Skin-prick and blood tests should not be used as the sole means of diagnosing allergies in children because that can lead to unnecessary avoidance of environmental exposures or food, according to allergists from Johns Hopkins Children’s Center in Baltimore and Mount Sinai Hospital in New York. A real culprit also could be missed.

The allergists say in an article published in January’s issue of Pediatrics that the tests should only be used to confirm suspicions based on symptoms and medical history. They should not be used to look for allergies.

In the case of a suspected food allergy, the children should undergo a food challenge, where they consume a small dose of the allergen under medical supervision.

The problem is that skin and blood tests detect antibodies from the immune system released in response to allergens, but not actual allergic reactions. That means they only detect sensitivity and can’t tell if there will be a reaction or how bad a reaction would be.

“Allergy tests can help a clinician in making a diagnosis but tests by themselves are not diagnostic magic bullets or foolproof predictors of clinical disease,” said Dr. Robert A. Wood, a Hopkins professor of pediatrics, in a statement. “Many children with positive tests results do not have allergic symptoms and some children with negative test results have allergies.”

Forgoing pizza, ice cream and other dairy products can be a tough adjustment for kids with milk allergies. But researchers at Johns Hopkins Children’s Center and Duke University say they may be able to help them build a tolerance.

A small study over two years found that giving patients higher doses of milk protein in powder form outperformed lower-dose therapy, which involved a few drops of liquid milk extract under the tongue.

Half of the 30 patients age 6 to 17 were able to consume 8 grams of milk protein, which is the equivalent of 8 ounces of liquid milk, without any allergic reaction at the end of the trial.

The results were published online in the Journal of Allergy and Clinical Immunology. The researchers had shown in the past that both approaches eased allergic symptoms but this was the first head-to-head comparison. There were three groups: one group who took light drops of milk under the tongue and two groups who got different doses of milk powder. The highest dose appeared the most effective.

“It is encouraging to know that children who in the past might have suffered violent reactions to microscopic amounts of milk now have no reactions or only mild reactions to a much higher dose and that their quality of life can improve dramatically,” said lead investigator Dr. Corinne Keet, a pediatric allergist at Hopkins Children’s Center, in a statement.

The effects wore off in the kids who did not continue to drink milk daily, showing the need for continued consumption. The researchers said more studies are needed, and they stressed that such experimenting shouldn’t be tried at home without close medical supervision.

The cold has zapped all the stuff outside making your allergies and asthma worse. But now you're inside the house with dust, pet dander and mold.

Here are some tips directly from the American College of Allergy, Asthma and Immunology:

--Reduce moisture in your home to keep dust mites in check. Maintain humidity below 55 percent, and don’t use a humidifier or a vaporizer.

--Filter out dust and other allergens by installing a high efficiency furnace filter with a MERV rating of 11 or 12, and be sure to change it every three months.

--Banish allergens from the bedroom (where you spend a third of your life). “Keep pets and their dander out, and encase mattresses and pillows with dust-mite proof covers,” said allergist Dr. Myron Zitt, ACAAI past president, in a statement. “Limit curtains – use blinds that can be washed instead.”

--Keep it clean. A clean home is especially important for allergy sufferers, who should wear a NIOSH-rated N95 mask while dusting, a chore that should be done regularly. Wash bedding and stuffed animals in hot water every 14 days and use a vacuum with a HEPA filter.

--Turn on the fan or open the window to reduce mold growth in bathrooms (while bathing) and kitchens (while cooking). Wear latex-free gloves and clean visible mold with a five-percent beach solution and detergent.

--Don’t overlook the garage if it’s attached to the house. Noxious odors or fumes can trigger asthma, so move insecticides, stored gasoline and other irritants to a shed, and don’t start the car and let it run in the garage.

--Box up books and knick-knacks and limit the number of indoor plants. When you are buying new furniture, like chairs or sofas, opt for leather or other nonporous surfaces to make cleaning easier.

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An official set of recommendations for doctors treating food allergies has finally been put together by a group of researchers lead by the National Institute of Allergy and Infectious Diseases.

