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Your Baby

Special Baby Formulas Don’t Prevent Asthma, Allergies

2:00

Parents that have a baby at risk or allergies, asthma or type-1 Diabetes sometimes turn to hydrolyzed milk formulas in hopes of lowering their infant’s risk of developing these problems.

A new review of the data on hydrolyzed formulas finds that there is no evidence that they actually protect children from these types of autoimmune disorders.

"We found no consistent evidence to support a protective role for partially or extensively hydrolyzed formula," concluded a team led by Robert Boyle of Imperial College London in England.

"Our findings conflict with current international guidelines, in which hydrolyzed formula is widely recommended for young formula-fed infants with a family history of allergic disease," the study authors added.

In the study, Boyle's team looked at data from 37 studies that together included more than 19,000 participants and were conducted between 1946 and 2015.

The investigators found that infants who received hydrolyzed cow's milk formula did not have a lower risk of asthma, allergies (such as eczema, hay fever, food allergies) or type 1 diabetes compared to those who received human breast milk or a standard cow's milk formula.

The researchers also found no evidence to support an FDA-approved claim that a partially hydrolyzed formula could reduce the risk of the skin disorder eczema, or another conclusion that hydrolyzed formula could prevent an allergy to cow's milk.

Other experts in the United States said that the finding casts doubt on the usefulness of these kinds of specialized products.

"Allergies and autoimmune diseases [such as asthma, and type 1 diabetes] are on the rise and it would be nice if we did have a clear route to preventing them," said Dr. Ron Marino, associate chair of pediatrics at Winthrop-University Hospital in Mineola, N.Y.

"Unfortunately, despite U.S. Food and Drug Administration support [for hydrolyzed formula], the data are not compelling," he said.

Dr. Punita Ponda is assistant chief of allergy and immunology at Northwell Health in Great Neck, N.Y. She stressed that when it comes to infant feeding, breast milk is by far the healthiest option.

However, "current mainstream guidelines for infant formula do recommend that parents consider using hypoallergenic formula if a close family member -- like an older brother or sister -- has a food allergy," she said. That was based on prior studies supporting some kind of protective effect, Ponda said.

Protein hydrolysate formulas were first introduced in the 1940s for babies who could not tolerate the milk protein in cow’s milk.

Protein hydrolyzed formulas are formulas composed of proteins that are partially broken down or “hydrolyzed.” They are also called hydrolysates.

There are two broad categories of protein hydrolysates:

•       Partially hydrolyzed formulas (pHF)

•       Extensively hydrolyzed formulas (eHF)

Both partially and extensively hydrolyzed protein formulas are based on casein or whey, which are proteins found in milk.  

Hydrolyzed formulas have had the protein chains broken down into shorter and more easy-to -digest chains. The more extensively hydrolyzed the formula, the fewer potentially allergenic compounds remain.

Hydrolyzed formulas are also more expensive than regular cow’s milk formulas and often harder to find.

The researchers review was published March 08, 2016 in the BMJ.

Story sources: Robert Preidt, http://www.webmd.com/parenting/baby/news/20160308/special-infant-formulas-dont-shield-against-asthma-allergies-study

Victoria Groce, http://foodallergies.about.com/od/adultfoodallergies/p/hypoallergenic.htm

 

Daily Dose

Peanut Allergies

1:30 to read

Did you see the New England Journal of Medicine article which was recently published regarding peanut allergy? Interestingly, the study out of the UK seemed to confirm what some of us “old school pediatricians” had thought... the previous recommendation that babies and toddlers avoid peanut products in the first year of life may actually lead to more peanut allergies in children who are already at risk for developing food allergies.

In the late 1990’s allergists were concerned about the rise in peanut allergies and recommendations were made to delay introduction of peanuts (as well as some other foods).  At the time it did seem strange seeing that children born prior to this were raised on peanut butter...but like many things, nothing stays the same, right?

But over the years, the increase in peanut allergies continued, despite the fact that mothers were not eating peanut products during their pregnancy or while breast feeding and parents were delaying the introduction of peanut products until their child was 2 years of age. When the data from this period was analyzed, instead of seeing a decrease in children with peanut allergies... the incidence of peanut allergies continued to increase.

