Allergy Apps… Helpful, but Not a Cure

woman-sneezing

While watching the evening news, I was intrigued to hear announced “A New Breakthrough for Allergy Sufferers!” I am used to this kind of hype, but still curious to see what they had to say.

It wasn’t a medical breakthrough, but, instead, a computer breakthrough. Allergy Apps, which can be downloaded onto your smartphone, can give you helpful allergy information. I was reminded of the time Bill Gates was asked, “Why don’t you give out free computers in developing nations to help them advance?” His clear answer was that these countries didn’t need a computer – they needed safe food and water and vaccines. In that same line of thought, a phone won’t cure your allergies, but it can get you some useful information.

What followed was a demonstration of the app’s features. The app downloads the pollen count in your area from pollen.com, which can help you connect your symptoms to what’s going on outside. It can also help you locate a pharmacy in your area, if you need immediate relief.

This story caught my attention, but seemed a little disappointing. I was a little more impressed with a different app that I hear about the old-fashioned way – through the regular mail. Allergy Eats! Offers an app that can help people withfood allergies find restaurants that are safe and enjoyable to eat at. Users of the app can rate more than 600,000 restaurants quickly and easily by answering three simple questions about their dining experience. This is the real power of the online experience!

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island

New Treatments for Food Allergies and Anaphylaxis Presented at a Mount Sinai conference

I just attended this Saturday an all-day conference devoted to the latest research findings on food allergy diagnostics and treatment. Food allergy is definitely on the rise and a frightening problem for families afflicted with this condition. A recent report in the Journal of Allergy and Immunology in 2008 reported 54,000cases offood allergies in the U.S. – up from 32,000 the year before. The most frustrating thing for families and doctors is that there are no approved treatments for patients with severe food allergies-except avoidance.

The conference at Mount Sinai presented exciting new data that hope for children and adults with food allergies is on the near horizon. Several studies were presented that showed effectiveness using oral immunotherapy to treat milk, egg and peanut allergy. The treatments worked in many of the patients, however there were common adverse reactions (45%) in doing the immunotherapy. In contrast to the oral immunotherapy (the product is swallowed), sublingual immunotherapy was used in a peanut, hazelnut and peach study. These studies did show varying degrees of effectiveness. Dr. Hugh Sampson also presented data on a Chinese Herbal Formula his group is working on to prevent food allergy reactions and this looks very exciting; they have had success in animal models and are now starting to recruit for human trials. It seems to be a very safe treatment and I would encourage anyone interested in participating in the research to contact Dr. Julie Wang who is involved in the study.

One last thought, there is a medication that is available now that might be an effective treatment for food allergies- it’s called Xolair. It is presently only indicated for severeasthma, and it is an expensive drug only covered for this reason. However, I have used this for a few asthmatic patients and seen that they were more protected against their food allergies. The most dramatic case I had was a patient who had asthma and was highly allergic to salmon and tuna. She was so allergic she couldn’t even be in the same room as someone eating the food- it would cause an asthma attack. She hadn’t been to a restaurant in years because of this severe food allergy. She was treated with the Xolair injections once a month and not only did her asthma get better, but she noticed she didn’t have those severe reactions if she was near salmon or tuna, or if someone she was with had eaten either of these fish. I wasn’t recommending she eat these foods, but having more confidence that she was more protected did improve the quality of her life. Using Xolair for food allergies would be off’-label use of the product and expensive (around 1,000 per injection), but I can’t help thinking how many patients might benefit from its use.

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island

Chronic Fatigue, Fibromyalgia and Tick Diseases: The Ticking Time Bomb

Spring is here, and naturally, after our long harsh winter, we can’t wait to get outside and enjoy the outdoors. However, my patients who suffer fromChronic Fatigue Syndrome andFibromyalgia are not quite as happy because their symptoms prevent them from enjoying being active and outside.

When treating patients with both of these conditions, I am extremely vigilant in looking for an underlying infection, which may have brought on these illnesses. The diseases that are becoming the most prevalent and in some ways the most difficult to diagnose are tick borne diseases.

TICK BORNE DISEASES

Almost everyone has heard of Lyme disease. The Lyme epidemic seems to have exploded from a little known illness that was discovered in Lyme, Connecticut to a country-wide problem.

