EverydayHealth: Dust mites may be causing your winter allergies

Dust Mites May Be Causing Your Winter Allergies

By Michael Steven Blaiss, MD, Special to Everyday Health

Why am I sneezing so much this winter – and why does my nose run all the time? Why do I wake up every morning with nasal congestion? Is it a cold that’s lasting for weeks? If you’ve been asking yourself these questions, it’s likely you have winter allergies.

We usually think of allergies in the spring when the trees and grasses produce pollen, or in the fall with ragweed pollen in the air. But allergies can occur year round. House dust mites are a common trigger of winter allergies. The good news is there are many ways to help reduce the effect of dust mites and feel better.

What Are Dust Mites?

Dust mites are 8-legged bugs related to the spider family, and they’re too small to be seen by the naked eye. They are sightless and live off discarded dead skin cells. In fact, the two major dust mite species found in the United States get their name, Dermatophagoides, from the Latin meaning “skin eating.” Luckily, they are not parasites, and they don’t bite or sting. It is the proteins in the bodies of the mites and their droppings that cause allergy in people.

Dust mites have specific environmental requirements for growth. Ideally, they need temperatures above 70 degrees F, and relative humidity above 70 percent. Adult mites have a life expectancy of between 4 and 6 weeks, during which time females can lay between 40 and 80 eggs. With this rapid reproductive turnover, mites can colonize a new home within a year.

Most homes in this country have dust mites no matter how much they are cleaned. The highest levels of mites in homes are found in pillows, mattresses, sofas, carpet and other soft furnishings. These objects can trap and accumulate skin dander and moisture, leading to optimal growth of the mites. Studies have shown that a typical mattress may have 100,000 to 10 million mites inside. Ten percent of the weight of a two-year-old pillow can be composed of dead mites and their droppings.

How do you know if you have a dust mite allergy? If you have sneezing, nasal congestion, watery eyes, and wheezing on a year-round basis, especially outside the pollen seasons, dust mites may be the culprit. It is estimated that 20 million Americans suffer from a dust mite allergy. Your allergist can do either an allergy skin test or a blood test to confirm if dust mites are causing your symptoms.

Fighting Dust Mite Allergies

What can you do? First, there are ways to reduce your exposure. Concentrating on the bedroom is most important, as people spend more time in their bedrooms over a 24-hour period than any other room in the house. If possible, all carpeting and drapes should be removed. Levels of mites in the bedroom can be reduced by using small area rugs, blinds or window shades, all of which can be easily cleaned.

Enclose the mattress and pillow in mite-proof casing. These covers are made of a material with openings too small to let dust mites and their droppings get through. All bedding should be washed weekly with hot water. Unfortunately, cold-water washing will not kill dust mites.

In some cases, the use of a dehumidifier in the bedroom can help, as dust mites can’t grow with humidity below 50 percent. If your child has a dust mite allergy, try to limit the number of stuffed animals in their bed. Freezing stuffed animals for 24 hours weekly will also kill dust mites. Vacuum at least weekly using a double-layer bag or HEPA filter on the vacuum to prevent dust mites from circulating back into the air. 

Medications can help control symptoms. There are several over-the-counter treatments such as non-sedating antihistamines and intranasal corticosteroidswhich may give some relief to your nose and eyes. If these treatments are not effective, or if every time you stop using them your symptoms return, you may want to see a board-certified allergist for further management.

There are excellent prescription treatments, and you may be a candidate for immunotherapy for allergies. Allergy shots are the only way to reduce sensitivity over time to dust mites, and can lead to lasting relief of symptoms after the treatment is stopped. Remember: You don’t have to be miserable all winter with dust mite allergies. Relief is available. 

Michael Steven Blaiss, MD, is clinical professor of pediatrics at the Medical College of Georgia in Augusta and executive medical director of the American College of Allergy, Asthma, and Immunology.

 

The Nest: Cat allergies in babies

CAT HEALTH

Cat Allergies in Babies

By Melissa McNamara 

Infants can develop cat allergies.

The American Academy of Pediatrics recommends not adding a cat to your family until you're sure your baby doesn't have allergies. However, what if you already have a loving cat? Before placing a “free to good home” ad for Whiskers in your local newspaper, make your baby an appointment with an allergist.

Identification

The symptoms your baby experiences depends on the severity of the cat allergy. The most common symptoms are sneezing and a runny nose, according to MayoClinic.com. Nasal congestion, postnasal drip, coughing, dark circles under the eyes, wheezing and difficulties sleeping are additional symptoms. Nasal congestion can block both nasal passages, causing your baby to breathe from the mouth. Contact dermatitis from a cat allergy includes redness, hives and itchy skin.

Cause

Allergies appear first during infancy or childhood and are more common in families with a history of allergies, according to the American College of Allergy, Asthma & Immunology. Your baby's immune system is equipped to attack foreign substances, but if he has allergies, certain triggers cause the immune system to overreact. Cat allergies are caused by proteins that usually are harmless in the cat's dander, saliva or urine. As your baby inhales the cat dander, the immune system attacks and causes an inflammatory response of the lungs and nasal passages, according to MayoClinic.com. Even if you remove the cat from your home, dander and fluid can stick to walls, clothing and other surfaces in your home for several months, according to the Asthma and Allergy Foundation of America.

