Allergy App?

There is an interesting article referenced on the front page of the Indianapolis Star Monday October 31, 2016  .
The article actually is on page 3A and continues on 14A. It has an eye-catching title, “Think you have allergy? There’s an app for that”.
I am an allergist- one could say that my perspective is slanted and self-serving. I have looked at this with a critical eye. There are a number of things to ask about this app.
The article mentions that testing at an allergist can run as much as $1,200- be careful or now total cost would be $1,499.99 when you add the cost of the ‘app’.
Now I am confused. An ‘app’ in current context is a program or software, designed to fulfill a specific purpose as downloaded to a mobile device. So for $299.99 I can download this allergy app to my Iphone and have allergy testing done and since I have the app, I can continuously use it to monitor my ‘allergies’ in the same manner that I would use Waze to navigate traffic? Or each time I ask the app for service is that another $299.99 of cost generated? Is it a one and done ‘app’?
I first thought that the app would include a lancet for my mobile device for the blood extraction and the wherewithal to make the allergy diagnosis on site without any need to wait two weeks for results.
There are a few talking points on this.
1. I did not see anywhere that this was IgE vs. IgG. IgE is the antibody responsible for type I hypersensitivity reactions. IgG is not linked to any adverse clinical condition (Choosing Wisely Campaign)
2. The specific allergens were general categories- many commonly used panels for the blood testing of allergy contain items that are not seen in Indiana (Bermuda grass). All too often Food Panels contain foods that the child has never ingested. These types of tests have high false positive levels and cannot be used to predict allergy.
3. Allergy testing has been available for many years- through the specialists and through blood tests that are frequently used by primary caretakers. This app provides a diagnostic tool in the hands of the patient, avoiding the need for primary or specialty care.
4. I agree with Dr. Holbreich and I would add that the eye is critical but so are the ears and what is between the ears-the knowledge, training, and experience with allergy. The medical history is the critical part of the evaluation- the experienced ears listen to the story of cause/effect relationships and the expertise of the allergist decides what to look for.
5. I also agree that the safety of this app and the value may lie in the non-detectable result- no detectable antibody and the app diagnoses no allergy. (Any comments on the false negative rates on this?).
Safety? In the world of food allergy there is a concept called tolerance. Observations from oral immunotherapy and from performing oral food challenges indicate that even though antibodies (IgE) are made against a food and that food is ingested without any allergic problems, then there is immunologic tolerance. If that food is avoided, due to a test result and was previously eaten without symptoms, tolerance could be lost and an allergic reaction may occur.
6. Tests like this often include extra comments – like highly or very allergic. They only indicates the presence of the antibody. Severity is not predictable by a skin test nor by a blood test (see the National Guidelines for The Diagnosis and Management of Food Allergy 2010).
7. I would wonder if this is a yes or no type of test- is antibody there yes or no. Blood tests done in our IU Health Lab return with a concentration of IgE antibody per volume (kU/L). Through the allergist’s eyes this reflects the risk of a reaction with exposure. As an example, a blood test for milk would be positive at 0.8 kU/L, but at that value, the risk of an allergic reaction to milk would be <5%.
8. Interpretation, guidance, action plans, natural history, verification, questions, and treatment are then offered – by whom, with what credentials.
Other than having the test available for the patient, this is not new. There are a number of issues to be concerned about.
An allergy app that is needed is one that can quickly tell a mom or dad who happens to be grocery shopping for their food allergic child that a product poses a risk. A bar code scanner that links known allergies of the user to the scanned information on the product.
FEL 10/31/2016

October 31, 2016 · fleickly · No Comments
Tags:  · Posted in: Allergies, Allergy Testing

Teal Pumpkin Halloween

Teal Pumpkin Project.
 
Monday is Halloween- I recall when I was a cub scout (only a few years ago) at our Halloween Pack meeting all the cubs (now being a Cleveland Indian fan I do not want to mention anything related to that team in Chicago- Go Tribe!) would come to the meeting dressed up in their Halloween costumes.
 
Each of us had to say a little quip. My mom was the den leader and she put this together for me;
‘Three hundred and sixty four days of the year, I am a cowboy or farmer, but on Halloween, my secret dream is to be a knight in armor.”
 
My usual costume involved a lot of cardboard, tin foil, and a used KFC bucket for my helmet.
 
Halloween should be fun for kids and families. It is scary and can even be more scary because of what may lurk in the ‘treat’ part of trick or treat for a food allergic child.
 
The tradition is candy- and lots of it. The problem is that candy can contain, may contain, and may be made on the same machinery with foods that cause allergic reactions. The smaller individual packages may not have a label that lists contents.
 
Word of advice- and our patients have heard me say this before- If you do not know what is in the product- DO NOT EAT IT!
 
The Teal Pumpkin project is a welcome answer for a safe Halloween for the food allergic children. The founders clearly challenged the tradition that the treat needs to be a food. I looked at the Halloween rules and I did not see a bylaw indicating that all treats must be food.
 
Those who try to forward food allergy awareness (FARE) suggest that a Teal Pumpkin be there to greet the young ghouls, goblins, Steves (minecraft-Calvin), princesses, and knights etc. who march to your door and demand a NON-FOOD TREAT FROM YOUR TEAL PUMPKIN- or you will be tricked.
 
Last year we set up our Teal Pumpkin in our Allergy Clinic. This year, FARE sent one to us as well. Always with the parent’s permission, we allow the youngster to pick a treat from our Halloween bowl.
 
I should know better- I held the bowl out for a family of kids to make choices and I think I was standing there patiently waiting for 20 minutes before all were satisfied.
 
Have a safe TEAL Pumpkin Halloween- from all of us at IU Health North Pediatric Allergy.
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October 29, 2016 · fleickly · No Comments
Tags: , ,  · Posted in: Allergies, Allergy in Children, FARE, Food Allergies, Food Allergy Community Events

Grass Pollen Levels Overpower Ragweed Levels for Late September

Indianapolis Pollen Counts for the first day of fall 2016

Hard to believe that grass pollen is at a higher level than ragweed. The grass pollen counts have been low for most of September, however today the count was 12 grains of grass pollen per cubic meter of air sampled for the day. That puts grass in the moderate level.

Ragweed was low at 4 grains.

I am very grass pollen sensitive. Today was a sneezeorama! The grass pollen is probably from the ornamental grasses in the area. They still can generate a sneeze.

FEL 9/22/2016

September 22, 2016 · fleickly · No Comments
Tags: , , , ,  · Posted in: Grass pollen, Grass Pollen Counts, Pollen Counting, Pollen Counting- Indianapolis, Ragweed, Ragweed Pollen Counts, Seasonal Allergies, Seasonal Allergies-Pollen Counts

Indianapolis Pollen Counts for mid-September 2016

Once again, long overdue- Ragweed is out there. Over the past week the levels were mostly in the moderate range (10-49 as defined). This past weekend the ragweed count was low at 6 grains of ragweed pollen per cubic meter of air sampled for the day. The other weed counts were low with nettle and the chenopod weed species present. Of note, nettle has a very long pollenating season!

There have been low to moderate levels of grass pollen. I saw this last year as well. September is not the typical ‘grass’ pollen season in our area.

september-19-2016

 

 

 

 

 

 

FEL 9/19/2016

September 19, 2016 · fleickly · No Comments
Tags: , , ,  · Posted in: Pollen Counting, Pollen Counting- Indianapolis, Ragweed, Ragweed Pollen Counts, Seasonal Allergies, Seasonal Allergies-Pollen Counts

Flu Vaccine and Egg Allergy Children 2016

There are two major organizations who have provided flu vaccine guidance; the American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC).

Thankfully, the recommendations have been very similar.

The AAP is child-focused and has the input from the American Academy of Allergy, Asthma, and Immunology (AAAAI) as well as the American College of Allergy, Asthma, and Immunology (ACAAI). The CDC also has significant input into their recommendations and they are intended for all age groups. In our allergy clinics we abide by the AAP recommendations.

 

From the AAP

 

All children with egg allergy can receive influenza vaccine with no additional precautions from those of routine vaccinations.

 

The Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology, states that special precautions regarding medical setting and waiting periods after the administration of IIV to egg-allergic recipients beyond those recommended for any vaccine are no longer warranted. Therefore, the algorithm used beginning in the 2011–2012 influenza season to guide vaccination precautions on the basis of the severity of the allergic reaction to eggs is not necessary.