The big problem in the past decade was the hot debate over what symptoms caused Lyme disease. Rashes, arthritis and neurologic symptoms were well-documented in the scientific literature. However, the medical literature seemed to indicate that with appropriate treatment the symptoms would be resolved.

INSURANCE COMPANIES

Other symptoms, such as fatigue and chronic generalized pain were not as widely accepted by the medical community or insurance companies that were contesting the concept of a Chronic Lyme disease state.

Insurance companies refused to pay for long courses of antibiotics to try and cure the disease. To further complicate matters, the laboratory tests to diagnose Lyme disease were not easy to interpret and there was a significant variation from one lab to another.

THE LYME CONUNDRUM

The big medical question was to treat or not to treat? The medical world did not know whether they should treat Lyme disease.

Also, patients withChronic fatigue syndrome andFibromyalgia were usually told that if they didn’t show any evidence of a Lyme infection, they didn’t have the tick and had no hope of getting better with antibiotics. This may have been a big mistake!!

While Chronic Fatigue Syndrome andFibromyalgia are completely separate to Lyme disease, it does not mean a tick borne infection cannot cause any of these conditions.

GOOD TESTING

My own frustration in diagnosing tick borne diseases was that I could not seem to find a lab that did consistently good testing. However, my luck and the luck of my patients has changed. I recently discovered the company Imugen, that specializes in Lyme and other tick borne infections.

IMUGEN

Imugen has several types of laboratory testing that utilizes the latest advances in diagnostic testing for ticks – Polymerase Chain Reaction, or PCR. PCR tests DNA for the presence of the tick, not the antibody.

I know this seems very scientific, but the bottom line is that like in criminal investigations, nothing trumps DNA evidence. An antibody test can miss an infection or give a false positive test due to a cross reaction, but DNA does not lie.

While talking to the head nurse epidemiologist in Suffolk county, Long Island she informed me that they frequently see many patients who are co-infected with multiple tick infections at the same time.

IT MAKES SENSE…

If you go into the woods and get exposed to various ticks, some may carry the Lyme infection and others may carry not so famous infections such as Borrelia Miyamotoi, Babesia Microti, Anaplasmosis, Ehrlichiosis. These infections can cause even nastier illnesses than Lyme disease.

Realistically, until we find a more specific cause for Chronic Fatigue Syndrome and Fibromyalgia, I believe any patient has the right to be tested for all of these very important tick illnesses that happen more frequent than most of us realize!

– Dr. Dean Mitchell
Mitchell Medical Group, NYC

5 Holiday Travel Tips to Prevent Allergies & Infections

Preventing illness on the road

Christmas and New Year’s Day are literally around the corner…. I’ve spoken to many of you who are excited to get out of town and visit friends and family. One concern many of my patients have expressed to me is: How can I avoid getting sick, from either my allergies or infections, on my trip? I’ve done some research over the years and I think have come up with some good tips to ensure a healthier travel experience.

Tip #1:

If you are traveling to a friend or family that has a pet, cat or dog, and you are allergic, there are some sensible things to do. First, if you are on allergy drops, continue to take them while on your trip to maintain protection – unless you get very sick. Second, make sure to take preventive medications a few days before you travel. Topical medications like nasal sprays (ex. Flonase, Nasonex), eye drops (Elestat or Pataday) or inhalers (Advair, Flovent) are the best way to add extra protection before you get the exposure.

Also, if possible ask your host if they can make sure the room where you are sleeping is off-limits to the pet- this is critical: the worst reactions I see is when a person sleeps in a room where the pet has been staying for long periods of time- even if it’s not when they are sleeping there. The cat dander especially stays airborne for up to 4 months! If you develop symptoms while you are there, you should use antihistamines, such as Zyrtec or Claritin (both are over-the-counter) which will give added relief. Try to get out of the house during the day to get some periods of fresh air.

