period but they will still get symptoms when exposed to other similar animals.

My advice to any family with a dog-allergic child is to think hard before bringing a puppy into your home. The animal will become part of your family. It is heartbreaking to have to get rid of a beloved pet when health issues flare—and it can take up to a year for the allergen to dissipate from your home after the animal is removed.

Allergic to Dogs

Q Can my egg-allergic daughter get a flu shot?
A Influenza is a viral respiratory illness characterized by high fever, cough, muscle aches and fatigue. Lasting from seven to ten days, it can be life-threatening to young children, the elderly and anyone with chronic disease or weakened immune system. Peak flu season usually occurs in January or February each year.  

The Centers for Disease Control recommends that children and at-risk adults be vaccinated but I would not recommend the flu shot for your daughter without further guidance from your physician. The vaccine is contra-indicated for anyone who has an IgE-mediated egg allergy. Both injectable and intra-nasal flu vaccines are incubated in hen’s eggs and there is a possibility of egg protein in the vaccine.

Under certain conditions, an allergist can desensitize an egg-allergic patient in order to administer the vaccine. Check with your doctor for more information.

Q Do food allergies increase the risk of getting asthma and seasonal allergies later in life?
A Yes. Recent studies show that food allergies may have a wider impact than originally thought—even if the allergies are outgrown. Many researchers suggest that early manifestation of food allergies is just the beginning of allergic development and that seasonal allergies, asthma and other allergic diseases are very likely to occur later. One new study, for example, revealed that young infants with documented food allergies to milk or egg began to show early elevations of an inflammatory marker, suggesting airway dysfunction and risk for eventually developing asthma. Of course, many factors can influence the development of asthma and allergic disease but growing evidence indicates the process begins early. Anyone with food allergies should be aware of this and report any new symptoms to their doctor.

Q My little boy is allergic to tree nuts. We’re moving to a house that has acorns and chestnuts in the backyard. Should I be worried?
A Oak (acorns) and chestnut trees belong to the Fagaceae plant family. Although they have some biological similarity to nut trees (cashew, walnut, almond, pecan, etc.), the two plant groups are distinctly separate families. Their allergenic proteins are not the same. That means someone who’s allergic to tree nuts will not automatically be allergic to acorns or chestnuts. There are documented cases of anaphylaxis to acorn or chestnut but that’s another subject.

Q I’m allergic to saltwater fish. Can I eat freshwater fish?
A Most people who are allergic to fish are allergic to a particular albumin protein, a component common in any fish, whether it’s freshwater or saltwater. That said, people respond in different ways. For example, some can tolerate cod or tuna but develop a reaction when they eat perch or bass. There is enough cross reactivity between fish species that, to be on the safe side, I advise anyone who is allergic to fish to avoid fish all together.

Q I’m confused about the “may contain” language on some product labels.
A You’re not alone. I’m frequently asked by parents how to interpret the “may contain a food allergen” or “processed in a factory that may contain a food allergen” statements on many food labels. Studies reveal that food-sensitive people often ignore or misinterpret these statements.

The Food Allergy Labeling and Consumer Protection Act requires that manufacturers identify when a product definitely contains any of the top eight food allergens—wheat, milk, soy, egg, tree nuts, peanuts, fish and shellfish. The “may contain” language, called an allergy advisory label, is additional information that some companies include voluntarily, often to address potential liability issues. The FDA is weighing in on this voluntary labeling system and regulators are working to make labels more uniform and, hopefully, a clearer tool to help consumers identify product contents and avoid allergic risk.

The fact is that if a label states a product “may contain” a certain food allergen, there’s a possibility that it does. There is a risk to eating these products if you are allergic to that particular food. For conclusive information about product contents, contact the manufacturer directly.

Harvey L. Leo, M.D., 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. LW

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