House CallJune/July 2010 Issue

Pediatric Allergies Q & A - Sun Screen, Meat Allergy, & More!

Pediatric specialists answer your questions about allergies and sensitivities

Sun Screen for Sensitive Skin

My son has eczema and sensitive skin. I’m worried that sunscreen may cause him to break out. Are there certain ingredients I should avoid?

Dr. Jain People with eczema are apt to have problems with virtually any chemical that’s applied to their skin but a few ingredients in sunscreens are particularly troublesome. Watch out for para-amino benzoic acid (PABA, used less commonly today than in the past), padimate A and O, and benzophenones (such as oxybenzone and any other chemical ending with -benzophenone). In addition, avoid dibenzoylmethanes, such as avobenzone. Other active ingredients, such as titanium dioxide, zinc oxide, alumina and triglycerides, are more benign and most people can tolerate them. The perfumes in sunscreen products can also be irritating to those with sensitive skin. To see whether or not the product is well tolerated, try the sunscreen on a small patch of your child’s skin a few days before using it. Many sunscreens that are for babies or are labeled “sensitive skin” are better tolerated. If you’re still unsure, ask your allergist or dermatologist for product recommendations.


What's the Beef?

My 2 year old was diagnosed with a milk allergy when he was 6 months old. He recently had a pretty severe reaction to hamburger. Is there a connection? Can children really be allergic to beef or other meat?

Dr. Leo Up to 5 percent of young children with milk allergy can develop allergic reactions to beef. There’re a couple reasons for this. First, milk and beef have similar allergens that can cross-react. Second, hamburger and other beef cuts can sometimes contain actual milk proteins left over from processing. If the meat isn’t properly cooked (high temperature changes protein structure so that the body may no longer recognize it as an allergen), certain sensitive people may react to it.

Allergists have noted increasing numbers of children and adults with anaphylactic reactions to “non-traditional” allergenic foods, such as beef, pork and chicken. Researchers at the University of Virginia report that people with unexplained anaphylaxis and angioedema (swelling) could, in fact, have an allergy to beef or pork proteins. Interestingly, these people develop sensitivity to an alpha-galactose-containing protein that’s common in all mammalian tissues (in this case, meat). Since these folks are also at risk for reacting to medications containing similar proteins, they should be evaluated by an allergist who’s familiar with this syndrome.


No Moo-re Milk

The allergist says that my milk-allergic child must avoid milk even when it’s cooked or baked. I’ve heard some milk-allergic kids can safely eat milk in baked products. Is there any way to find out if my daughter can?  

Dr. Leo Several studies suggest that up to 25 percent of children diagnosed with a true milk allergy can tolerate some forms of baked or cooked milk. Right now, the only way to ascertain whether or not your child is in this group is to have her regularly undergo an oral challenge. (This should be conducted by a medical expert in a controlled setting.) But this situation could be changing. Researchers at the Jaffe Food Allergy Institute at Mt. Sinai School of Medicine in New York  found that some children whose immune systems recognize multiple epitopes (or protein forms) of milk are less likely to tolerate baked or cooked milk. The study is preliminary and more research is needed but the implication is that a blood test may one day be able to determine whether or not a child can safely ingest baked or cooked forms of milk without having to perform oral challenges as frequently. Until that time, doctors recommend that all youngsters diagnosed with an IgE-mediated milk allergy avoid milk in all its forms—baked, cooked and processed.


The Water's Fine

Is swimming in a chlorinated pool bad for my child’s eczema?

Dr. Jain Not necessarily. Many people affected by eczema notice that their skin actually improves after spending time in the swimming pool. There’s mounting evidence that people with eczema are colonized by Staphylococcus aureus, a bacteria that contributes to the skin inflammation seen in eczema. Swimming in chlorinated water may reduce the amounts of staph growing on the skin, thereby helping quell the eczema. I recommend that patients shower off after swimming and immediately apply a thick moisturizer to their skin while it’s still damp so that it doesn’t dry out from the chlorinated water.

It's a Breeze

Are there days in the summer that are worse for allergies?

Dr. Leo Seasonal allergies to pollen generally worsen on very windy days when pollen is whipped around in the air and can travel far. Rain triggers the release of certain mold spores, which means that mold allergies can be a bigger problem on rainy days. In terms of time of day, most trees shed their pollen early in the morning. Grass pollens tend to be worse in the late afternoon after the ground has warmed and mid-day winds pick up. Allergens remain airborne at night, which means that people who open their windows for fresh air and a cool breeze may be exposing themselves to troublesome allergens while they sleep.


Hard to Breathe

My little boy’s asthma is getting worse. The doctor wants to start him on daily medicine to control the symptoms but I’m reluctant because I’m worried that the drugs may have side effects. What should I do?  

Dr. Jain This is probably the most frequently asked question I hear in my practice—and the most important. Before starting long-term daily medications to control asthma, you and your doctor should identify potential triggers and clear them from your child’s environment. This may include investing in dust mite control or making hard choices about removing pets from your home. You and your doctor can also look at alternative therapies that may help symptoms, such as deep breathing and relaxation exercises, yoga or acupuncture. If these measures don’t help, allergen immunotherapy (allergy shots) can be effective if administered properly. Allergists generally don’t start this treatment until children are at least 10 years old.

There are two main classes of preventative medicine commonly prescribed for people who have persistent asthma, defined as someone who has symptoms during the day more than twice a week or symptoms at night more than twice a month. One class of medication is the inhaled corticosteroids (ICS), the first line of treatment for patients with mild persistent asthma; these drugs have been FDA-approved for asthma treatment for two decades. The other medication type is leukotriene inhibitors, a newer treatment option. Generally speaking, the risk of side effects related to either of these classes of medications is low. And multiple long-term studies have demonstrated that, when used appropriately, ICS do not cause growth delay, a parental concern I commonly hear.

Frankly, this is an emotionally charged topic. I see a lot of asthmatic kids who are untreated (or treatment is delayed) because parents have concerns about using medications. The risks of uncontrolled asthma are many, including growth problems, increased rate of obesity—and even death. I recently saw a child whose asthma was unmanaged because her parents were afraid to put her on appropriate medications, even though treatment had been recommended multiple times by other doctors. When she arrived in my office, her symptoms were so advanced that she was at risk of dying. She ended up in the ICU and ultimately did okay. But I’ve seen kids who weren’t so lucky and died from their untreated asthma.

Fortunately, the death rate related to asthma has decreased steadily over the last decade, in large part due to the increased use of these long-term controller medications. Asthma, like food allergies, can be deadly. Appropriate treatment is very important.

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.

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