Diagnosis

A skin test and blood test can confirm or deny a cat allergy. In some cases, pollen or mold gets trapped in your cat's fur and is released into the air during petting or brushing sessions, according to the American Academy of Pediatrics. The allergist may suggest removing the baby from your home for a few days to see if allergy symptoms subside. This may seem obvious, but be sure to stay somewhere that doesn't have a cat. Temporarily removing the cat from the home is ineffective, since the dander remains.

Treatment

The United States Food and Drug Administration advises parents never to give children under the age of two any cough and cold products containing decongestants or antihistamines without consulting with a pediatrician. Infants can use a cool mist humidifier to reduce congestion by reducing swelling of the nasal passages. Saline nasal drops and suctioning your baby's nostrils with a bulb syringe also provide comfort to a congested baby. Discuss with your baby's pediatrician the use of allergy shots, which are small injections of the cat allergen that help your baby develop a tolerance to the proteins in cat dander. Do not allow the cat in rooms where you're baby sleeps, and clean the bedroom thoroughly and often. Its best to remove carpeting in the home, but if this is not an option, vacuum with a high efficiency particulate air filter and steam clean the carpet often. The Asthma and Allergy Foundation of America suggests covering bedroom vents with cheesecloth. If your baby's allergies are severe, a new home for your cat is the best option.

References

About the Author

Melissa McNamara is a certified personal trainer who holds a Bachelor of Arts in journalism and communication studies from the University of Iowa. She writes for various health and fitness publications while working toward a Bachelor of Science in nursing. 

 

Health.com: Six surprising new places nuts are hiding

Chili, cocktails, and other surprising foods to watch out for if you are allergic to peanuts or tree nuts

By Lisa Lombardi

LAST UPDATED: JAN 20, 2017

My younger son has food allergies and I'm absolutely obsessive about helping him steer clear of peanuts and tree nuts. Yet somehow, last month, I brought him home a pistachio sandwich.

Let me explain: I ran to the deli to buy chicken salad, but it was next to a salad with nuts. Trying to avoid that cross-contamination risk, I pivoted and grabbed Gus, who is 10, a slice of an Italian Combo hero, stupidly without asking what was in it. One bite in he said, "My mouth feels itchy and numb." I ripped apart his sandwich and found a meat dotted with green flecks...oh nopistachio? A quick call to the deli revealed he had eaten mortadella—an Italian pork studded with one of his worst allergens.

Thankfully, after an injection of epinephrine and a few hours in the ER, Gus was fine. But my husband and I were traumatized. Where else were there nuts lurking? Raising a child with a food allergy sometimes feels like being a hockey goalie, to use an analogy from Gus's favorite sport: You're always guarding against not only the obvious threats (that Thai takeout) but also the surprise wraparound ones you never see coming (nut meat, I'm talking to you).

And, in a way, having a food allergy is a paradoxical health problem: You are perfectly healthy. And yet the wrong food, in the wrong amount, without prompt administration of the right amount of epinephrine, can kill you. To make sure that we know all the wild cards out there, I consulted Sujan Patel, MD, an allergist/immunologist at New York University Langone Medical Center in New York, and David Stukus, MD, a Columbus-based spokesperson for the American College of Allergy, Asthma, and Immunology.

Chili

In 1986, a freshman at Brown University tragically died after she ate restaurant chili thickened with peanut butter. More recently, a 28-year-old dad in England reportedly died from anaphylaxsis after having a chili burger that likely contained peanuts. PB may not be a classic ingredient in this comfort food, says Dr. Patel, "but with chili cook offs and all kinds of ways to prepare things, you shouldn't assume it is safe."

Still, the even more common danger in Mexican joints is the mole sauce. While mole's most famous ingredient is chocolate (itself a potential disaster for the nut-allergic), peanuts or peanut butter may also be in the mix. "Sauces in general are dicey," warns Dr. Patel, adding that Indian and Thai cuisines are particularly tricky. "Indian cooking uses cashews and almonds made into a paste and then used as a thickener."

French fries

Most frites are a-ok, but when grabbing them out, do ask about the oil. Peanut oil is the go-to at some chains such as Five Guys, as well as smaller restaurants. "The interesting thing about peanut oil," says Dr. Patel, "is that when it's made in the U.S. it is so refined that almost nobody with a peanut allergy would react to it. But the problem is we don't know if it is one from China, which are much less refined. We don't tell people this because we don't want them to take a chance."

My family got stumped by cottonseed oil on a trip to Florida. ("Siri, is cottonseed a nut? Help!") Nope, cottonseed oil, I've since learned, is not a nut, though it's pretty terrible for your health.

Deli meat

My son's kryptonite—mortadella—is a fancy Italian bologna that was banned from import to America for years due to an Italian outbreak of African swine fever, according to The New York Times. More expensive than bologna and speckled with fat and pistachios, it isn't a big seller in the U.S (which almost explains how I could be half Italian-American, raised on antipasto spreads, and never heard of it). "A real fluke," is how Dr. Patel described my son's close call. And yet in 2016, BJ's Wholesale Club issued a recall of deli meats for undeclared pistachios; they had been sent Citterio's Mortadella by mistake and sold it—along with other meats sliced on the same equipment—without listing pistachio on the labels.