Tip#2:

If you are staying at a hotel, dust mites – and possibly mold – are the allergens to be concerned about. This is especially true if you are travelling to a warm, humid climate (Florida or the Caribbean). What can you do realistically? You can tell the hotel management that you are allergic to dust and mold, and would appreciate a thorough cleaning of the room – especially the headboard area. This area gets overlooked in cleaning and is literally right by your head, where you are breathing in all that dust. This may sound obvious, but ask them to make sure the sheets were changed from the prior guests and if possible washed in hot water (over 135 degrees) which kills the dust mites. If you want to be fanatical (but to me not unreasonable) bring your dust mite covers, at least for your pillowsand see what a difference this can make. If you smell mold in your room, pump up the AC. Mold spores don’t like cold temperatures.

Tip#3:

This one’s simple but overlooked: ask for a smoke-free room. You probably think most people don’t smoke anymore, but there are many European travelers to the U.S. with the weak dollar and they are smokers. The chemicals in the smoke last in the room for days. The hotel staff will try to spray air-freshener all over the room, but the smoke fumes linger and are damaging to your sinuses and respiratory tract- making you more prone to an infection.

Tip#4:

Don’t use the bathrooms on the plane! Of course, unless you have to. The bathrooms on the plane are germ infested! I have gotten sick several times before I read an article explaining what is going on in these bathrooms. My advice is to put on rubber gloves. I do this all the time. I have my lavender or blue latex-free gloves in my carrying-on bag and if the urge to go to bathroom gets too much, I put on my gloves and take my chances. So far, over the last 8 years I haven’t gotten sick on a trip. If you forget a pair of rubber gloves, no problem- the TSA security has plenty of those gloves as they examine your bags: ask politely if you can have a pair or two.

Tip#5:

Get some sun if you are going to a warm climate. Do it safely and try not to burn on your first day or two. In the Northeast, all of us get a paucity of Vitamin D during the cold, dark winter months. There is no substitute for good old sunshine. Start out with at least an hour a day, and slowly build up an extra half-an hour on top of that. It is good idea to use sunscreen on your face, but let your arms and legs go sunscreen free to soak up the Vitamin D. Many of the new studies clearly show Vitamin D strengthens our immune system- and many new allergy articles show it helps decrease allergies- it’s also great to clear up your eczema.

I hope these tips make your holiday allergy and infection-free. Have a great time!

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island

Egg Allergy Relief: Tests Show Oral Immunotherapy Works!

two-kids

Allergy drops have been and found effective for many people tested for egg allergies.

The New England Journal of Medicine published an article this week titled “Oral Immunotherapy for Treatment of Egg Allergy in Children“. The lead author was Dr.Wesley Burks, president of theAcademy of Allergy,Asthmaand Immunology. The significant finding is that oral immunotherapy can desensitize a high proportion of children with egg allergy. In the long run, oral immunotherapy can induce long-standing protection against egg sensitivity so that children can continue to eat eggs after the treatment is stopped.

The excitement in this new field of oral immunotherapy is that previous studies have shown that this treatment is effective forpeanut allergy, and now the same has been shown foregg allergy. Parents should be warned that this is not an overnight treatment success. Results take time.

  • At 10 months of therapy about 55% of the children treated with oral immunotherapy passed an egg food challenge.
  • Even better– at 22 months 75% of the treated children were desensitized
  • At 36 months all (100%) the children that had passed the challenge at 24 months passed that time.

IgG4

lgG4, called the “blocking antibody” can be a marker of immune intolerance.

I’ll take those scores any day of the week! However, a few children did drop out of the study because of allergic reactions. Interestingly, one of the markers that seems to correlate with the children’s inability to pass the challenge is anelevated IgG4 level. This is the so-called “blocking antibody” which seems to be a marker of immune intolerance.

Some of the researchers of the article have been quoted in seminars as saying that this type of treatment is still under clinical investigation and is not ready for use in routine practice. That may hold some validity, but with parents clamoring for a safe and effective treatment for potentially life-threateningfood allergies, a more rapid evaluation of how to bring this treatment into the mainstream is most needed.

