Tuesday, March 31, 2009

Hay Fever Robots Make Theur Debut in Japan- Why Do the Japanese get all the Fun Stuff First?

It's a bird, it's a plane... it's an allergy-bot!

Weather News, a Japanese weather information company, has installed hundreds of globe-shaped light-emitting "robots" throughout the country, which estimate pollen levels and glow a different color based on the concentration of pollen in the air. Allergy sufferers can tell with a quick glance how miserable their day is likely to be, and can also sign up for pollen counts to be text-messaged to their cell phones each morning...

Although not nearly as George Jetson-like in its appeal, allergic folks state-side can also access up to date pollen conditions from the National Allergy Bureau. We don't use robots, though. Pollen counts in the U.S. are done manually, by volunteers!

To access airborne allergen information for your area, visit the National Allergy Bureau website.

Thursday, March 26, 2009

Oral Immunotherapy for Peanut Allergy- On the Horizon, but Not Ready for Prime-Time

Since the recent American Academy of Allergy, Asthma & Immunology conference in Washington D.C., much has been made of studies describing oral immunotherapy for peanut, egg and milk. These studies have demonstrated that some food allergic children can eventually tolerate ingestion of significant amounts of their trigger food after a protocol or gradually increasing oral doses of that food.

You may have seen this story on the morning/evening news programs, or read about it in your local paper or online. Certainly, parents of my patients have been coming in asking if I can provide this therapy for their food-allergic children in my office.

They are invariably somewhat disappointed when my answer is: "Sorry, not yet."

Let me explain why.

Although the prospect of inducing some measure of tolerance to a food allergen is exciting, there are a number of things to keep in mind:

1) To date, the peanut immunotherapy studies have evaluated relatively small numbers of children (<40), although larger controlled studies are in the works.

2) Of the 33 children enrolled in the initial phase of the peanut study, 4 (~12%) dropped out due to allergic adverse events (as determined by either the parents or investigators). This is not something that should be attempted in the home setting!

3) We're still not completely sure if the tolerance induced by food allergen oral immunotherapy is temporary (effective for only as long as the maintenance therapy is continued) or permanent (with lasting benefit after the discontinuation of maintenance administration). Until these questions are answered, it is inaccurate to say that oral immunotherapy "cures" food allergy. At best, we can state that oral ummunotherapy appears to increase the threshhold for food reactivity, potentially reducing the risk to a child from accidental exposure. This is not a license to consume peanuts with abandon...

4) Oral immunotherapy is still considered investigatonal, and the major insurance plans specifically state in their policies that oral immunotherapy is not a covered procedure. FDA approval is probably ten years away, because large-scale, placebo-controlled studies will be needed, and long-term effects of the treatment will need to be evaluated before the therapy can be considered safe for widespread use.

That said, as an allergist, and as the mother of a peanut-allergic child, I do believe that oral immunotherapy holds great promise. When it is ready for prime-time, I will be pleased to offer it to my patients.

For more information, please visit the American Academy of Allergy, Asthma & Immunology at http://www.aaaai.org

Wednesday, March 18, 2009

Don't Use Hand Lotion Before Going through Airport Security- Or, Why Mommy's Milk is "Da Bomb"

Guess whose breastmilk tested positive for explosives?

As my family, friends, and patients know, I am a huge proponent of breastfeeding. Nursed Son #1 for a little over a year, and going on 8 moths with Son #2. Benefits definitely outweigh the occasional inconveniences. But yesterday, my dedication to "La Leche" was certainly tested.

Any nursing mother who works outside the home is intimately familiar with "The Pump". At work, in a restaurant, in the car (preferably not while driving, although I've been known to attempt such multitasking madness in the past) - you name it, we've pumped there.

Planning a trip away from baby is never easy, but when you're nursing, it complicates matters. Rather than pump and dump, I elected to store the milk and bring it back home for baby. I did a good deal of planning: arranged for a large fridge in the hotel room, packed plenty of bottles, bottle brush, a zillion little plastic storage bags, coolers, ice packs... even checked with the TSA website, which stated that I could carry onboard the aircraft " a reasonable quantity" of breastmilk.

Well, reasonable for me was a little over 100 ounces, all packed up in 6 ounce ziploc storage bags. I knew that the milk might need to be tested with a little device that checks for vapor from liquid explosives- as long as they don't touch the milk, I'm okay with it. That's why I deliberately packed some of the milk in easily opened bottles.

What I didn't anticipate was the following conversation:

TSA guy: "Ummm.... okaaay. Hmmm. Can I get a supervisor over here, please?"
Me: "What's wrong?"
TSA guy to me and the supervisor: "This breastmilk is testing positive."
Supervisor: "Really? Well, that's never happened before."
Me: "Please don't make me dump it. I'll cry."
Supervisor: "Don't worry, ma'am. We'll just have to open some of these bags at random, though."

So, I ended up have to mess up my awesome system, upack the nicely stored bags, open them up to be vapor tested, and somehow get them bag in the cooler befoe my plane took off without me. It took a while. Good thing I was early!