So how do you make sure your cold cuts don't come with an unwanted side of nut residue? "Ask the person at the counter about any potential source of cross contact," advises Dr. Stukus, who is also an associate professor of pediatric allergy and immunology at the Ohio State College of Medicine.  And if they're unsure, steer clear and opt for a prepackaged lunch meat with a nut-safe label.

Cocktails

Better ask what's in that signature cocktail before you knock it back. Major vodka makers now sell bottles infused with hazelnut, almond, and other tree nuts. Frangelico gets its flavor from hazelnuts and Nocello from walnuts. And here's a who knew: Many gins, including Bombay Sapphire, are flavored with almonds. Not even beer is completely safe. Brown ales may contain peanuts and/or macadamia, walnut, or other tree nuts.

Pet food

Is your toddler at the stage where she puts everything in her mouth? If she's allergic to peanuts or tree nuts, watch out for your dog food, warns Dr. Patel. Pet foods are not subject to The Food Allergen Labeling and Consumer Protection Act—a law mandating that food labels clearly list out in plain English if they contain any of the top eight most common allergens (peanuts, tree nuts, milk, eggs, wheat, soy, shellfish, fish). But a scan of that puppy chow label should alert you to peanuts, he adds. (When in doubt, call the manufacturer.) Bird food almost always contains nuts, or has a nut warning. Our family's solution is to buy food-grade sunflower seeds (labeled as nut-safe) for our outdoor feeders.

Gluten-free treats

A gluten-free cupcake or bread may seem harmless for all, but don't be fooled: It can pack lupin, "a legume frequently used as flour in gluten-free products that can cross react with a peanut," says Dr. Stukus. He notes that there have been many reports of people with peanut allergies having reactions from lupin. Also watch out for almond flour, sometimes used to hold things together in G-free sweets.

Another 2017 concern? Nut butters popping up in unexpected places. "I had a mom whose child had a reaction to kale chips," shares Dr. Patel. "Randomly, they were made with cashew butter."

To stay one step ahead, read labels every time (ingredients on familiar products can change). And, as I learned the hard way, always ask, even when it seems unlikely that a dish would contain nuts. When it comes to managing food allergies, you can never be too careful. My son knows this well: Hand him a banana and he'll ask you, "Are there nuts in it?"

 

 

 

Health IT Pulse: Telemedicine can minimize disruption in patients’ lives

Health IT Pulse

JAN 19 2017   11:09AM GMT

Kristen Lee

Telemedicine

Telemedicine has the potential to helpdiverse patient groups – from nursing homes to rural communities – get better healthcare; One place where telemedicine  can minimize the disruption to a patient’s life is in schools, according to a Huffington Post story.

The article gives an example of a girl who had trouble breathing at recess at a school in Maryland. The school was outfitted with telemedicine equipmentabout a year ago. The girl went to the nurse, who determined that the girl was having an asthma attack. The girl’s father was an hour away and there was no time to wait for him to come get his daughter. The nurse could have also called an ambulance but that would have meant the girl would miss the rest of the school day.

Luckily, the girl’s parents had has agreed to enroll their daughter in the school’s telemedicine program, allowing the nurse to set up an online video and audio link with an emergency room pediatrician at a nearby county general hospital.

The doctor confirmed the school nurse’s diagnosis, the nurse administered the necessary medicine, and the girl was breathing normally again within 10 minutes and was able to go on with her day.

According to a study in the Annals of Allergy, Asthma and Immunology, children with asthma who were given treatment via telemedicine were able to gain control over their asthma just as well as when children saw a doctor in person to address their asthma.

 

Health.com: 11 unexpected places mold may be hiding in your home

Plus, how to keep your toothbrush, dishwasher, blender, washing machine, and more fungi-free, according to an allergist.

When Dana Chianese noticed a musty smell coming from her son's Sophie the Giraffe teether, she decided to cut it open. Inside the popular baby toy, she discovered a "science experiment": The latex figurine was lined with "smelly, ugly" mold, Chianese, a pediatric dentist, recently told GoodHousekeeping.com—even though she had always cleaned it according to the instructions (with hot, soapy water and a damp sponge) and never submerged it.

She's not the only mom to make that disconcerting discovery: Last February an Amazon customer posted a photo of the inside of her child’s Sophie, also covered in mold. Yikes.

But allergist Janna Tuck, MD, a spokesperson for the American College of Allergy, Asthma, and Immunology, isn't surprised by these reports: "Teething infants drool a lot and I think it would be impossible to keep the inside of a well-loved Sophie completely dry," she told Health via email. “Mold can grow on almost any surface if there is enough moisture."

RELATED: 20 Allergy-Control Products to Sneeze-Proof Your Life

The good news is that a moldy chew toy isn't as risky as it sounds: "While disgusting, the amount of mold in a toy would not likely cause significant harm unless the child has an immune deficiency or a mold allergy," says Dr. Tuck, who runs a private practice in Cape Girardeau, Missouri.