My own experience with an egg-allergic patient was unforgettable. It was my first year in private practice and my patient said he wanted to be tested to see if he was still egg-allergic. He was diagnosed in his twenties with severe egg allergy after having allergic shock (anaphylaxis) after eating a plate of eggs in a diner. He had to avoid restaurants because even a miniscule amount of egg in a pancake would cause a severe reaction. After 20 years, he came to see me. I initially did a blood test called the RAST on him and it was negative. Today, blood testing is much more accurate with the ImmunoCap and ISAC testing by Thermo fisher. However, the patient couldn’t believe, nor could I that he was really ok to eat eggs. I decided to test further, and performed a prick skin test to see his allergenicity. That was an unforgettable moment. The patient immediately broke out inhives and had trouble breathing, I had to give him 2 shots of adrenaline (epinephrine) to calm down the reaction. Needless to say, he stayed on his egg-free diet.

I believe we are at an exciting time in the treatment for food allergy. My message to children, adults and parents: “Hang on– a cure is in sight.”

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island

This Spring Don’t Just Adjust the Clock, Plan Ahead to Prevent Allergy Symptoms

runningThe spring allergy season has officially started! The mild winter and the unusually warm weather last week has prompted the trees to bloom and start scattering pollen everywhere. Patients who are extremely sensitive to tree pollen have already begun experiencing symptoms such as itchy, red eyes for which I prescribe oral cortisone, in severe cases. The eyelids are a very vulnerable area because they are the thinnest area of skin on the body. The conjunctiva, the normally pink area under the eyelid, releases histamine when it is exposed to substances they are allergic to. If you have experienced any of these symptoms already or have experienced them in the past – it’s not too late, but don’t wait! Have a preventive plan in place to minimize the effects of spring tree pollen, which takes off early in April, and again in May, when the grass pollen which gets going.

My tips to reduce springallergy symptoms:

1. Go to your drug store and find the nasal spray calledNasalcrom. Nasalcrom is now over-the-counter, but it used to be a prescription. It is very safe and can be very effective… if you start ahead of time. It mainly works as apreventive spray to decrease nasal sneezing and congestion. If you wait until the pollen gets bad, you won’t get as much benefit. Nasalcrom is not a steroid spray, it is based on the Egyptian herb Khellin, and can be used at least twice a day.

2. Ask your doctor for a prescription eye drop the moment you begin to experience eye irritation. I likeElestat andPataday. They are both effective and well-tolerated; however, Pataday can be pricey so I’d recommend trying Elestat first.

3. Keep yourantihistamine ready. They are all now over-the-counter. They are all effective, but I have some additional thoughts. My experience is that Claritin is the lightest in the sense that it will help for mild allergies, but not severe ones. Allergra (fenofexitidine) and Zyrtec (Cetirizine) are more powerful; however, Zyrtec has a sedative effect on many patients so Allegra would be my optimal choice. Be sure to check with your pharmacist since Allegra can interact with other medications or if you have heart arrhythmias.

If you wait too long and are already getting hammered by the pollen your allergist can prescribe you a short course of oral cortisone to get you well enough to return to work and your responsibilities. However, we now haveAllergy Drops (sublingual allergy immunotherapy), which can help you to build resistance and tolerance to the pollen allergies permanently. I’ve been pleased to see how well my patients, who have been using the allergy drops for several months, are doing. The studies being done at Stanford Medical Center and Johns Hopkins are showing that sublingual allergy treatment can be an effective way of changing an allergic patient’s immune system to a non-allergic state.

At the American Academy of Allergy meeting that I attended recently, I was excited to see the data presented from around the world, showing that sublingual allergy immunotherapy is achieving the results every allergy patient has been waiting for: a safe, convenient, effective therapy that lasts!

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island

Dr Dean Mitchell on Fox 5 News (video)

Dr. Dean Mitchell on Fox 5 News describes how oral Allergy Drops are an effective alternative to allergy shots and allergy medication especially for seasonal allergies. These drops are convenient and effective forpet allergies and nearly all othercommon allergies.

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island

Chronic Fatigue Syndrome Renamed Systemic Exertion Intolerance Disease (SEID): What does that mean for Patients?

The Institute of Medicine (IOM) committee just announced they are recommending changing the name ofChronic FatigueSyndrome to Systemic Exertion Intolerance Disease (SEID). Why the name change and what does it mean for patients suffering from this condition?

