House CallApril/May 2010 Issue

Pediatric Allergies Q & A - Bee Allergy, Egg Allergy and More!

Pediatric specialists answer your questions

Bee Prepared?

My son has hay fever and is highly allergic to peanuts. Now I’m concerned about bees, that if he gets stung he’ll have a severe reaction. Am I right to be worried?

Dr. Jain Fortunately, children (and adults) who have food allergies or seasonal allergies that cause hay fever-type symptoms are not at increased risk for developing an allergy to insect sting. Another piece of good news is that kids who’re allergic to insects tend to have more mild reactions than adults; if they do develop a systemic reaction from a sting, it’s usually hives. Most doctors recommend that testing be performed after a sting, not before. This is because the screening test doesn’t distinguish very well between those who develop local swelling after a sting from those at risk for anaphylaxis. Testing helps confirm that a patient is, indeed, allergic and also helps identify which insect or insects—wasp, honey bee, hornet or yellow jacket—he may be allergic to. Treatment options include avoidance and the use of self-injectible epinephrine (when there’s a reaction) and immunotherapy or allergy shots, which are a very effective way to reduce or eliminate the risk of reaction to future stings. Allergy shots are directed against the venom of the specific insect the patient is reacting to.

Allergic to Eggs

Our son was just diagnosed with an egg allergy. He’s been eating muffins and other baked goods that contain eggs but now our allergist recommends strict avoidance. What’s the difference between an egg that’s baked as part of a recipe and one that’s scrambled?

Dr. Leo At this time, most medical experts recommend strict avoidance of any food that is identified as allergenic. Although some research suggests that certain egg-allergic children may tolerate small amounts of baked or processed egg, most allergists recommend that children, particularly babies and toddlers, avoid all such products for two reasons. First, a very young child doesn’t have the language to alert a caregiver to the beginnings of discomfort or a reaction. (We often find that kids self select; they avoid the food or eat very small bites and then lose interest.) Second, the amount of allergen in a baked product is influenced by multiple factors, including the temperature cooked, the matrix (the substance that encloses the egg protein) and the number of eggs in the recipe. The allergenic properties of an egg mixed in a brownie baked at 325 degrees for 20 minutes will differ from an egg cooked in a pancake at 400 degrees for 2 minutes. There hasn’t been much research on this topic but it certainly warrants more attention. Until there are definitive answers, most specialists will opt for safety and instruct patients to steer clear of an allergen.

Rash from Rabbits

We notice our child who has seasonal allergies gets itchy and develops rashes after coming in contact with bunnies. We had her tested and she’s not allergic to rabbits. What’s going on?

Dr. Leo Some children with seasonal allergies, particularly to grasses, can have a reaction to animals (guinea pigs, hamsters, rabbits) that eat or spend time in grass. I also see children reacting to the hay or Timothy grass (alfalfa) used in animal pellets and bedding. Avoidance is the best treatment but if that’s not possible, you may be able to minimize reactions by having your child thoroughly wash hands after handling the animal and also bathing the animal weekly.

Mystery Hives

I’ve been repeatedly breaking out in hives since I was a child. Sometimes they last several weeks, even months. I’m baffled about what brings them on. I have no other symptoms. I think I’m allergic to a dye or some hidden ingredient in food I’m eating. Is this possible?

Dr. Jain Hives are a frustrating problem for doctors and patients alike. Between 50 to 95 percent of people who develop hives have no specific or identifiable allergy causing them. In many cases, particularly in children, hives will begin after a viral illness. In other cases, usually in adults who have recurrent hives lasting more than six weeks, the problem (that can include swelling) may be related to an abnormal immune response. About 20 to 30 years ago, it was commonly believed that dyes and preservatives were a cause of recurrent hives that could not otherwise be explained. Since then, numerous studies have demonstrated that a true allergy to dyes and preservatives is far less common than previously thought. Ultimately, if you’re concerned that a food you’re eating may be causing hives, keep a food diary to monitor the link between your diet and the hives and consult an allergist.

Peanut Challenge

Several weeks ago, my daughter passed an oral challenge to peanuts. I was elated until the allergist told me there’s still a chance she could be allergic. Based on his advice, we’re carrying an EpiPen. How concerned should I be?

Dr. Leo An oral food challenge is the gold standard in determining whether or not a person can safely tolerate an allergenic food. When a child passes the challenge, it generally means that he or she can safely consume that particular item—with a few very important exceptions. There are circumstances when a child can become re-sensitized to the allergen even after passing the initial challenge. In addition, a few studies suggest that up to 6 percent of children who pass an oral food challenge may experience a return of their symptoms up to six months or a year after the challenge. To be on the safe side, many allergists advise parents to continue to closely monitor their child’s food intake and to take precautions regarding reintroducing problem foods for about six months after the challenge. This is particularly true regarding peanuts and tree nuts, where allergic reactions can be quite serious and even deadly. Although many children do very well after an oral challenge, we don’t have any predictive measure to know which child could re-sensitize. That’s why your allergist instructed you to keep that EpiPen handy. 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 an allergist and immunologist with San Tan Allergy and Asthma in Phoenix, Arizona.

Food allergies affect more than 12 million Americans, including 6 percent of children under the age of three. Allergic reactions can range from mild to anaphylaxis, a serious condition that can cause hives, swelling, nausea, closing of breathing passages and even death. There is no cure, just the strict avoidance of the offending foods. Ninety percent of all food allergies are caused by eight foods: wheat, milk, peanut, tree nuts, egg, soy, fish and shellfish.

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