Posted in allergies, food, Health, news

Death By Cookie: How Common are Food Allergies?

A 15 year-old girl with known peanut allergies has died after eating a Chips Ahoy cookie that she mistakenly thought was peanut-free.

Alexi Ryann Stafford, of Weston, Florida, was at a friend’s house when she reached for a cookie in the red Chips Ahoy packaging, famous for being the “Chewy” type. However, she did not read the package delineating it was the “Chewy Reeses Peanut Butter cups/chips” brand.

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Both packages are similar in color, and Alexi immediately began to feel symptoms. She went home, was given two Epi-Pens while waiting for paramedics, but unfortunately went into anaphylactic shock and died within 90 minutes of consuming the cookie.

Her mother, Kellie Travers-Stafford, is now calling for more warning labels on the packaging.

If one is allergic to an insect or food, a severe allergic reaction may ensue upon exposure, in which the immune system releases a flood of chemicals that can cause throat tightness, hives, lip and facial swelling, difficulty breathing, nausea, vomiting, low blood pressure, rapid heart rate, cardiac arrest and possibly death.  This anaphylaxis needs to be treated immediately while maintaining airway support and minimizing the allergic response.

The EpiPen® auto-injector contains epinephrine, a drug of choice in these situations.

Epinephrine stimulates the heart to increase cardiac muscle contractility, cardiac output, subsequently raising the blood pressure. Additionally it relaxes the muscles surrounding the airways, allowing one to breathe easier and take in more oxygen. Moreover it helps to stop the release of additional immune chemicals.

The EpiPen® is manufactured by Mylan.  Its cost made headlines when the EpiPen two-pack recently stickered for close to $600. Now generic forms are available costing anywhere from $109-$300 for a dual pack.

The disposable auto-injector, for an adult, delivers 0.3 mg of epinephrine, while the EpiPen Jr., used in pediatric populations, delivers 0.15mg of the medication.  It can be self-administered, through clothing if necessary, into the thigh muscle in one smooth movement once the safety release is removed.

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What Foods Cause Anaphylaxis?

Any food could theoretically cause an allergic reaction, mild or severe, but the most common culprits include:

  • Nuts (peanut, tree nuts, pistachio, etc.)
  • Milk
  • Shellfish
  • Fish
  • Soy
  • Wheat
  • Fruits

 

Food Allergies are Rising

According to FARE – Food Allergy Research and Education, 15 million adults have food allergies, including approx. 6 million children, or 1 in 13 kids.

On their website they report:

  • The Centers for Disease Control & Prevention reports that the prevalence of food allergy in children increased by 50 percent between 1997 and 2011.
  • Between 1997 and 2008, the prevalence of peanut or tree nut allergy appears to have more than tripled in U.S. children.

Why are food allergies rising?

Multiple theories have been suggested.  Some include:

  1. The hormones in our food alter our immune system, making it more sensitive
  2. The preservatives in our food may have the same effect, sensitizing our immune system
  3. We may be “too clean”…over sanitizing or not exposing our children to the outdoors as we did as children, thus preventing their immune system to mature
  4. Our gut microbiome may be changing as we eat more of a fatty, junk food diet, having some effect on our ability to manage food allergens.
  5. Vitamin D deficiency, caused by lack of sunlight and playing outdoors, might be a risk factor for severe allergies
  6. Obesity has been linked to allergies and asthma, and the average weight of an American has risen over the past few decades

Researchers are desperately working on desensitization treatments for those with severe food allergies.  In the meantime, however,  those who are vulnerable need to be extremely cautious about what they eat, stock EpiPens®, have a plan for alerting the Emergency Medical System, and wear medical alert bracelets for others to be aware in time of an emergency.

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

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Posted in allergies, Health, news

Allergy Season Getting Worse and Longer Each Year

Experts report allergy season will worsen each year due to environmental changes.

Allergy season usually begins in March with the start of Spring and can extend to the Fall even leading to new Fall allergies.

Each year we find allergy season starting a few weeks earlier as temperature changes prompt early blooms.

Tree pollens start first in January and then taper off in April.  Grass pollen starts to rise in February and March.   Finally weed pollens join the party by the Spring and extends through the Summer and Fall.

Dr. Jeffrey Demain, Board Certified Allergist and Immunologist reported at the March meeting of the American Academy of Allergy, Asthma and Immunology the following, “We have higher temperatures and expanding levels of carbon dioxide.