Essentially, experts caring forChronic Fatigue Syndrome patients felt their patients were being labeled as malingerers or fakers. The name ‘chronic fatigue’ did not help in having this condition recognized as areal disease.

THE NEW DIAGNOSIS FOR CHRONIC FATIGUE, NOW SEID

The committee now requires 3 core symptoms to make the new diagnosis of Systemic Exertion Intolerance Disease:

  • A substantial impairment in the ability to engage in pre-illness levels of activities. The fatigue is usually debilitating and not relieved by rest.
  • Postexertional malaise following physical, cognitive or emotional stress.
  • Unrefreshing sleep.

In addition, patients should havecognitive impairment ororthostatic intolerance for at least 6 months.

LET’S BREAK THESE POINTS DOWN

Basically, patients will be diagnosed with Systemic Exertion Intolerance Disease if:

  • They cannot function in their normal capacity prior to their diagnosis.
  • They don’t get better by resting or taking a break.
  • Any type of stress makes them weak.
  • They don’t get adequate deep sleep, so they feel exhausted all the time.
  • They cannot think straight and get weak just standing up for short periods of time.

chronic fatigue treatment

THE FRUSTRATING PART OF CHRONIC FATIGUE

The frustrating part ofChronic Fatigue is that we don’t know the underlying cause. Is it due to a virus like Epstein-Barr? Is it due to a hormonal imbalance in the adrenal glands? Is it due to an undiscovered tick-borne disease, like Lyme’s disease? Remember, it’s not that long ago that children with Lyme disease where originally thought to be faking their illness.

THE COMMON DENOMINATOR

We see the following symptoms with many of our patients:

  • They are female
  • They tend to have low blood pressure to begin with.
  • The difficulty they have standing up is exacerbated when their blood pressure drops by even a few points.

In some cases, we have seen an apparent viral infection set off the fatigue. In other cases true life catastrophes seem to drain the body’s metabolism. The common denominator in many of the patients is their lack of good, deep sleep.

OUR APPROACH TO TREATING SEID

It’s estimated there are 835,000 to 2.5 million Americans withChronic fatigue or now Systemic Exertion Intolerance Disease. However, only about 10% of these people will receive a proper diagnosis. At Mitchell Medical Group, you won’t have to worry about getting properly diagnosed – we know this illness when we see it!

With our thorough examination and laboratory testing, we check your vitamin and mineral levels, thyroid and adrenal hormone levels, and possible infections to give us clues as to the best way to restore your health.

TO TREAT YOUR CHRONIC FATIGUE OR SEID

We recommend you get good, deep sleep and we will balance your hormones if needed. We also treat any underlying infections, offer state of the art nutritional advice and design safe ways for you to exercise, even while dealing with Systemic Exertion Intolerance Disease.

To add to all of this, we have specially formulated intravenous vitamin drops to boost energy and we use gamma globulin injections to boost immune defenses.

Ultimately, we don’t care what they call this illness…. we just focus on getting you and all of our patients better and back to your lives!

– Dr. Dean Mitchell
Mitchell Medical Group, NYC

Allergy Drops vs. Shots: Which Would You Prefer?

sneezing-allergies

There is exciting news for those of you who suffer from pollen allergies (specifically grass pollen allergies). You can now safely choose between three proven pollen allergy treatment options: sublingual grass pollen tablets, sublingual grass pollen drops or subcutaneous grass pollen injections.

The currentJournal of Allergy and Clinical Immunology: In Practice (March 2015) published a meta-analysis (which means they looked at and compared multiple published studies) and determined that each of these treatments were equally effective for treatment of pollen allergies.

Big News for Pollen Allergy Sufferers

This is big news because for years, some doctors in the allergy community said sublingual allergy treatment wasn’t effective at all, while others said even if it was effective it wasn’t as good as shots.

Now we know for sure – they all work! But what does this mean if you suffer from environmental allergies? You have to make a decision about which allergy treatment is best for you.

Which Allergy Treatment is Best?

The choice of which allergy treatment to choose seems to be obvious. Who wants to get shots on a weekly basis? But it is important to look closely at the advantages and disadvantages of each allergy treatment option.

Subcutaneous Allergy Injections (aka Allergy Shots)

Allergy injections have been around since the days of the horse and buggy. You probably think this is a joke but that is when Dr. Robert Cooke developed this treatment in the United States.

