Twitter Facebook RSS Feed Print
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

Pink Eye

1:30 to read

This is another time of the year that I see a lot “pink eye”.  Any time the eye is pink..you have “pink eye”, which mothers seem to be quite confused by!!   They often comment…”this is pink eye?” , to which I respond, “well, the child’s eye (conjunctiva) is pink (red), so yes…this is pink eye”.  The term is just a description of the eye….but then you need to determine why the eye is “pink”.

 

Conjunctivitis is one of the most common causes of a pink eye….and there are many different types of conjunctivitis.  As with any condition the history is really important in helping to determine why a child’s eye is inflamed.  Several of the most common causes of the “pink eye” are bacterial, viral and allergic conjunctivitis.

 

Bacterial conjunctivitis often shows up in younger children and they have lots of matting of the eye lids and lashes and a mucopurulent discharge (gooey eyes). Some moms say that the “goo of gunk” comes as quickly as they can wipe it.  The child often has a lot of tearing and will rub the eyes as they feel that something is in their eye and it is irritated.  Bacterial conjunctivitis will typically resolve in 8 -10 days on its own, but antibiotic eye drops are used to shorten the course  of the pink eye and also reduce the contagiousness.  It seems as if every child in a day care class room will get conjunctivitis as they constantly rub their eyes and touch toys!!  Hand washing helps….but you can’t wash a child’s hands every time they touch their eyes.

 

Viral conjunctivitis usually occurs in combination of with systemic viral illness. Sore throat, fever and bright red eye are often seen in older children and teens and is due to adenovirus.  While the eye is red, the discharge is typically watery and matting is much less common. These patients are contagious for up to 12 days so it is important to practice good eye/hand hygiene, especially in the household. Artificial tears may help the feeling of eye irritation, but antibacterial eye drops rarely help except in cases of a secondary infection.  I get many phone calls from parents saying, “we tried prescription eye drops and they are not working”. I make sure to tell my older patients to take out their contacts and wear glasses for 7-10 days.

 

At this time of year I am also seeing a lot of seasonal allergic conjunctivitis.  These children have intensely itchy and watery eyes, as well as swelling of the eyelids and area surrounding the eyes. They look like they have been crying for days as they are so swollen and miserable. Many also have a very watery nasal discharge. They do not have fever. Using over the counter medications for allergy control, such as nasal steroids and anti-histamines will help some of the allergic symptoms. There are also over the counter eye drops (Zaditor, Patanol) that help when used daily.  During the worst of the season I make sure that the child has daily hair wash and eyelash and eyebrow wash with dilute soapy water to make sure the pollen is removed after they have been playing outside. It is nearly impossible to keep a child indoors for the 6 or more weeks of allergy season!

 

Daily Dose

Allergy Suffering Continues

Allergy suffering continues with itchy eyes, nasal congestion and sneezing. Dr. Sue explains how to treat season allergies.With pollen blowing across the country and “the worst spring allergy season in 10 years” in the headlines I thought I would follow up with a second blog on treating seasonal allergic rhinitis (SAR).