As many as 3 percent of Americans have a food allergy, and scientists say the number has been rising in the last two decades, but there hasn’t been agreement on how to diagnose and manage them.

There guidelines are being published this week by the Journal of Allergy and Clinical Immunology.
“Paradoxical as it may be, up until now we have lacked uniform guidelines based on hard scientific evidence about how to diagnose and treat these very common conditions that affect the lives of millions of people,” said Dr. Robert Wood, one of the six lead authors of the guidelines, in a statement.

Wood, also director of the Division of Allergy and Immunology at the Johns Hopkins Children's Center, said the guidelines should mean suffers get up-to-date care anywhere they seek treatment – which basically includes allergen avoidance and treatment of symptoms.

The guidelines for clinicians include definitions (as in how to tell the deference between food allergy and intolerance) and information on proper tests and management of allergic reactions that are non-life-threatening and life-threatening.

A synopsis for families seeking information will be available early next year. If you want to get through the clinical version, you can find it here.

Nearly 3 out of 100 Americans have a food allergy, according to a new study believed to be the largest one conducted on food allergies.

The study of 8,200 people of all ages was conducted by Johns Hopkins Children's Center, the National Institutes of Health and other institutions. NIH funded the study. It found more than 2.5 percent of the population, or 7.5 million people, have at least one food allergy.

The most common allergy is peanuts antibodies, the proteins made by the immune system in response to allergens. Others big allergens were allergic to shrimp, eggs, milk. Many people had more than one allergy.

The use of antibodies allowed the researchers to see only those with actual disease and not a risk for allergies.

The findings are published in the October issue of the Journal of Allergy and Clinical Immunology and are based on blood samples and interviews.

In general, allergies were most common in children 5 and younger, followed by those 6 to 19. Black people were more likely to have allergies, as were men. The researchers also looked for links to asthma, eczema and hay fever, and found a allergies were more common in those with asthma.

“Our findings confirm a long-suspected interplay between food allergies and asthma, and that people with one of the conditions are at higher risk for the other,” says investigator Dr. Robert Wood, director of Allergy and Immunology at the Johns Hopkins Children's Center.

He said many children develop a food allergy first and later get asthma and then hay fever.

Associated Press photo

There's been a lot of interest in the story today in The Sun about mold growing in the fancy Harborview apartment building.

That had me take a look back at our coverage of mold, allergens and chemicals that can make people sick in their own homes.

I found some tips that may help:

+Keep the basement dry to keep mold from growing. Wipe up moisture and use your shower vent to control moisture. If you see moisture near a vent or smell it, have your duct work inspected. Carpeting and wallboard that get moldly can't effectively be cleaned and must be removed -- and quickly so mold doesn't spread. Soap and water or vinegar, not bleach, will clean up most mold you can see on hard surfaces.  

+Make sure the house is properly ventilated to improve air quality. Change your house air filter monthly, or whenever it looks dirty.

+Humidity should be at about 40 percent. Too much promotes mold growth, and too little moisture can be irritating. If there's moisture on the window, humidity is too high. Use the exhaust fan for 10 minutes after a shower and air conditioning to cut humidity and a whole house humidifier to raise humidity.

+Keep use of household cleaners and sprays made from chemicals to a minimum because they can irritate and poison. Use a mop dampened with water once a week to lift ordinary dirt and allergens.

+Air out new carpeting, stain-treated furniture, or anything with that new smell outdoors because they probably contain formaldeyhde or volitile organic compounds (VOCs) that can be irritating or make people sick.  

+Have a professional check for carbon monixide when servicing furnaces because it's odorless and can kill. Intall a detector for it and for radon, another odorless gas, which can cause lung cancer at high levels.

+Vacuum frequently to cut down on allergens such as dust mites that feed on skill cells humans shed and thrive in pillows, mattresses and carpeting. Consider allergen covers for your pillows and mattresses and wash linens in hot water once a week. Reduce clutter such as stuffed animals that house dust mites.  