Dr. Cooke had a severe horse allergy, and in those days his ambulance was a horse and buggy. He came up with allergy shots as a way to desensitize himself to the horse, and he later developed shots for pollen and dust allergies as well.

Strangely, in the almost 100 years since this treatment was developed it has not changed at all! The process still involves going for weekly injections for the first year and trying to build up immunity.

The treatment has been proven to work, but the negative sides are clearly the inconvenience of going to your doctor’s office for the weekly shots. I also have concerns that the shots could cause a severe allergic reaction, a risk patients have to be willing to take.

The injection treatment typically lasts 3 to 5 years, and the good news for patients is that insurance companies cover this medical service.

Sublingual Allergy Tablets

Last April, the FDA approved two new products for treatment of grass pollen and one for ragweed pollen. These sublingual tablets are called Grastek, Orlair and Ragwitek.

oral-and-injectibles-antihistamines

These three products are the first allergy immunotherapy products to be approved in a century! The importance of this is that there is now proven scientific evidence that sublingual allergy immunotherapy is effective in treating pollen allergies.

One of the important points to note however, is that these products must be started at least 4 months prior to an allergy season. So it’s too late to start the Grastek or Orlair to treat grass pollen this season.

Grastek and Orlair are approved for children 5 years of age and older, while Ragwitek is approved only for those 18 years and older. I have two main concerns with these tablets:

  • Firstly, the tablets come in only one strength – the high maintenance dose. This means many patients will experience adverse reactions, such as itching in the mouth or an upset stomach.
  • It’s also likely that the cost will be expensive. They should be covered by many insurances but, like all new products, it may come with a high co-pay.

Sublingual Allergy Drops (aka Allergy Drops)

I wrote about this treatment in my book –Dr. Dean Mitchell’s Allergy andAsthmaSolution (De Capo 2006) – and I predicted that sublingual allergy treatment would become the new way to treat environmental allergies.

I had the good fortune of training with the early pioneers in this field and went on to develop custom-made treatments for my patients.

There are a number of advantages to taking allergy drops over tablets:

  • With allergy drops you can combine several different allergens in the liquid form. There are very few allergic patients who are only allergic to one allergen, so for example, we mix grass pollen with tree pollens to get full spring protection.
  • Drops can be custom made to start at low doses and gradually built up to higher doses. This is very important because many allergic patients are highly sensitive to the allergen and this technique avoids side-effects.
  • Drops are easy to take – all you have to do is place a few drops under your tongue.
  • These drops taste pretty good.
  • You can take them at home, so there’s no need to go to your doctor’s office on a regular basis.

I have treated patients with allergy drops for 16 years and have had wonderful results. These allergy drops are not currently covered by insurance companies (maybe this will change with these new findings), but we try to make them an affordable price. Currently, they cost slightly more than you would pay in copays for a weekly allergy shot.

When I first started in my allergy practice 22 years ago, my fellow doctors called me, ” The Shot Doctor.” Now I’m so thrilled that they refer to me as the “Drop Doctor.”

If you suffer from allergies contact your doctor to find out which treatment options are best for you.

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island

Allergy Prescriptions for Back to School: Information Every Parent Should Know

kids

This time of year I get lots of calls and forms to fill out from parents who have children in school that need their allergy prescriptions filled out for the school nurse. The main prescriptions are for the EpiPen, which is the injectable adrenaline used for severe allergic reactions to foods or insect stings. The other prescriptions are forasthma inhalers, in case a child experiences an acute asthma attack. This is routine for my office- but it should be anything but routine for parents whose child needs to have these medications available and be used in case of an allergic or asthmatic emergency.

