The Epi-Pen that talks to you!

Click here to read the article that was in the New York Times about the newest epinephrine device.

Lawmaker introduces bill requiring EpiPens in all school systems

Sen. Christopher B. Shank wants policies in place for treating students with life-threatening allergies.  A bill is being introduced requiring EpiPens in all school systems.  Read the full article here.

Childhood Asthma and Reflux

Esophageal acid reflux can trigger asthma at any age.  A study recently published in the in the Journal of Asthma suggested that children with higher intensity acid reflux (with abnormal results on esophageal pH monitoring) had more frequent or difficult-to-control nighttime asthma attacks.

It is important to consider GERD, or gastroesophageal reflux, in young children with asthma whose nighttime asthma control is difficult, especially if they are found to have no underlying allergies triggering their asthma.   The age of onset of nighttime uncontrollable asthma was younger for children with abnormal pH results:  3.63 vs. 5.77 years.

This study raises the possibility that some asthmatic children may have coexisting GERD in need of treatment.

Kwiecien J, Nachura E, Halkiewicz F, et al: Clinical features of asthma in children differ with regard to the intensity of distal gastroesophageal acid reflux.  J Asthma. 2011; 48: 366-373.

How Do Kids Describe Their Asthma Symptoms?

It is often difficult to tell what a child is feeling, and they may have a hard time describing symptoms to a parent or the doctor.  A recent study published in the medical journal, Chest, looked at the most common words used by children with moderate to severe asthma, ages 8-15 years, to describe their symptoms of moderate to severe asthma.

The most common descriptions were "My chest feels tight" and "I cannot get enough air in".  This is very similar to the way adults describe their breathlessness.  

But it is important to watch for nonverbal cues that asthma is causing trouble for your child.  Look out for night cough, or a cough triggered by cold drinks, laughter, or running.   Remember also that cough is a more common symptom of asthma than wheezing, which may or may not be heard without the aid of a stethoscope.

Harver A, Schwartzstein RM, Kotses H, et al: Descriptors of breathlessness in children with persistent asthma.  Chest. 2011; 139: 832-838.

Food allergy blood or skin tests are just a starting point

Allergy skin tests or blood tests (specific IgE to foods) are commonly used to diagnose food allergies in children, especially those with severe eczema.   However, these results are just a starting point -- oral food challenges in a systematic way are essential to developing a reasonable diet that will not trigger the eczema.  

While a large percentage of young children with moderate to severe atopic dermatitis (eczema) do have one or more food allergy triggers, and will improve with elimination of that food, often they will have several false positive results to other foods on skin testing or blood tests.

A 2011 study in the Journal of Pediatrics confirmed that 84% to 93% of implicated foods did not need to be avoided after oral challenges.  Of the 131 oral food challenges performed, only 11 were positive.

We feel that our job as allergists is not only to tell patients what they need to avoid, but also what is okay to keep in the diet.   It is often unnecessary to severely limit a child's diet, especially if based on the results of serum IgE testing alone!

Fleischer DM, Bock A, Spear GC, et al: Oral food challenges in children with a diagnosis of food allergy. J Pediatrics. 2011;158:578-583.

Treating peanut allergy through a patch

Can your peanut-allergic child be treated by simply wearing a patch? That is what researchers at National Jewish Health are researching. National Jewish Health, along with four other institutions in the Consortium of Food Allergy Research (CoFAR), are currently testing the safety of a peanut patch.

The peanut patch would work to desensitize allergic patiens by exposing them to increasing amounts of peanut protein, similar to the way allergy shots can desensitize people to pollen. The patch will release minute doses of peanut oil under the skin, like nicotine patches used by people trying to quit tobacco. The aim is to educate the body so it does not over-react to peanut exposure.

Human safety trials have started in Europe and the United States and it is hoped the patch could become available within three to four years.

One of its inventors, Dr Pierre-Henri Benhamou, said, "We envisage that the patch would be worn daily for several years and would slowly reduce the severity of accidental exposure to peanuts. The beauty of the patch is that it is absorbed just under the skin and is taken up by the immune system. But because it doesn't go directly into the bloodstream there is no risk of a severe reaction. We have carried out a number of small safety trials and now moving to trials that will establish the size of the dose needed and for how long the patch would need to be worn."

They believe that after about a year of wearing the patch, patients may be cured of a severe reaction to peanut. But it would need to be worn for several more years before a nut allergy sufferer could safely be exposed to peanut.

Dr Benhamou said, "At best we are talking about a sufferer eventually being able to eat modest amounts of peanut without a reaction. But what we want to do most is eliminate the severe reaction that occurs when people are exposed to the tiniest speck of peanut."

Read the whole article from physorg.com at http://bit.ly/dGGkAD

Exercise Improves Asthma Control

Among patients with asthma, those who are physically active use less health care.  A recent study in Europe showed that a 12-week supervised aerobic and strength training exercise program led to improved asthma control, quality of life, and aerobic fitness in 21 adults with partially controlled asthma.  The benefits were maintained with another 12 weeks of self-administered exercise.

The improvements were not supported by measurements of airflow obstruction, however there was clearly a benefit suggesting that this "natural" adjunct to asthma treatment may be helpful -- and there is no copay or authorization needed for this prescription!

Dogra S, Kuk JL, Baker J, Jamnik V:  Exercise is associated with improved asthma control in adults.  Eur Respir J. 2011; 37: 318-323.