The not-so-good news? Toys aren't the only unexpected objects that can harbor fungi (mold is a type of fungus). Mold may be lurking in your washing machine, dishwasher, blender, or refrigerator, says Dr. Tuck. It can be found in the soil of potted plants, on ceiling fans, and in window AC units. In your bathroom, it might be growing in your toilet, sink—even in the bristles of your toothbrush, or inside your electric toothbrush

When mold grows in hidden places, it can cause real problems for people who are allergic. "They can suffer with allergic rhinitis symptoms," Dr. Tuck says, such as itchy eyes, congestion, runny nose, and sneezing. Or the mold may worsen their asthma symptoms.

RELATED: 31 Everyday Things You Didn't Know You Could Be Allergic To

So what can you do to keep your home fungi-free?

To reduce the growth of mold in your washing machine and dishwasher, you can regularly run the "clean cycle" with diluted bleach. Most manufacturers recommend monthly cleanings, or whenever the machine begins to smell musty, says Dr. Tuck. Check the owner's manuals to see exactly how much to dilute the bleach before using. "Vinegar is a very good substitute," she adds. "I personally run vinegar in my dishwasher."

When you're taking a bath or shower, always use the vent in the bathroom. Also be sure to turn on the vent in the kitchen whenever you're cooking and washing dishes, says Dr. Tuck, "to reduce spikes in ambient humidity."

After you use any food prep vessel (like your blender), clean it promptly and dry it fully, so no moisture is left sitting inside. And replace your toothbrush every three months, says Dr. Tuck.

Another place mold likes to hide: "cold" spots in your home. If you have rooms or closets that seem cooler than the rest of the house, leave the doors open to improve air circulation, and help prevent condensation. Leaving the fan in your central heating/cooling unit on at all times can help as well. "Mold needs water to grow. Anything you can do in your home to reduce humidity, condensation, or pooling of water goes a long way in reducing mold growth," says Dr. Tuck.

RealSimple.com: What you should know about mold and children’s toys

Sophie the Giraffe probably isn’t the only teether with a mold problem. So what’s the safest thing to do?

January 19, 2017

If this week’s news about mold hiding in popular baby teether Sophie the Giraffe has you freaked out about your own child’s toys, we don’t blame you. (Those pictures were pretty frightening.) Even if you don’t have a Sophie, any house with kids—or pets, even—likely has at least a few rubber or plastic figurines with the same potential to get totally gross inside. 

So what’s the right thing to do? Should you throw away any rubber teething toys? What about soft plastic toys, bath toys, or dog toys, for that matter? We were definitely concerned—but before we cleaned house, we ran our worries by Janna Tuck, M.D., an allergist in Cape Girardeau, Missouri and spokesperson for the American College of Allergy, Asthma, and Immunology.

Here’s Dr. Tuck’s advice on the matter. Thankfully, it doesn’t involve a full-on playroom purge. 

First, mold is everywhere

“Mold is pervasive in our environment—it’s outside and it’s in our homes, even if you have a clean house,” says Dr. Tuck. “We live with it every day, and the vast majority of us have absolutely no problem with it.”

That includes tiny mold particles that get filtered through our noses as we breathe, and even small amounts of mold that we occasionally eat in food. It is possible to get sick from toxic forms or huge amounts of mold, she adds, but for the most part, our immune systems protect us pretty well.

For most babies, a little mold isn’t a big deal

Because rubber is a soft, porous material, it’s easy for mold to stick to it, says Dr. Tuck. And it’s not surprising to her that saliva could get inside a hollow teething toy and trigger run-of-the-mill mold growth.

“And when a baby squeezes that toy, does she potentially get exposed to a little mold? Yes,” says Dr. Tuck. “But for most children, that small amount is not going to be toxic.”

Unless they have an allergy

The two exceptions? If that baby has a mold allergy or an immune deficiency; in these cases, mold exposure can indeed be harmful. It’s not common for children under 2 to have a mold allergy, says Dr. Tuck, since it usually requires exposure to a substance over time for someone to become allergic to it. Because of that, she says, a parent may actually be more likely to have a reaction to a moldy toy than their baby would.

But if your little one has frequent colds or sinus infections, or “always seems snotty compared to other kids,” mold or another allergen could be to blame, she adds. If you do suspect an allergy, ask your doctor about getting your child tested.

Keep toys clean and use your best judgment

“If a toy stinks or it’s visibly contaminated, I don’t think any of us with a parental instinct would want our child to play with it,” says Dr. Tuck. “We’re hardwired not to like mold, because we can get sick if we’re exposed to too much of it.” 

But you don’t have to throw away all of the hollow toys or rubber teethers in your house, either. Just inspect and clean them regularly, and make sure they dry thoroughly before putting them away, she says. If the material allows it, add a small amount of bleach to your cleaning solution (and then rinse well with plain, hot water) to kill invisible bacteria. 

Bath toys and dog toys need regular cleanings, too

See an Old Fashioned Vegetable Soup Recipe 

The same goes for the toys your kids use in the bathtub, or the toys your dog plays with—especially ones that are meant to hold treats or pieces of kibble. “If a piece of dog food gets stuck in there, yes, it will probably get moldy. No, it probably won’t hurt the dog, but it’s still a good idea to clean it out.”

Overall, the saga of Sophie the Giraffe should be a good reminder to keep a close eye on your kids’ toys—not just for signs of mold, but for other risks, like small pieces that could break off and be swallowed or aspirated, as well. “If you think a toy is massively contaminated or unsafe, you’ll probably sleep better if you get rid of it,” says Dr. Tuck. “But really the best thing you can do is to regularly clean and monitor these toys, to make sure they’re in overall good shape.”

New York Times: Feed your kids peanuts, early and often, new guidelines urge

By RONI CARYN RABINJAN. 5, 2017

Peanuts are back on the menu. In a significant reversal from past advice, new national health guidelines call for parents to give their children foods containing peanuts early and often, starting when they’re infants, as a way to help avoid life-threatening peanut allergies.

The new guidelines, issued by the National Institute of Allergy and Infectious Diseases on Thursday, recommend giving babies puréed food or finger food containing peanut powder or extract before they are 6 months old, and even earlier if a child is prone to allergies and doctors say it is safe to do so. One should never give a baby whole peanuts or peanut bits, experts say, because they can be a choking hazard.

If broadly implemented, the new guidelines have the potential to dramatically lower the number of children who develop one of the most common and lethal food allergies, said Dr. Anthony Fauci, the institute’s director, who called the new approach “game changing.”

Could the new guidelines mark the end of the peanut-butter-and-jelly sandwich bans so common in school lunchrooms? “If we can put this into practice over a period of several years, I would be surprised if we would not see a dramatic decrease in the incidence of peanut allergies,” Dr. Fauci said.

Peanut allergies are responsible for more deaths from anaphylaxis, or constriction of the airways, than any other food allergy. Though deaths are extremely rare, children who develop a peanut allergy generally do not outgrow it and must be vigilant to avoid peanuts for the rest of their lives.

“You have the potential to stop something in its tracks before it develops,” said Dr. Matthew Greenhawt, chairman of the American College of Allergy, Asthma and Immunology’s food allergy committee, and one of the authors of the new guidelines. It appears there “is a window of time in which the body is more likely to tolerate a food than react to it, and if you can educate the body during that window, you’re at much lower likelihood of developing an allergy to that food,” Dr. Greenhawt said.

The guidelines, published in Annals of Allergy, Asthma and Immunology and several other journals, represent an about-face from the advice given out by the American Academy of Pediatrics as recently as 2000, when parents were told to withhold peanuts from children at high risk for allergies until they were 3 years old.

Despite those recommendations, the prevalence of peanut allergies kept increasing. Ten years later, around 2 percent of children in the United States had the allergy, up from less than half of 1 percent in 1999, and the academy started retreating from its advice, which didn’t seem to be working.

The new guidelines grow out of several studies conducted in recent years that challenged the advice to ban peanuts in infancy, long a standard practice in the United Kingdom, Australia and the United States.

One report, published in 2008, was carried out by scientists intrigued by anecdotal reports that Jewish children in Israel rarely suffered from peanut allergies. Dr. Gideon Lack, the senior author of the study and a professor of pediatric allergy at King’s College London, compared the allergy rates of Israeli Jewish children with those of Jewish children in Britain, and found that British children were 10 times as likely to have peanut allergies as Israeli children, a disparity that could not be explained by difference in genetic background, socioeconomic class or tendency to develop other allergies.

One of the main differences between the two populations was that starting in infancy, Israeli children ate foods containing peanuts, often in the form of Bamba, a popular peanut-butter puffed corn snack that has the consistency of a cheese puff but is 50 percent peanuts, according to the manufacturer, Osem Group. Was it possible that early exposure to peanuts actually protected the Israeli kids from allergies?

Dr. Lack and fellow scientists tested the hypothesis in a large clinical trial in England. They recruited hundreds of infants aged 4 to 11 months, all of whom were deemed at high risk of developing a peanut allergy because they had eczema or an allergy to eggs. After running skin-prick tests on the babies and excluding those who were already allergic to peanuts, they randomly assigned some babies to be regularly fed peanut products, and others to be denied all peanut-containing foods.

By the time they turned 5, only 1.9 percent of 530 allergy-prone children who had been fed peanuts had developed an allergy, compared with 13.7 percent of the children who were denied peanuts. Among another group of 98 babies who were more sensitive to peanuts at the start of the study, 10 percent of those who were given peanuts developed an allergy, compared with 35 percent of those denied peanuts. The findings, published in The New England Journal of Medicine in 2015, “shook the foundation of the food allergy world,” Dr. Greenhawt said.

The new guidelines divide children by risk. Low-risk infants, who don’t have eczema or an egg allergy and who have started solid foods, can be introduced to peanut-containing foods around 6 months at home by their parents. So can moderate risk children, who have mild eczema.

High-risk infants, who have severe eczema or an egg allergy, should be introduced to peanut-containing foods as early as 4 to 6 months, after they start other solid foods and are evaluated by a doctor for safety.

If your baby is determined to be high-risk, the guidelines recommend an evaluation by an allergy specialist, who may order allergy testing and introduce a peanut food in the doctor’s office, Dr. Greenhawt said. Even if allergy tests show sensitivity to peanuts, the baby isn’t necessarily allergic and may benefit from eating peanut foods, he said. A baby with a stronger reaction to the skin test may already be allergic, however, and the doctor may decide to recommend complete avoidance.

One way to introduce your baby to peanuts safely is to mix a couple of teaspoons of smooth peanut butter with a couple of teaspoons of warm water and stir until it has a smooth soupy or purée-like consistency, suggested Dr. J. Andrew Bird, pediatric allergist with UT Southwestern Medical Center and Children’s Medical Center in Dallas, who wrote a paper on the subject.

Foods containing peanuts should not be the first solid a baby eats, Dr. Greenhawt said. It’s also important to continue feeding the peanut-containing food regularly, aiming for three times a week, through childhood.

He acknowledged the new recommendations may face resistance. “The nuts and bolts of getting everyone to buy in to this and trust the recommendation and the data is a big unknown,” Dr. Greenhawt said. But the potential, he says, is enormous.

“This won’t outright prevent every single case of peanut allergy – there will still be some cases – but the number could be significantly reduced by tens of thousands,” Dr. Greenhawt said. “In the best case scenario, every allergist across the U.S. could be seeing fewer cases of peanut allergy — and that’s a good problem to have.”

A version of this article appears in print on January 6, 2017, on Page A1 of the New York edition with the headline: Feed Children Peanuts Early, Doctors Advise. Order ReprintsToday's Paper|Subscribe

Time: How to prevent peanut allergies

Alice Park @aliceparkny

Jan. 5, 2017

About six million young children in the U.S. suffer from food allergies—most commonly to peanuts. Pediatricians and allergy experts once agreed that the best solution was to avoid peanuts altogether, and for years, the American Academy of Pediatrics (AAP) advised pregnant women with peanut allergies to stop eating peanuts while pregnant and to not feed peanuts to their children when they started on solid foods.

That changed in recent years, when two major studies proved that advice wrong. In one, the rate of peanut allergies was about 10 times lower for children who ate peanuts from an early age, compared to kids whose parents avoided giving their infants peanuts. Then, a rigorous trial in which young children were assigned to either eat peanuts early or avoid them showed again that kids who were introduced to peanuts when young had up to an 80% lower risk of developing peanut allergies than those who were not.

Based on those results, the AAP changed its advice for pregnant women about avoiding peanuts, recommending instead that women not avoid any particular groups of foods in the hopes of protecting their children from allergies. Now, the National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID) has issued new guidelines to help doctors and parents adopt this new thinking. The advice, for introducing peanuts to infants in order to prevent peanut allergies, appears in the Annals of Allergy, Asthma and immunology as well as on the NIAID website.

The recommendations provide guidance about how to safely introduce young children to peanuts from an early age. If babies are already allergic to eggs, or have severe eczema that doesn’t respond to treatment, they are considered at high risk of developing a peanut allergy, since their immune systems are already primed to be sensitive to certain allergens. For these babies, the guidelines recommend introducing peanuts at about four to six months, just as a baby is transitioning to solid foods. To make sure they don’t have a severe reaction to the peanuts, the panel advises that the peanuts be given in the doctor’s office.

For the other two groups—babies with mild to moderate eczema, and those without any known allergic reactions—the guidelines say that parents can introduce peanuts gradually at home, beginning at six months. (The guidelines also include recipes for the best type of peanut foods to use; whole peanuts aren’t appropriate for infants, since they can be a choking hazard.)

The hope is that by introducing peanuts early enough to children who might be allergic to them, doctors may be able to prevent them from ever developing a full-fledged allergy. While it’s not entirely clear how that happens, some kind of tolerance is likely involved. Just as babies can be trained to recognize that hot stoves are dangerous, so too can their immune systems be educated to see peanut proteins as harmless rather than as threats.

If such tolerance starts to reduce the number of new cases of peanut allergy, that could save millions of dollars in health care costs for treating children for allergic reactions, as well as the anxiety and stress of potentially life-threatening allergies. “We anticipate that if this works as well as we think it will, it will drop not only the incidence and prevalence of peanut allergy, but also the host of problems that come with having a food allergy,” says Dr. Matthew Greenhawt, an assistant professor of pediatrics at Children’s Hospital of the University of Colorado, and chair of the food allergy committee of the American College of Allergy, Asthma and Immunology. “Food allergies are associated with a poor quality of life, high cost to the patient and society, fear, anxiety and self-imposed restrictions. By preventing the allergy we also prevent this whole host of adverse things that accompany having a food allergy.”

The guidelines may take some getting used to, since they represent a significant change in the way doctors have previously handled peanut allergies. For one, the new advice does not use family history of peanut allergies as a criterion for whether an infant might be at high risk. Instead, it relies on the infant’s own reactions to egg and the presence of eczema. The guidelines also require specialists to spend more time, at least at the beginning of an infant’s care, to introduce peanut to the diet. But that time spent up front could save more later on, if that child does not develop an allergy and won’t need the years of medical care associated with it.

“I’m fired up about these guidelines; it’s something we can do to change the face of food allergy,” says Greenhawt. “If we can prevent tens of thousands of kids from developing peanut allergy, we have to pounce on that opportunity.”

Washington Post: New NIH guidelines on infants and peanuts may contradict everything you’ve heard before

 

New NIH guidelines on infants and peanuts may contradict everything you’ve heard before

By Ariana Eunjung Cha January 5 

Peanut allergies: you've been doing it wrong

The American Chemical Society explains why some people are allergic to peanuts and how new research could help decrease the number of children suffering from peanut allergies. (American Chemical Society)

When my husband and I had our first child seven years ago, the prevailing wisdom was that babies at risk of allergies should avoid peanuts or peanut products until age 3 or older. The idea behind this restriction — which was based on American Academy of Pediatrics (AAP) guidelines released in 2000 — was that feeding peanuts too early to little ones might risk severe, possibly life-threatening allergic reactions.

Over the years that thinking has done a 180. Now, scientists believe the exact opposite: Giving your baby peanuts earlier rather than later might prevent them from developing an allergy.

While many doctors and medical groups have come out over the past year to endorse this view, there has been a lot of confusion about which kids could benefit from early exposure, the optimal timing of the exposure, and how exactly one should feed peanuts (which, after all, are a choking hazard in their raw form) to babies.

On Thursday, the National Institute of Allergy and Infectious Diseases released formal, detailed guidelines for pediatricians and allergists.

The document, published in six medical journals, includes three separate sets of recommendations based on the level of risk an infant has for developing a peanut allergy. Those at highest risk are defined as babies with severe eczema — a skin condition where patches of skin become inflamed, itchy, red and cracked — or egg allergy or both. Those in the middle group have mild-to-moderate eczema. And those in the lowest-risk group have no eczema or food allergies.

The guidelines come at a terrifying time for new parents in terms of allergies. The number of American children with nut allergies has quadrupled in the past 13 years, and peanut allergies are now estimated to affect 2 percent of them. Most schools now ban foods with peanuts, and manufacturers are required to label major allergens. The soaring price of EpiPens, which are used to treat a severe allergic reaction and retail for up to $650 for a two-pack, has become a hot political topic.

A growing number of schools are updating their peanut butter policies in response to the rise in peanut allergies among children. The Post asked the experts to sample a few alternative spreads. (Davin Coburn, Jason Aldag, Randolph Smith and Kate Tobey/The Washington Post)

Anthony S. Fauci, NIAID director, said in an interview that the new thinking on peanut exposure grew out of observations of Israeli children in Israel versus Israeli children in Britain. In the former, he said, parents as part of their culture often give various types of peanut preparations such as paste or nuggets in the very earliest days of a child's life. Scientists noted that the incidence of peanut allergies in Israeli children in Israel is lower than in Israeli children in Britain and wondered whether the two things could be related.

“They thought that perhaps we should try the counterintuitive approach of feeding peanuts to babies early on rather than withholding them in order to protect them,” Fauci explained.

That theory was put to a test in the much-praised Learning Early About Peanut Allergy (LEAP) study, a randomized trial led by Gideon Lack of King's College London involving 640 infants considered at high risk of developing peanut allergies. The results, published in 2015 in the New England Journal of Medicine, showed that children at high risk who regularly consumed peanuts as infants had an 81 percent lower chance of developing a peanut allergy by age 5.

This Risk Bites video describes a study that introduced peanuts to newborns at varying risks of peanut allergies and what the study found. (Risk Bites)

Fauci called the results “very striking” and estimated that the new guidelines could prevent thousands of children from developing peanut allergies.

“If you can get anywhere close to an 81 percent decrease that we saw in the original study, we're talking about saving thousands and thousands of kids from peanut allergies,” he said.

Similar studies are being conducted on early exposure to tree nuts and eggs, but results probably won't be available for a few more years.

Matthew Greenhawt, a physician at Children's Hospital Colorado who is chair of the food allergy committee of the American College of Allergy, Asthma and Immunology, explained that the new guidelines are closely tied to eczema because it is an obvious external measure that has been linked to food allergies going back to the 1900s. While no one has been able to definitively explain why these conditions appear together so often, children with eczema produce a lot of immunoglobulin E antibodies, which play a role in food allergies, hay fever and asthma.

He said that children with severe eczema are probably already in the care of a doctor for the condition so they should be easy to identify, noting that “severe eczema is not a kid with a little arm or cheek rash. These are kids with a decent percentage of their bodies covered despite good moisturizing, bathing and increasing topical prescriptions.”

Those children at highest risk should be exposed to peanuts earliest — at 4 to 6 months — and be referred to a specialist who might perform a blood or skin test before deciding how to handle their first exposure to peanuts. Some may decide that with low readings, the child could be given peanuts at home, while others may suggest giving a child peanuts for the first time in a doctor's office anyway. Those precautionary measures reflect the tricky nature of diagnosing a peanut allergy. Many people can test positive for allergies through a skin test or a blood test but may tolerate the food just fine. The opposite, while less common — that you can have a low reaction to a blood or skin test but still have a severe allergic reaction — also can be true.