“When you look at a pollen grain, there are certain proteins that cause the allergy, they are the allergenic peptides,” he said. “It’s been shown that in rising carbon dioxide, the allergenic peptide of each pollen grain goes up.”

Plants utilize carbon dioxide for respiration as humans use oxygen.  The higher carbon dioxide levels, the higher the pollen counts and proteins in pollens that contribute to allergies.

The increase in storms may contribute to allergy season as well as moisture in the air causes pollen to swell and “explode” into multiple little pollen particles, smaller and easier to breathe in.

Moreover stagnant flood water may cause fungi, mold and spores to grow, also leading to allergies.

The Allergy Capitals Spring 2018 report found many cities are worse off this year than they were in previous seasons. McAllen, TX , Louisville, KY, Jackson, MS, Memphis, TN  and San Antonio, TX ranked in the top 5 in “Most Challenging Places to Live With Spring Allergies.” The copy of the report is below:

AAFA-2018-Spring-Allergy-Capitals-Report

Let’s review allergies…..

What are allergies?

Allergies are the result of the immune response to a foreign particulate that our body senses.  One could be allergic to pollen, dust, dander, food, insects, mold, metals, transfused blood, grafts, medicine and anything the body senses as a foreign intruder.  Even though these may be individually harmless, a hypersensitivity reaction occurs as a result of their intrusion into the body.  IgE antibodies find the allergen (intruder) and activate mast cells in the tissue and basophils in the blood.  When these cells get activated, they release substances to help protect the body, including histamines, leukotrienes, and cytokines. These help the body attempt to sneeze and cough the allergen out, wall off the antigen, signal more antibodies, or produce tears and nasal secretions to flush it out.

What are symptoms of seasonal allergies?

Symptoms of allergies could include any or a combination of the following:

  • Sneezing
  • Coughing
  • Wheezing
  • Runny nose
  • Eye watering
  • Red Eyes
  • Itchy eyes
  • Itchy skin
  • Rash
  • Itchy throat
  • Fatigue
  • Congestion….. to name a few.

How do they differ from a cold?

Colds may have very similar symptoms to allergies.  However they are different.

The common cold is caused by a virus.  When one gets infected by the virus they may feel malaise, fever, and achy.  This does not occur with allergies.

Moreover, nasal secretions from allergies are usually clear.  In a cold, the mucous could be thicker and with color.

The same holds true with sputum.  During an allergy the cough may have little to no mucous and if so, be light colored.  Thick mucous could be a sign of an infection.

An allergic sore throat will seem more dry and scratchy.  A sore throat from a cold is more uncomfortable and less easy to soothe.

Allergies may persist or be cyclical.  Cold symptoms will usually subside after a few days and rarely persist longer than 10 days.

Can allergies lead to a cold?

Yes and no.  Allergies should not in and of themselves cause an infection. However they may make one more vulnerable for a virus or bacteria to take over.    Hence a bronchitis, sinus infection, or pneumonia could uncommonly follow an asthma attack.

Are seasonal allergies dangerous?

As stated previously, if one is susceptible to colds, an allergic attack could make them vulnerable. Moreover if one suffers from asthma, an allergy attack could incite an asthma attack.  Very rarely would we see a life threatening anaphylaxis to an allergen such as pollen.

How can we prevent and treat allergies?

Avoiding, or decreasing exposure to the allergen is key.   We suggest the following:

  1.  Be aware of your local weather and pollen counts.  If the weather begins to warm and regional vegetation is blooming, allergy season may be upon you sooner than you know.
  2. Avoid outside pollen from coming into your house.  Avoid the urge to open all the windows during Springtime as wind will bring the pollen in.
  3. Clean your air filters.  Replace air filters frequently and consider using HEPA Filters
  4. Wash off pollen from your hair and clothes before you sit on the couch or jump into bed.
  5. Close your car windows when you park.
  6. “Recirculate” the air in your car
  7. Discuss with your medical provider if you are a candidate for medications such as antihistamines, nasal corticosteroids or leukotriene antagonists.  
  8. If you suffer from respiratory illnesses or a chronic medical condition, discuss with your medical provider if you need to start your allergy medication before allergy season hits. Some of these medications may take a couple of weeks to reach therapeutic levels.

How can I find my local pollen counts?

Local tree, ragweed and grass pollen counts can be obtained here.

 

                                                                                                       

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician