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Spring Allergies

Control Spring Allergies

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

 

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

Spring Allergies

1:30 to read

It is definitely allergy season around the country. The weird weather this year has made all things blooming start early, with sky high pollen counts. Some areas have had a few recent super cold days, but warmer temperatures are starting again.  While the cherry blossoms really suffered, the oak, elm, mulberry and ash trees are all just starting to spread their pollens and causing a lot of runny noses, itchy eyes and scratchy throats.

 

If you know that your child is a spring allergy sufferer or if they seem to be developing allergy symptoms (which often occurs after the age of 2 years), there are many products now available over the counter.  The mainstay of allergy treatment is the use of nasal steroids, which actually act as a preventative. They are used on a daily basis during allergy season.  There are many different nasal steroid sprays available including Flonase, Nasacort, Nasonex and Rhinocort.  Both Flonase and Nasacort now have a children’s brand and may be used in children as young as 2 years. While the word “steroid” scares many parents, these steroids are not “the bad”  ones associated with bodybuilding. The steroid is sprayed directly into the nasal lining and therefore very little is absorbed systemically, so there are few side effects. Some children do not like sprays and “water up their nose”, but each brand is a bit different in how it is delivered, so you might switch around and see which brand is easiest to use.

 

Many of the allergy symptoms that occur including the runny nose and watery eyes are related to the allergic cascade and histamines that the body produces in response to exposure to the pollen.  So….anti-histamines are also a mainstay of treatment. Again, many of the previous prescription anti-histamines are now all available over the counter. This class of drugs includes second generation non sedating anti-histamines such as Allegra, Zyrtec and Claritin and now the newest Xyzal.  First generation anti-histamines are more likely to cause drowsiness and sedation and the best known of these is Benadryl (diphenhydramine).  For those with severe allergy symptoms I sometimes use a morning non-sedating anti-histamine followed by Benadryl at bedtime. 

 

For those children who have significant allergies, particularly year round, and who do to respond well to typical treatment with nose sprays and antihistamines, it may be time to see a pediatric allergist. I recently sent one young boy for allergy testing. The testing is usually well tolerated and not painful.  When I saw him for follow up he told me he had gone to the “pokemon” doctor…as he had gotten lots of pokes on his back!! 

 

 

 

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Your Baby

Having a Baby? Keep Your Pets!

1:00

In a world full of allergens, you might think that having pets around could only make things worse.  But according to a new study from Canada, families with dogs and cats may unwittingly be protecting their infant children from not only allergies but obesity as well.

University of Alberta epidemiologist Anita Kozyrskyj and a team of researchers analyzed more than 700 Canadian children. They found babies exposed to pets while in the womb or up to three months recorded an "abundance" of ruminococcus and oscillospira (both are bacteria found in the gut,) the latter of which is associated with leanness or lower body mass index, notes the study - published in the journal Microbiome.

Kozyrskyj said the two types of bacteria increased "twofold" when a pet was in the house. The team said the theory is that early exposure to bacteria — like that from a dog — creates a type of resistance.

Unborn babies can benefit from allergy resistance by being indirectly exposed through their mother’s womb. The microbes can pass from pet to mother to baby.

Even if a parent decides not to keep pets after the baby is born, if pets were in the house during the pregnancy, the infant may gain some benefit anyway.

The findings also suggest pet exposure could cut down the risk of group B strep, which the Centers for Disease Control and Prevention said could cause blood infection, pneumonia and meningitis in newborns. Doctors treat against group B strep by giving mothers antibiotics during the delivery process.

Dogs were shown to offer higher levels of the beneficial microbes.

Story source: Sean Rossman, https://www.usatoday.com/story/news/nation-now/2017/04/07/why-owning-pet-could-protect-your-baby-obesity-and-allergies/100162098/#

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.

Daily Dose

Allergy Season

1:30 to read

Allergy season is here and if your child is known to have seasonal allergic rhinitis (nasal congestion, runny nose, itchy nose and sneezing) during the fall months, it is time to begin the use of their intra-nasal steroids and oral antihistamine on a daily basis.  It is also easy to begin therapy for suspected allergic rhinitis as both nasal steroid sprays and non-sedating antihistamines are available over the counter, and there are many choices as well (liquids, chewables, and pills).

 

Interestingly, I just read an article from a study done in India which looked at Vitamin D levels in children with allergic rhinitis.  It was a small study, only 42 children, between the ages of 5-15 years were followed. The authors looked at nasal symptom scores in children who were maintained on their allergic rhinitis protocol but one group received a Vitamin D supplement as well. 

 

Vitamin D is known to have effects on T and B cells which may link Vitamin D to immune related conditions and allergies. There are many interesting studies involving Vitamin D and the role it plays in our daily lives and there continues to be a lot of controversy on the topic as well. 

 

But, with that being said, in this study children who received Vitamin D supplementation (400-800 IU per day depending on age of the child) not only had higher Vitamin D levels, they also had lower nasal symptom scores. 

 

Of course in the study they looked at Vitamin D levels pre and post treatment. But it would seem to me (being an allergy sufferer myself) that adding a daily dose of Vitamin D to my allergy regimen couldn’t hurt.  

 

There continues to be an increase in allergic disease around the world and at the same time, more and more people are seeking protection from the sun (from which we make cutaneous Vitamin D). Sun protection continues to be a good idea too. Of course, this is only one study, and further research with greater study participants are necessary. But in the meantime, you might discuss adding a dose of Vitamin D to your child’s allergy regimen with your pediatrician. 

 

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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