Those in the middle group should be fed peanuts when they are about 6 months old. This can be done at home. Those at lowest risk can have them at any time, also at home, but can typically start when they are about 6 months old, as well.

“For these kids, we are not considering peanut as different than any other type of food,” Greenhawt said.

The NIH guidelines also contain some common-sense advice such as reminding parents that all infants first progress to solid foods such as pureed vegetables and cracker puffs on their regular schedule before being exposed to peanuts. The guidelines also provide step-by-step instructions along with “recipes” for home exposure to peanuts. They remind parents to feed their infant peanuts for the first time only when he/she is healthy (with no vomiting, diarrhea or other signs of illness), at a time when at least one adult can focus all of his/her attention on the infant for at least two hours to watch for signs of a reaction, and to not give whole nuts or a huge spoonful of peanut butter to an infant to avoid choking. A child's pediatrician should go over the signs of an allergic reaction, but they could include things like a hivelike rash, vomiting, coughing, wheezing or a child otherwise looking lethargic or ill.

Greenhawt also emphasized that the guidelines are simply recommendations and that “your child dictates when they are ready for some foods.” The same could be said of exposing kids to broccoli or fish.

“As a parent, I know the child has a mind of their own. They will eat what they want to and will spit out what they don’t want,” he said. “It's always a challenge to give them new foods. You have to be persistent and creative.”

Here's how to feed your infant, from the guidelines: 

1. Prepare a full portion of a peanut-containing food such as peanut butter dissolved or thinned with water, peanut butter, peanut flour or powder mixed with a fruit or vegetable puree or several pieces of Bamba, a puffed maize snack with peanuts, which can be softened with water or not depending on the child's age or preferences.

2. Offer your infant a small part of the peanut serving on the tip of a spoon.

3. Wait 10 minutes.

4. If there is no allergic reaction after this small taste, then slowly give the remainder.

And here is the passage containing infant-friendly peanut recipes:

At-home peanut “recipes” for infants from the Annals of Allergy, Asthma & Immunology.

 

Summary of new peanut exposure guidelines:

Group 1: At highest risk, with severe eczema, egg allergy or both

Strongly consider evaluation by blood test, skin prick test or oral food challenge. Based on test
results, introduce peanut-containing foods at 4 to 6 months.

Group 2: Moderate risk, with mild-to-moderate eczema.

Introduce peanut-containing foods around 6 months.

Group 3: Less risk, with no eczema or any food allergy

Introduce peanut-containing foods at an appropriate age and in accordance with family preferences and cultural practices.

 

National Public Radio: New guidelines recommend when to introduce peanuts to babies

listen here

January 5, 20174:27 PM ET

Heard on  All Things Considered

ALLISON AUBREY

New guidelines recommend introducing babies to peanut containing foods in the first year of their lives. The recommendations are based on studies that show early introduction of peanuts to infants reduces their risk of developing a peanut allergy later in life.

ARI SHAPIRO, HOST: 

Forget what you think you might know about peanut allergies. Federal health experts released new guidelines today for parents of young children. They draw on research that shows there is a benefit to introducing peanuts during a baby's first year. NPR's Allison Aubrey reports.

ALLISON AUBREY, BYLINE: The guidance on peanuts has come full circle over the past two decades. Back in 2000, as the prevalence of peanut allergies seemed to be on the rise, parents of infants were told to hold off on introducing peanuts sometimes until the toddler years, especially if there was a family history of allergies.

The new guidelines from the National Institute of Allergy and Infectious Diseases are based on the findings of more recent studies. Allergist Matthew Greenhawt of Children's Hospital Colorado helped develop them.

MATTHEW GREENHAWT: Now we're saying introduce peanut to your child as early as 4 to 6 months of life. And by doing so, it's associated with a reduced likelihood of developing peanut allergy.

AUBREY: This is in stark contrast to the old thinking that early exposure to peanuts increased the risk of developing an allergy. But over the last few years, several large studies have found that babies at high risk of becoming allergic to peanuts are much less likely to develop an allergy if they are regularly fed peanut-containing foods in the first year of life.

Greenhawt says parents should not worry that these guidelines might flip flop again. He says the new evidence supporting early introduction is very strong.

GREENHAWT: We wouldn't change these guidelines if we didn't feel that this was safe. So parents should rest assured that it's based on very, very cutting-edge science.

AUBREY: And some doctors have already changed the way they treat infants at risk of having a peanut allergy. These are babies who are brought in with severe eczema or egg allergy, the two big risk factors for a peanut allergy. Hugh Sampson is a professor of pediatrics and an allergy specialist at the Icahn School of Medicine at Mount Sinai.

HUGH SAMPSON: We've taken the approach that if you have a child that has severe eczema or that has egg allergy, that we should try to introduce peanut preferably in the first four to six months of life.

AUBREY: What's important to note is that according to the new guidelines, these high-risk kids who have persistent eczema and other risk factors should be evaluated by an allergy specialist before their parents or caregivers introduce them to peanut-containing foods at home. Allison Aubrey, NPR News.

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