There is some good news for children with peanut allergy.

The White House - Let there be peace! (Dr. Noorali Bharwani)
The White House - Let there be peace! (Dr. Noorali Bharwani)

Allergy to peanuts is the most common children’s food allergy. And the prevalence of peanut allergy is rising. It tends to present early in life, and affected individuals generally do not outgrow it. It is not clear why some people develop allergies while others don’t.

Eight foods are responsible for more than 90 per cent of food allergies: cow’s milk, eggs, soy, wheat, peanuts, tree nuts (walnuts, hazelnuts, almonds, cashews, pecans and pistachios), fish and shellfish. Peanuts and tree nuts are responsible for the majority of serious acute allergic (anaphylactic) reactions.

While EpiPens are used to control general allergic reactions, there is no specific treatment available for peanut allergies – until now. A Harvard University blog of March 1, 2018 (A cure for peanut allergies in sight?) reports that within the past year, three new peanut allergy therapies have gone through clinical trials.

Despite the treatment’s success, there were some safety concerns: 20 per cent of patients discontinued the trial, with 12 per cent withdrawing due to moderate side effects. But there is still hope. The researchers are planning to get FDA approval, which would make it the first protective treatment against peanut allergies, says the Harvard University blog. We have to learn more about the complex mechanisms of peanut allergy and tolerance before success is achieved.

Food allergies affect between four and eight per cent of children and between one and two per cent of adults. The perceived prevalence of food allergies is substantially higher than the actual prevalence. Up to 30 per cent of the general population believe they have a food allergy, and up to 30 per cent of parents believe that their children have a food allergy.

All food allergies have the potential to induce anaphylaxis, but some foods are more likely than others to cause potentially life-threatening reactions. Peanut allergy deserves particular attention. It accounts for the majority of severe food-related allergic reactions, it tends to present early in life, it does not usually resolve, and in highly sensitized people, trace quantities can induce an allergic reaction.

Parents have to understand that all degree of peanut allergy should be taken seriously – even mild allergy can cause serious problems. An allergic response to peanuts usually occurs within minutes after exposure.

Should pregnant women avoid peanuts to prevent peanut allergy in their children?

We need more studies to advise pregnant mothers about avoiding peanuts during pregnancy. We have no evidence to suggest that pregnant women should be encouraged to ingest peanut or suggest an amount of peanut to be ingested to ensure a preventive effect, as there is insufficient evidence to support it at this time, say experts.

To summarize, peanut allergy is the most common cause of food-induced anaphylaxis, a medical emergency that requires treatment with an epinephrine (adrenaline) injector (EpiPen) and a trip to the emergency room.

Call 911 if you or someone else displays severe dizziness, severe trouble breathing or loss of consciousness. There is no time to waste.

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Making Sense of Celiac Disease and Non-Celiac Gluten Allergy is Not Easy

Gordon Wright waiting for birds to fly by so he can take pictures in Police Point Park on a beautiful spring afternoon in Medicine Hat. (Dr. Noorali Bharwani)
Gordon Wright waiting for birds to fly by so he can take pictures in Police Point Park on a beautiful spring afternoon in Medicine Hat. (Dr. Noorali Bharwani)

“Celiac disease is common and is associated with other immune diseases,” says an article in the Canadian Medical Association Journal (CMAJ January 8, 2013).

The symptoms of celiac disease are triggered by gluten (a protein found in wheat, rye, barley and triticale) in people who are genetically susceptible. Triticale is a hybrid of wheat and rye first bred in laboratories during the late 19th century.

Ten things to remember about celiac disease as summarized from the CMAJ article:

  1. A first-degree relative with celiac disease has a 10-fold increased risk of acquiring the condition. It affects one in 133 North Americans.
  2. The risk is increased among people with autoimmune thyroid disease (three to five per cent), type one diabetes mellitus (five to 10 per cent) and Down syndrome (5.5 per cent).
  3. Gluten perpetuates the destruction of villi in the small intestine. Intestinal villi are small, finger-like projections that help in digestion.
  4. The disease can develop at any age.
  5. Clinical symptoms can be diverse from abdominal pain to diarrhea, weight loss and malnutrition.
  6. Screening for celiac disease is recommended for people who have associated symptoms, an associated condition or a family history of celiac disease.
  7. The most widely available test is the tissue transglutaminase IgA antibody test, which has an estimated 95 per cent accuracy rate. If antibody testing is negative and celiac disease is suspected, the IgA level should be measured.
  8. All adults with an abnormal screening result should undergo a small-bowel biopsy to confirm the diagnosis of celiac disease.
  9. Because of an increasing awareness of celiac disease, people may choose to adopt a gluten-free diet before diagnostic testing. That is not the right way to manage the problem. Further diagnostic testing should be performed following a medically supervised gluten challenge of at least four weeks, with sufficient gluten to produce symptoms.
  10. Treatment is lifelong adherence to a gluten-free diet. Examples of gluten-free grains are oats, buckwheat, millet, rice and quinoa. Gluten-free diet reduces the risk of complications such as osteoporosis and intestinal lymphoma.

Is there an illness called non-celiac gluten sensitivity?

Yes. You have symptoms of celiac disease but it cannot be confirmed. Then you may have non-celiac gluten sensitivity.

An article by Sapone et al. (BMC Medicine 2012) titled, “Spectrum of gluten-related disorders: consensus on new nomenclature and classification,” says in only 10 years, key milestones have moved celiac disease from obscurity into the popular spotlight worldwide.

What has generated more interest is the spectrum of illnesses associated with ingestion of gluten. These are: 1. Allergy to wheat 2. Autoimmune celiac disease, dermatitis herpetiformis and gluten ataxia 3. Possible immune-mediated gluten sensitivity.

Research estimates that 18 million Americans have non-celiac gluten sensitivity. That’s six times the amount of Americans who have celiac disease. Researchers are just beginning to explore non-celiac gluten sensitivity.

These individuals seem to be sensitive to gluten often also experience headaches, rashes and fatigue. It is possible that it may in fact be other proteins or sugar in wheat (other than gluten) that may be triggering the reaction. There is no inflammation or damage to the intestinal lining as in celiac disease. More research is needed to understand this problem. Did I hear you say, “If only things in life would be simple and straight forward?”

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There is Hope for People with Egg Allergy

A broken egg. (iStockphoto/Thinkstock)
A broken egg. (iStockphoto/Thinkstock)

Millions of people around the world suffer from egg allergy. It is a hypersensitivity to dietary substances from the yolk or whites of eggs, causing an overreaction of the immune system which may lead to severe physical symptoms.

Egg allergy appears mainly in children although some adults are affected by it as well. It is the second most common food allergy in children, the most common is cow’s milk allergy.

The most severe food allergy reaction is called anaphylaxis and is an emergency situation requiring immediate attention and treatment with epinephrine. The Asthma and Allergy Foundation of America estimates that most children outgrow egg allergy by the age of five, but some people remain allergic for a lifetime.

It is estimated that one in every 13 Canadian suffers from a significant food allergy. Besides egg and milk, other common food allergies are to peanut, fish and sesame. Research indicates that peanut and nut allergies were much more common in children than adults and the opposite was true with fish and shellfish allergy.

Here is the good news now. A study published in The New England Journal of Medicine (July 19, 2012) provides hope for children with egg allergy. It says egg allergy can be substantially reduced and in some cases can be cured.

The research was conducted by feeding children with severe egg allergies with tiny amounts of egg protein (oral immunotherapy). Over time, the dose was steadily increased. The idea was to allow the body to gradually learn to tolerate exposure to the substance.

Results:

-After 10 months of therapy, 55 per cent of those who received oral immunotherapy passed the oral food challenge and were considered to be desensitized.

-After 22 months, 75 per cent of children in the oral immunotherapy group were desensitized.

-At 30 months and 36 months, all children who had passed the oral food challenge at 24 months were consuming egg.

About 25 per cent of the children who did not respond to oral immunotherapy suggests that some patients will need treatment on a regular basis for a longer time. The researchers believe even if it doesn’t provide a complete cure for everyone, the treatment may be able to reduce the severity of allergic reactions in many patients.

Parents are cautioned not to try this kind of treatment (oral immunotherapy) at home without medical supervision. A lot more research needs to be done before the therapy is ready for the general public. Oral immunotherapy is still considered experimental and should not be attempted outside a research trial. For now, this research paper provides hope for millions of people who have food allergies.

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