As discussed previously I typically begin seeing seasonal allergic symptoms of runny nose, sneezing, itchy eyes and cough in children after the age of 2, and more typically around 4 years of age.  Prior to that most physicians think that recurrent viral respiratory infections account for many similar symptoms in the toddler age group. Parents who are convinced that their 8 month old baby has allergies this spring are most likely facing their child’s first “cold” as allergic symptoms to pollens are brought on after repeated exposure, so we therefore see the symptoms later on.  Allergies do seem to be hereditary so a child who has two allergic parents has between a 50-80 % chance of developing those seasonal allergies. Seasonal allergies at this time of year are typically due to pollen from trees, and will then be followed by grass and weed allergies. By far the best way to prevent the misery associated with SAR is to begin a nasal steroid spray early in the spring in order to help prevent the histamine release that occurs when  microscopic pollen particles enter the nasal passages.  For children with known allergies I typically begin nasal steroids in mid March. The histamine release in the body following exposure to the offending pollens will cause all of the seasonal allergic rhinitis (SAR) symptoms.  On top of using a nasal steroid children who have classic allergic shiners (darkened areas beneath their lower eyelid), clear watery nasal discharge with frequent sniffing and/or blowing or throat clearing, cough and sneezing may benefit from taking a daily anti-histamine. (in other words to fight the histamine release that has already occurred).  There are both 1st and 2nd generation anti-histamines. The 1st generation antihistamines are the older drugs that often cause sedation or drowsiness but are still excellent antihistamines.  Examples of these are Benadryl (see recall info for this product), Tavist, Dimetapp, and Triaminic products that are all available over the counter.  I use Benadryl (see recall info for this product) most frequently as there are so many different choices as to dosing methods. Many allergists also feel that if one class of anti-histamine does not work to try another, so many people have their own favorite medication. The newer 2nd generation antihistamines such as Claritin, and Zyrtec (se recall info for this product) are now available OTC also and come in both liquid and chewable preparations.  There are also prescription products in this group such as Allegra, and Clarinex and Xyzal.  These antihistamines are labeled non-sedating and are usually given once a day.  Again, one child may prefer one brand over another and some do not have a chewable or liquid option so are used in older children and adolescents. There are also other drugs that are used to combat allergy symptoms and these drugs may be used in combination with antihistamines and nasal steroid sprays.  Decongestants help constrict blood vessels and shrink the nasal mucous membranes and may improve nasal congestion.  The most common medications are Sudafed which is pseudoephedrine (now found behind the medicine counter) and Sudafed-PE which contains the decongestant phenylephrine.  These decongestants may also be found in nasal sprays to use topically, but if used locally within the nose may cause actual rebound symptoms of more congestion so are not recommended for use as a nasal spray for more than 3-7 days. Therefore it is preferred to use systemically to avoid that problem.  Decongestants may also cause hyperactivity and insomnia so I rarely recommend them for use in the evening in children. Singulair which is a leukotriene inhibitor (anti –inflammatory) may help relieve nasal allergic symptoms as well as the allergic cough, especially in children who have frequent night time coughs during allergy season. It comes as both granules, chewables and pills and may be given to children down to 2 years of age, especially those that have asthma as well as nasal allergies. Lastly, there are antihistamine nasal sprays now available but they have the problem of “really tasting badly” and I find most children will not use them. There are also several good eye drops for those that get seasonal allergic conjunctivitis (SAC) several of which, Zaditor and Patanol are now available OTC and older children find them quite helpful. Despite this huge armamentarium of products, no one (or two or three) will totally prevent symptoms. So make sure that your child bathes or showers after playing outside, including washing their hair, to get the pollen off of their skin and hair.  It is also helpful to wipe off the dog or outside cat with a dryer sheet to get some of the pollen off of the pets. While I love to sleep with the windows open and ceiling fans going, if your children suffer from SAR you are better off keeping windows closed and the AC on. That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue!

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!! 

 

 

 

Tags: 
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.

Tags: 
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

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!

Your Toddler

Thumb Sucking and Nail Biting Linked to Fewer Allergies

1:30

An interesting new study out of New Zealand suggests that young children who suck their thumbs or bite their nails may be at a lower risk for developing allergies.

The study included data from 1000 children born in New Zealand in 1972 or 1973, and spanned three decades.

While the results of the study suggests these habits may lower children’s risks of developing allergies, researchers noted that they are not recommending that kids take up these habits, only that the habits may play a role protecting them against allergies into adulthood.

 "Many parents discourage these habits, and we do not have enough evidence to [advise they] change this," said Dr. Robert Hancox, an associate professor of respiratory epidemiology at the University of Otago in New Zealand. "We certainly don't recommend encouraging nail-biting or thumb-sucking, but perhaps if a child has one of these habits and [it] is difficult [for them] to stop, there is some consolation in the knowledge that it might reduce their risk of allergies.”

The researchers asked the parents of the children participating in the study about their kids’ thumb-sucking habits and nail-biting habits four times: when the kids were 5, 7, 9 and 11 years old. Researchers also tested the children for allergies using a skin-prick test when they were 13, and then followed up with the kids again when they were 32.

It turned out that 38 percent of the children who had sucked their thumbs or bit their nails had at least one allergy, whereas among kids who did not have these habits, 49 percent had at least one allergy.

Moreover, the link between these childhood habits and a lower risk of allergies was still present among the study participants when they were 32 years old. The link persisted even when the researchers took into account potentially confounding factors that may also affect a person's risk of allergies, such as whether their parents had allergies, whether they owned pets, whether they were breast-fed as infants and whether their parents smoked.

By the time the children were 13 years old, researchers found that the ones who both sucked their thumbs and bit their nails were even less likely to have allergies compared with children who had just one of the two habits. However, by the time they were 32, this association was no longer found.

The study was published in the July edition of the journal Pediatrics.

The results of this study are inline with another study published in 2013, which found that children whose mothers sucked their kids’ pacifiers clean had a lower risk of developing allergies.

"Although the mechanism and age of exposure [to pathogens] are different, both studies suggest that the immune response and risk of allergies may be influenced by exposure to oral bacteria or other microbes," the researchers wrote in the new study.

The new findings also lend support the so-called hygiene hypothesis, which holds that environments that have too little dirt and germs may make children more susceptible to certain conditions, including allergies. It seems that "exposure to microbial organisms influences our immune system and makes us less likely to develop allergies," Hancox told Live Science.

Kids that suck their thumbs or bite their nails, receive mixed reactions from adults. Most adults will encourage kids to stop biting their nails, while it’s probably 50/50 on the thumb sucking. Either way, it appears that oral bacteria may play a role in lowering the risks of developing allergies in kids.

Story source: Agata Blaszczak-Boxe, http://www.livescience.com/55340-children-thumb-sucking-nail-biting-allergy-risk.html

 

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

Can q-tips harm your baby's ear?

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.