So, in 2008 the AAP changed their recommendations and again encouraged parents to let their children eat peanut products in the first year of life just NO peanuts due to the choking hazard.  But many parents continued to be wary...in fact some, who had no history suggesting allergies ( eczema, wheezing, family history of food allergies), would actually bring peanut butter to my office for a trial. One mother came for a quick “house call” one day and I handed her child (who was 20 months at the time) a peanut butter cracker I was eating and her mother “freaked out”.  Fortunately, the child loved the cracker and no issues with peanut butter either. She was thrilled when she left with another cracker in hand 

This article was just the first of many studies being undertaken to “help solve the puzzle of food allergies”. There is so much about this topic on the horizon but in the meantime, if your child does not have a  history to suggest allergies I would try introducing peanut butter, almond butter, as well as eggs and dairy to your child. If you have a family history of food allergies, or concerns talk to your doctor about beginning these foods earlier than later even if that is in a controlled situation in the pediatrician’s or allergist’s office.

I can’t wait to give baby granddaughter some of these foods as well (she just started to get some veggies) and peanut butter is not far behind.  I did “sneak” her a morsel of pancake the other morning...you should have seen that smile.

Your Baby

“Furry Pets” May Help Kids Avoid Some Allergies

2:00

You might think that having pets would be a nightmare if you have small children with a family history of allergies. A new study says that furry pets may actually help protect children against some allergies.

The infants’ mothers had a history of allergy, so the babies were at increased risk too, and it was once thought that pets might be a trigger for allergies in such children, the authors point out in the Journal of Allergy and Clinical Immunology.

“Earlier it was thought that exposure to pets early in childhood was a risk factor for developing allergic disease,” said Dr. Merja Nermes of the University of Turku in Finland, who coauthored the research letter. “Later epidemiologic studies have given contradictory results and even suggested that early exposure to pets may be protective against allergies, though the mechanisms of this protective effect have remained elusive.”

Adding pet microbes to the infant intestinal biome may strengthen the immune system, she told Reuters Health by email.

The study team collected fecal samples from diapers when the babies were one month of age and these were tested for the DNA of two types of Bifidobacteria that are found specifically in animal guts: B. thermophilum and B. pseudolongum.

One third of infants from the pet-exposed group had animal-specific bifidobacteria in their fecal samples, compared to 14 percent of the comparison group. It’s not clear where the infants without furry pets at home acquired their gut bacteria, the authors write.

When the babies were six months old they had skin prick tests to assess allergies to cow’s milk, egg white, flours, cod, soybeans, birch, grasses, cat, dog, potato, banana and other allergens.

At six months of age, 19 infants had reactions to at least one of the allergens tested. None of these infants had B. thermophilum bacteria in their fecal samples.

Other studies have pointed out the connection between kids exposed to farm animals and household pets and building a better immune system.

“When infants and furry pets live in a close contact in the same household, transfer of microbiota between pets and infants occurs,” Nermes said. “For example, when a dog licks the infant´s face or hand, the pet-derived microbiota can end up via the mouth into the infant´s intestine.”

Human-specific Bifidobacteria have beneficial health effects, and animal-specific strains may also be beneficial, she said. It is still unclear, however, if exposure to these bacteria protects against allergies later in life, she said.

“Future research is needed to assess if these infants develop less atopic dermatitis, asthma or allergic rhinitis later,” she said.

Nermes also noted that she believes pediatricians should not discourage pregnant women or parents of infants from having pets in order to prevent allergies.

“If a family with a pregnant mother or an infant wants to have a pet, the family can be encouraged to have one, because the development of allergic disease cannot be prevented by avoiding pets,” she said.

Source: Kathryn Doyle, http://www.reuters.com/article/2015/09/10/us-health-allergy-pet-microbes-idUSKCN0RA2CK20150910

 

 

Daily Dose

Special Series: Allergies

1.30 to read

We've had plenty of questions about allergies this time of year, and with so many already suffering, we decide to put together a series on what you need to know to help your family survive allergy season. 

It is the season for allergic rhinitis (inflammation of the nasal passages) which are triggered by tree pollens and grasses as spring blows in.  Allergy symptoms affect about 1:5 people and the first symptoms often begin in childhood. Children typically develop symptoms of allergic rhinitis between the ages of 3–4 years. Many of these children might have shown symptoms of eczema (atopic dermatitis) and asthma at even younger ages. If one parent has allergies, there is about a 40-50% chance that their child may also be allergic and if two allergic persons marry (guess you should ask about that while dating), then there is a 70-80% chance that their children will also be allergic. 

It also seems that early exposure to cigarette smoke, cat dander and house dust mites may promote other allergic symptoms later in life. (Another great reason not to smoke if you have children) The most common symptoms of an allergy are complaints of an itchy nose, watery and red eyes, sneezing, runny nose (typically clear), post nasal drip and cough.  These allergic symptoms are brought on by the release of histamines in the body after exposure to the allergen, such as inhaled pollens.  