 

The CDC statements (from the MMWR) regarding egg allergy are as follows;

 

 

  • Removal of the recommendation that egg allergic recipients should be observed for 30 minutes post vaccination for signs and symptoms of an allergic reaction.  Providers should consider observing all patients for 15 minutes after vaccination to decrease the risk for injury should they experience syncope, per the ACIP General Recommendations on Immunization.
  • A recommendation that persons with a history of severe allergic reaction to egg (ie., any symptom other than hives) should be vaccinated in an inpatient or outpatient medical setting (including, but not necessarily limited to hospitals, clinics, health departments, and physician offices), under the supervision of a health care provider who is able to recognize and manage severe allergic conditions.The egg-allergic population is at no increased risk of a severe reaction to the flu vaccine due to egg content and as with all vaccine policies, flu vaccines should be given in environments that are equipped to handle severe allergic reactions.

The egg-allergic population is at no increased risk of a severe reaction to the flu vaccine due to egg content and as with all vaccine policies, flu vaccines should be given in environments that are equipped to handle severe allergic reactions.

FEL 9/14/2016

September 14, 2016 · fleickly · No Comments
Tags: ,  · Posted in: Egg Allergy, Influenza vaccine

Indianapolis Pollen Counts September 1-7, 2016

Ragweed counts have been up elevated for the past week.

September started with high counts for the first two days, followed by moderate counts for three days, and recently two days in a row of high counts. On Thursday (9/1/2016)we had the highest count so far at 251 and the past two days we have had 177 (Tuesday) and 208 (Wednesday).

The other weeds have been in the low to moderate level. More of the chenopods seen especially today.

september-7-2016

 

 

 

 

 

FEL 9/7/2016

September 7, 2016 · fleickly · No Comments
Tags: , , ,  · Posted in: Pollen Counting, Pollen Counting- Indianapolis, Ragweed Pollen Counts, Seasonal Allergies-Pollen Counts, weed pollen counts Indianapolis

Indianapolis Pollen Counts August 26-29, 2016

Moderate and high ragweed counts for the past four days- just high, not very high. Very high counts are more than 500.

August 26, 2016 (Friday) – 82 high

August 27, 2016 (Saturday) – 59 high

August 28, 2016 (Sunday) – 45 moderate

August 29, 2016 (Monday) – 140 high

August 29, 32016

 

 

 

 

 

 

FEL 8/29/2016

August 29, 2016 · fleickly · No Comments
Tags: , , , ,  · Posted in: Pollen Counting, Pollen Counting- Indianapolis, Ragweed, Ragweed Pollen Counts, Seasonal Allergies, Seasonal Allergies-Pollen Counts, Weed Pollen, weed pollen counts Indianapolis

Indianapolis Pollen Counts for Thursday August 25, 2016

The total weed count was high at 166. Ragweed made up 156 of this total. The other weeds were nettle and chenopods.

August 25, 2016

 

 

 

 

 

 

FEL 8/25/2016

August 25, 2016 · fleickly · No Comments
Tags: , , , , ,  · Posted in: Pollen Counting, Pollen Counting- Indianapolis, Ragweed, Ragweed Pollen Counts, Seasonal Allergies, Seasonal Allergies-Pollen Counts, Weed Pollen, weed pollen counts Indianapolis

Indianapolis Pollen Counts for Wednesday August 24th, 2016

Ragweed makes up most of the pollen count for today (and for most days). The total weed count was 61 which included ragweed, chenopods, and nettle. The ragweed contribution to the 61 is a count of 59 grains of ragweed pollen per cubic meter of air sampled for the day.

At 59, the count is high. Last year on this day we had a count of over 400.

August 24, 2016

 

 

 

 

 

 

FEL 8/24/2016

August 24, 2016 · fleickly · No Comments
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Indianapolis Pollen Counts for Tuesday August 23, 2016

The total weed count was high at 100 grains of weed pollen per cubic meter of air sampled for the day. Ragweed again is the predominant weed. The ragweed count was high at 89. The other weeds were at a moderate level of 11. These weeds were nettle and chenopods.

August 23, 2016

 

 

 

 

 

 

FEL 8/23/2016

August 23, 2016 · fleickly · No Comments
Tags: , , , ,  · Posted in: Pollen Counting, Pollen Counting- Indianapolis, Ragweed, Seasonal Allergies, Seasonal Allergies-Pollen Counts, weed pollen counts Indianapolis