+Keep insulation in good shape because indoor air quality can be compromised by deteriorated insulation

Baltimore Sun file photo of mold/Elizabeth Malby                        

Sneezing? Stuffy? It seems allergy season is upon us. Dr. Manav Singla, who is board certified in allergy and immunology and pediatrics, will be here to answer questions at noon. Singla, of Union Memorial Hospital, is a clinical assistant professor at the University of Maryland School of Medicine, and he has published articles about allergy and immunology. He's also involved in teaching physicians-in-training about asthma, allergic disease and immune problems.

The live chat doesn't start until noon, but you can begin to ask questions now, either in the comments or via our widget below.

Pollen. It's everywhere. Causing itchy eyes, scratchy throats and blanketing cars with yucky green dust. Already high pollen counts this spring are causing serious trouble for allergy sufferers.

Do you have questions about your allergies? Looking for remedies that work? We'll have answers for you Tuesday at noon during our live chat with Dr. Manav Singla, a Union Memorial Hospital allergist and immunologist.

You can start asking your questions now in the comments space below, or email me at kelly.brewington@baltsun.com.

 

Oh, the pollen, the grass, the trees! 

A new poll from Consumer Reports say that 60 percent of allergy sufferers have not been able to stop seasonal misery. A fifth say they missed work because of allergies.

The primary season starts in March and gets really bad in April and May, according to the survey.

Survey respondents said the main strategies were not helping enough. Almost 60 percent had to see a doctor for relief.

If you'd like to see the full survey or get advice on coping, go to www.ConsumerReportsHealth.org.    
 
“Seasonal allergies affect all parts of the upper respiratory system plus the eyes,” said Dr. Marvin Lipman, chief medical adviser for Consumer Reports, in a statement.  “There’s usually no single magic bullet.” 

In search of relief, consumers spent some $325 million last year on prescription allergy drugs. The poll found the average sufferer took three kinds of medications; 26 percent took five or more. Some were switching around to find more effective ones or avoid side effects. The most common side effects were drowsiness and dry mouth. 

The three main strategies for dealing with allergies were avoidance, over-the-counter drugs and prescriptions. Most successful was avoidance. 
                         
Of the drugs, Consumer Reports Health gives steroidal nasal sprays the high marks for treating spring allergies. Very likely to work, the group says, also are OTC antihistamines such as Benadryl, Claritin, Zyrtec and their generic versions. But they often make people sleepy or cause other problems.

Are you suffering? What do you do to cope?

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It's just about allergy season and guest blogger Jill Rosen shares with us her take on the neti pot. Oprah loves them, some studies say they work, and there are even You Tube videos on how to use em, parodies included.

Here's Jill's take: 

Has anyone tried the neti pot – the organic-seeming, would-be cure to clogged sinuses? Yesterday I was so insanely stuffed up with allergies and god only knows what else, I was willing to try anything medicine, science or, in the case of the neti pot, yogis offer.

A friend had given me a neti pot months ago and it’s sat in pretty much the same spot in my kitchen ever since. I put mail on top of the box. It’s an ancient technique that involves what looks like a miniature Aladdin's lamp. That and a lot of balancing over the sink….

But desperation had me opening the box last night. Out came a little plastic kettle and an instruction sheet that told me to fill it with water and mix in one of the little Neti solution packets that came with it.

Then it had me leaning most awkwardly over the sink, head tilted to one side, kettle spout stuck hopefully up one nostril….. What’s supposed to happen at this point is the solution flows up one nostril, and out the other, flushing out your nasal cavity along the way. What happened to me is that 80 percent of the solution immediately streamed right out the nostril and into the sink.

I tried again and a little came out the other side. Not much. I repeated the deal with the other nostril.

No one was more skeptical of the pot than I – and I’m pretty sure I didn’t even do it right – but this morning my nose is markedly better.

I think I’m a believer and I’m wondering how others have experienced the Neti…. especially anyone with daily allergy issues….

Photo from NeilMed