While allergic symptoms have been labeled, “hay fever” this is an inappropriate term as allergies do not cause a fever and the child is not necessarily allergic to hay. There are also different pollens responsible for allergic symptoms at different times of the year. Children that develop seasonal allergies have several characteristic physical findings. They may have allergic “shiners” which are darkened areas beneath the lower eyelid from swelling, they also often have a crease across their nasal bridge (termed the allergic salute) which occurs due to constant rubbing of the nose. You can often see the child rub their little watery eyes while you are examining them and they often have a clear, watery nasal discharge.  Some of these allergic children will also have a cough and may even be wheezing.  They often look rather uncomfortable rather than sick as with a cold. 

There are many different treatment options for controlling allergic rhinitis.  The first is to control the environment as much as possible by closing windows and turning on the AC in order that the airborne allergens do not blow into the house. After your child has been playing outdoors have them come in and shower to remove the pollens from their hair and body (not a favorite pastime for little boys). You can also watch the pollen count for your area and limit a child’s time outdoors on especially high pollen count days. Medical treatment of allergic rhinitis coming up in part 2 of our special series. Send your question to Dr. Sue!

Daily Dose

Control Indoor Allergens

2.00 to read

Fall is the perfect time of year to open the windows and air out the house! Sounds like a great idea, however, this can cause some problems for fall allergy sufferers in your home. It can start stir up some pesky allergens that may bother your kids. So, how about a few tips to keep these allergens at bay.

There are an array of things that can trigger an allergy attack in your home including dust mites and mold.

Working fulltime and raising three boys, I know how hard it is for busy families to find time to clean (my least favorite thing to do). But spring is the best time to get a jump on controlling indoor allergies.

Start with washing all bedding at least once a week.  Throw your linens in water at least 130 degrees.  Place dust mite covers on mattresses and pillows.  While changing sheets, vacuum the mattress as well.

Carpeting harbors plenty of items, so if there is someone very allergic, consider replacing carpets with hard surfaces such as hardwood or tile. By doing so, this can eliminate as much as 90% of dust mites.  If you can’t live without carpet, think about buying low pile not shag.

Get rid of any mold!  Mold is caused by moisture and can hide in your kitchen, bathroom and basement.  Keep things as dry as possible to avoid any mold build up.

One thing many people miss? Turn on the ventilating fan or open a window in the bathroom.  Try to keep humidity below 50%.  Too much moisture is a breeding ground for mold and mildew.

I know how much families love their pets (we love our yellow lab Maggie and treat her like a member of the family).  But Maggie and your pet can track pollen into your home from the outside.  Also, many children can be allergic to pet dander.  Here’s a trick: wipe your pet down with a dryer sheet! It will pull the dander and any loose pollen off your pet.

Spring and fall cleaning means de-cluttering, so go ahead and box up those knickknacks.  They are very decorative but are a magnet for dust.

And, check your air filters.  Every 1st of the month, clean or replace your air conditioner, furnace or dehumidifier filter.  It will inhibit dusty air from circulating throughout your home.

Try these tips and let me know how it works out for your family.  I’d love to hear from you.

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Daily Dose

Allergy Nasal Sprays

1:30 to read

Since we are in the throes of allergy season (even though there was a recent late snow event in the midwest and northeast) I thought I would provide some additional information on steroid nasal sprays.  In fact, the climate changes that we are seeing are predicted to increase the length of pollinating seasons and therefore increase the amount of pollen produced, which will only make those with allergies (and children with developing allergies) even more miserable with symptoms of runny nose, sneezing, throat clearing and itchy eyes.  

Although I recently discussed the use of non sedating and sedating anti-histamines for intermittent allergy symptoms, the use of intranasal steroids have been found to be far more effective in controlling allergy symptoms.  The first thing to remember is that unlike an antihistamine, intranasal steroids require several days of consistent use before you will see any real change in allergy symptoms (I must repeat that line 10 times a day, especially to my teenage patients who want instant gratification!).  For anyone who knows the season for their allergies (depending on the pollen one is sensitive to), I recommend starting the intranasal steroid spray 1-2 weeks before their symptoms typically begin. (Which means if you are allergic to tree pollens - you should have already started by now). Using the nasal spray daily and continuing throughout the allergy season will provide the best results.  Watching the pollen counts in your area will be important to time the use of intranasal steroids.

Although some children seem to be more sensitive about using a intranasal steroid spray, it is well tolerated by most with few side effects.  Prescription intranasal steroid sprays have been approved for use in children as young as 2 years and the over the counter sprays for children 4 years and older.  The most commonly reported side effects are nasal irritation, burning and bloody noses.  I always try to show my patients how to use the spray properly and to “aim” the spray towards the outer aspect of the inside of the nostril rather than towards the septum (middle) which may help reduce irritation and bloody noses. By spraying towards the outer aspect you also maximize the amount of area that is covered by the spray.  Everyone seems to have their “favorite” intranasal steroid as some are an aqueous spray and others are an aerosolized puff….but in many cases the product choice may be based on the age of the patient, prescription vs OTC, insurance coverage and cost.  Although there are many to choose from there have been no head to head studies with these medications and their efficacy is generally thought to be comparable….but discuss your choices with your own pediatrician.

Lastly, there was a study done in 2014 published in The Journal of Allergy and Clinical Immunology, which measured growth rates in children between 5 and 8 years of age who were treated with an intranasal steroid (specifically fluticasone furcate - Veramyst ) as compared to a placebo. The study did show a significant improvement in nasal allergy symptom scores, but there was a 0.27 cm (0.65 inch ) reduction in growth rate over the course of the year as compared to placebo.  Due to this study, I use the lowest effective dose for the shortest amount of time in younger patients, and explain the reasoning to their parents.  Again, you can read the study and discuss this with your pediatrician before beginning intranasal steroids.   

Just make sure you use the intranasal spray consistently during the height of allergy season…I tell my own family, it doesn’t work as well if it sits on the counter for a few days between use!

 

Daily Dose

Special Series: Food Allergies

2.00 to read

We continue our special series on allergies. This time we look at food allergies and how they are diagnosed.We continue our series on allergies and this time we shift the focus on food allergies. This topic was top of mind for a mom who sent us an email question via our free iPhone app. She wrote “could my 9 year old daughter be allergic to strawberries as she gets a stomach ache and sometimes vomits after she eats them?  She has not had problems eating strawberries before." This is very interesting because I have been reading & reviewing several articles on food allergies and their diagnosis.

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One was in JAMA (I saved the May  2010 issue for research) and another was in the March issue of Consultant for Pediatricians. Both of these articles emphasized that there continues to be a great deal of confusion and lack of uniformity for diagnosing food allergies. Food allergy is also not uniformly defined, but according to the National Institute of Allergy and Infectious Diseases (NIAID), it is an “adverse immune response that occurs on exposure to a given food and is distinct from other adverse responses to food such as food intolerance.”  Statistics show that somewhere between 1%-2% of the population may have food allergies.  It is also unclear if food allergies are on the rise, as data on this is conflicting. With all of that being said, it sounds more like this child has developed an intolerance to strawberries rather than an allergic response.  It would be important to get more history such as what else she has eaten with the strawberries when this occurs, if the symptoms are always the same and are there any other problems associated with the ingestion. Specifically, does she complain of hives, itching, swelling of her tongue, lips or difficulty breathing? Does she have problems with any other foods? I also wonder if she has the same symptoms if she picks fresh strawberries or if they are from the store or if they are frozen. In other words, like so many things in medicine a good history is probably the most important part of this “strawberry story”. If she continues to have problems and her symptoms, this sounds more like intolerance than a true allergic reaction she can just avoid the strawberries (not much fun, especially in the summer). She might also check with her pediatrician about doing a blood test for IgE antibodies to strawberries.  A food intolerance would not have an increase in IgE antibodies as it is not an allergic reaction.  If confusion persists she could be referred to a pediatric allergist for further evaluation and even an oral food challenge. There continues to be a great many studies surrounding the etiology of food allergies, and I will keep you posted as new information is presented. That's your daily dose for today.  We'll chat again tomorrow. What do you think?  Send your question or comment to me!

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Your Child

The Eczema, Allergies and Asthma March

1:45

Eczema refers to a number of different skin conditions in which the skin becomes red and irritated and sometimes has small, fluid filled bumps that ooze.

The most common cause of eczema is atopic dermatitis (sometimes called infantile eczema), which affects older kids as well as infants.

Children with eczema may eventually get food allergies, hay fever, or asthma. But you can take steps to soothe the itch and possibly cut the risk of allergies.

While most experts don't think eczema is purely allergic, it's clearly connected to allergic conditions like food allergies, hay fever, and asthma.

·      Up to 80% of kids with eczema get hay fever or asthma later in childhood.

·       35% of adults with asthma or nasal allergies had eczema as kids.

·      If a mom has allergies, there's almost a 1 in 3 chance that her baby will have eczema.