Luckily, the TSA supervisor was really nice. Turns out his wife is a member of La Leche League, and actually had something to do with getting the TSA rules changed to allow more than 3 ounces of breastmilk onboard if you didn't have baby with you.

He also gave me this little tidbit: hand lotion has a chemical in it that causes the explosives testing machine to test falsely positive. Turns out the hotel was dry, and I was using hand cream a few times a day. It must have gotten onto the bags of milk as I packed them, hence the positive explosives test.

All is well that ends well. The TSA folks treated me with dignity, I made my flight, and I will never use hand cream before flying again.

Tuesday, March 17, 2009

Your Kiddo Won't Eat?- It May Be More than Pickiness...

Yesterday, I attended an excellent lecture series on eosinophilic esophagitis, a relatively newly recognized disease in adults and children which results in difficult to control heartburn symptoms and difficulty eating.

Eosinophilic esophagitis results from abnormal accumulation of inflammatory cells in the lining of the esophagus (food pipe), and has a strong relationship to food allergy.

If you or your child have heartburn symptoms which have not improved with a proton pump inhibitor (examples include Prilosec, Prevacid, or Protonix, among others), you may be experiencing more than reflux. Ask your primary care physician if you might benefit from a referral to a gastroenterologist for an endoscopy (a video evaluation of the inside of your esophagus, stomach, and/or intestines).

If a biopsy reveals high numbers if eosinophils (specialized white blood cells which are highly involved in allergic inflammation), you may benefit from further evaluation and dietary management. Approximately 75% of patients managed with a specialized diet (based on food prick and patch testing) had significant clinical improvement.

Eosinphilic esophagitis is rare, but the prevalence of the disease appears to be growing. Because the symptoms can be confused for severe reflux, the diagnosis is often delayed. This delay can in some cases lead to severe scarring and stricture (narrowing) of the esophagus, resulting in a lifetime of difficulty eating.

Learn more about this condition at http://www.apfed.org/

Monday, March 16, 2009

Allergy Meeting News...

I am writing today from our nation's capital, where I have spent the last few days attending the annual meeting of the American Academy of Allergy, Asthma & Immunology.

The amount of research and clinical information presented at this meeting is enormous, and is already starting to show up on Good Morning America, the New York Times, etc...

Some highlights:

* Avoidance of milk, egg, and peanut for the first few years of life may not be protective against the development of food allergies in at-risk children.

* Oral immunotherapy to milk, egg and peanut is showing promise in children.

* Atopic dermatitis (eczema) benefits from proactive treatment with an antiinflammatory ointment twice weekly, even when the skin is clear.

And so much more! I will discuss these issues in more depth in upcoming posts- as always, nothing is ever as simple as it seems on the news or in the paper. Each patient's case is unique, so do not act on anything you hear or read before discussing it with your physician. Talk to your allergist about what they have learned at recent meetings... we'll be happy to share with you!

Wednesday, March 11, 2009

New Albuterol HFA Inhalers May Increase Breath Alcohol

In an effort to save the ozone layer, the government has ridiculously mandated the phase out of standard chlorofluorocarbon (CFC) albuterol inhalers, and replaced them with hydrofluoroalkane (HFA).

Yep, in all their wisdom, the feds decided that all those asthmatics puffing away on their albuterol inhalers were creating a larger hole in the ozone layer than a gazillion automobiles or horrendously outdated factories. Don't get me started.

Well, don't puff on that new HFA inhaler within 5 minutes of getting pulled by the police over while you're speeding down the highway in your SUV... turns out that some of the HFA inhalers include ethanol, and it just might transiently raise your breath alcohol (less so than a drink of wine, though). Or so report researchers from Australia in a recent issue of the journal Respirology.

To be honest, if you need to urgently take albuterol, maybe you should just pull over for a while.

So... how long before the Hollywood lawyers start using the "inhaler-defense" at DUI trials?

Wednesday, March 4, 2009

Show Someone You Love Them- Share Your Spitoon!

So, it's been a little while since my last post. The Bajowala household is dealing with a mini gastroenteritis epidemic right now. Lots of tummy aches, throwing up, and laundry.

My husband is out of town for work nearly every week, and it certainly makes parenting two young boys an adventure, especially when we're dealing with illness. But this time, dear hubby is sick as well, and all alone on the road. So, he called Son #1 from his hotel room to commiserate this evening. Here's a rough transcript of the telephone conversation.

Dad: How are you, buddy?
Son #1: Daddy, I throwed up. A lot.
Dad: Yeah, I'm throwing up too.
Son #1: Come home, Daddy. I will take care of you, and then you will feel better. You can puke in my bucket, okay?
Dad: What?!?
Son #1: I throwed up in my bucket that Dadi (grandma) gave me. You can do it too. We can puke in it together. Then we will feel so much better.
Dad: Okay, buddy. Thanks! Feel better- I love you.
Son #1: I love you too, Daddy. Bye.

Father and son puking their brains out into a shared plastic bucket... the symbolism just melts my heart.

The imagery, however, makes me want to join them.