Last Saturday, (September 8, 2012)The Business Section of The New York Times ran a lead article entitled: “Tiny Lifesaver for a Growing Worry.” The article focused how many states (not New York) had passed a law that an EpiPen can be used in a school without a prescription by a school nurse to treat a child in danger of anaphylaxis (the most severe form of allergy). The article showed a picture how EpiPens would be mounted in the nurse’s office just like a defibrillator unit (to reverse cardiac arrest) to call attention to the use of this life-saving medication. This medical issue unfortunately only got national attention when a year ago, Amarrria Johnson, who had a known peanut allergy was given a peanut by another child and went into respiratory arrest due to the allergic reaction. The nurse did not have a documented prescription to give epinephrine and it was not given in time to prevent Amarria’s death. Law-makers and Health officials using common sense are now putting laws into place to allow a qualified health professional to administer the Epipen, regardless ifa prescription is in place. This is important because a child may develop a severe allergic reaction for thefirst time in their elementary school years and they may not have had the need for a prescription. A study in Massachusetts found that25% of children that received epinephrine never knew they had an allergy.

epipen

Food allergy is on the rise. Today 1 in 13 children have a food allergy- and 40% are found to have a severe reaction to the food. Peanut allergy is notorious for causing severe food allergy reactions. Today 1 in 70 children are allergic to peanuts- back in 1997 1 in 250 children had peanut allergy. The good news is that testing is getting better and safer. When I have a concern that a child has a peanut allergy I order theUKnowPeanut test (PIRL labs); this test can quite accurately detect if a child is at risk for a severe allergic reaction to peanut. These tests are more specific than a skin test- and safer because the child gets no exposure to the actual peanut, it’s all through the blood. I’ve also been fortunate to advise parents who were concerned their child might have a peanut allergy that in fact they were not allergic to peanut from the test. I can also order other food allergy tests in the blood or do skin tests if I think it is necessary.

So, once again, if your child has a food allergy please make sure the school has an updated prescription to use epinephrine from your doctor, and the same goes for asthma medications.

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island

A New Study finds High Rate of ER visits for Food Allergies

A medical article published by theJournal of Allergy and Clinical Immunology on December 17th, 2010 reported thatfood allergies are sending more Americans to the Emergency room than before. The researchers estimated that between 2001 and 2005, just over one million visits were made to the ER for a food allergy. Dr.Clark at Children’s Hospital in Boston, reported that food-induced allergic reactions have doubled over the six year period from 2001 to 2007. The U.S. Center for Disease Control and Prevention reported that 3 million school aged children in U.S. had a food allergy in 2007; this was up 18% from 10 years earlier. These are staggering numbers considering much of the lay press has been down-playing the significance of food allergies and saying that food allergies areover diagnosed.

Be prepared

As a NYC allergist, my concern is two-fold: that children and adults be properly evaluated and diagnosed for a true food allergy, and if they do have a food allergy that they be prepared to treat the unexpected emergency situation.The Food Allergy News (a newsletter fromThe Food Allergy & Anaphylaxis Network) in December 2010 had a lead article on a survey done at the University of Michigan to try and categorize the scope of the problem of food allergies on its undergraduate student population. Specifically, they were most interested in the food allergypreparedness of the student and the campus health facilities. 513 students responded to the survey and 293 reported they had a known food allergy. Almost 48% said they had emergency medication with them in case of a food allergy reaction. However, in most cases (41%) it was Benadryl, not the more powerful and effective self-injectable epinephrine (just 21%).

What’s baffling is that 24% of the students that had a life-threatening allergic reaction (anaphylaxis) hadnever been prescribed epinephrine. This problem is close to my heart as both a doctor and a parent. My alma mater, Brown University, had a tragedy occur a few years after I attended. A young man with a known peanut allergy had a bowl of chili at a restaurant, not knowing it was made in a peanut base; he went into anaphylaxis and died. I don’t know if he had an injectable epinephrine device, but I do know that studies done at Mount Sinai have shown that patients that use the epinephrine injectable device within minutes have much better outcomes – and a much lower risk of death. I try to teach my patients with severe food allergies to not only carry their EpiPen with them at all times, but to know how to use it properly, so they are ready and not afraid if the situation arises.

If someone has a severe allergic reaction, especially if it requires emergency room attention, I believe it is critical to see an allergy specialist to be tested to see which specific food caused the reaction – and to make sure there are no other related foods that may trigger a future reaction. The testing is highly accurate and safe. In my book, Dr. Dean Mitchell’s Allergy andAsthma Solution, I have a whole chapter on this topic and discuss some of the therapies that are being investigated.

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island