·      37% of kids with moderate to severe eczema also have food allergies.

For some kids, eczema and allergies develop in a specific order, as they get older. It starts with eczema, then food allergies, then asthma, and then hay fever. It's called the allergic march.

But just because your child has eczema doesn't mean they'll get these other conditions. It just means there's a higher risk.

There are several things that can increase a child’s risk of being part of the allergic march.  Kids who get eczema at a young age may be more likely to have allergies or asthma later. Kids with worse eczema symptoms may be more likely to get allergies or asthma.

You can do some things that might lower your child's chances of worsening eczema, asthma, or allergies. The evidence isn't clear, so talk to your doctor or your child's pediatrician. Depending on the situation, the doctor might recommend:

Breastfeeding your baby: It might lower the risk of eczema, later allergies, or asthma.

Diet changes: If your baby has a high risk of allergic problems, some doctors recommend changes in diet. Breastfeeding for at least 4 months can help protect your child. “Hydrolyzed” formula might help protect formula-fed babies.

Other ways to keep your child's eczema under control include:

Get allergy testing. If you can pin the problem on a specific allergen, you can figure out ways to avoid it.

Use a moisturizer. Go for thick creams and ointments that stop the skin from drying out.

Keep fingernails short. Your child will do less damage to the skin from scratching.

Avoid irritants. Always use unscented soap and laundry detergent. Stay away from cigarette smoke.

Watch for problems. If your child's eczema seems to be getting worse -- or if they get allergy symptoms, like congestion or a runny nose -- see a doctor. The sooner you get treatment, the sooner your child will feel better.

In many cases, eczema goes into remission and symptoms may disappear altogether for months or even years.

For many kids, it begins to improve by the age of 5 or 6; others may have flare-ups throughout adolescence and early adulthood.

In some kids, the condition may improve but then restart as they enter puberty, when hormones, stress, and irritating skin products or cosmetics are introduced. Some people will have some degree of dermatitis into adulthood, with areas of itching and a dry, scaly appearance.

Eczema is not contagious, so there's no need to keep a baby or child who has it away from siblings, other kids, or anyone else.

Story sources; http://www.webmd.com/skin-problems-and-treatments/eczema/child-eczema-14/allergies?ecd=wnl_prg_050116&ctr=wnl-prg-050116_nsl-promo-4_title&mb=HJinmVxrQQBBWXaWABbkR%40HnVev1imbCiW2HnNaB9FE%3d

http://kidshealth.org/en/parents/eczema-atopic-dermatitis.html#

 

 

 

Daily Dose

Treating Allergies

In our special series, we look at ways to treat your allergiesAchoo!  Yes, it has been a particularly bad allergy season and (I'm afraid to say) it seems like it's going to be like this for a bit longer. I continue to see a lot of children (as well as their parents) complaining of nasal congestion, sneezing, itchy and watery eyes.  It's very uncomfortable!

The surge in allergies this year has been due to a very wet winter and the weather this spring has brought erratic temperatures and lots of wind.  This is the perfect storm for the "allergic cascade" to inflict itself on everyone's nasal mucosa. The best preventative for nasal allergy symptoms (allergic rhinitis) has been the use of intranasal steroids. These steroid sprays have been used for the past 15 years and clinical studies have shown that intranasal steroids are superior to oral antihistamines for preventing and treating allergic rhinitis. Intranasal steroids function by inhibiting the production of chemical mediators such as histamine and prostaglandin that cause inflammation and mucous production. In other words they are more of a preventative medication, while an antihistamine is treating the histamine that was released once you inhaled the offending tree or grass pollen. Intranasal steroids may also help eye allergy symptoms. The biggest problem seems to be getting young kids to let you use a nose spray on them. The same holds true for the older tween and teen crowd who complain that they "just don't have the time to use it every day" (it must take all of 15 seconds to use on yourself!) Intranasal steroids have been shown to be effective within 3-12 hours, although will reach their maximum effectiveness after several days to weeks of use, so using it daily and throughout the allergy season is going to give you the maximum therapeutic effect. There are many different brands available (all by prescription) and everyone seems to have their favorite. If one spray seems to bother your child due to scent, or intensity of the spray ask your doctor to try another brand. Many times they will have a sample and give you several to try and then prescribe the one that is easiest to get your child to use. It may be trial and error, but finding the right nasal steroid may just change your allergy season. By the way, God Bless You! Keeping allergens away from your family will help everyone feel better.  We’ll talk about this in part 3. Send your question to Dr. Sue!

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If your child snores, is this a sign of something more serious?

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