Comments on: Highlights from the 2009 Allergy Meeting http://www.pediatricallergyindy.com/2009/03/23/highlights-from-the-2009-allergy-meeting/ Pediatric Allergist Frederick E. Leickly - Indianapolis, Indiana Wed, 01 Feb 2012 20:04:37 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: Rachel http://www.pediatricallergyindy.com/2009/03/23/highlights-from-the-2009-allergy-meeting/comment-page-1/#comment-91 Rachel Fri, 24 Apr 2009 17:05:49 +0000 http://leicklystory.wordpress.com/?p=259#comment-91 Thank you for your reply. Yes, it is hard to know when you get back the positives, when it is multiple foods, if it is all the foods. We obviously cut out all the foods and his skin is no longer bothering him and the stools are normal. This was after months of skin and stool problems (all other testing from the GI were normal). However, since so many things came back positive, I wish there were a way to know if it is indeed all the foods or just one (or two). We had months on end of the mucusy loose stools along with the eczema. After testing, we cut out the foods, and his skin and stools improved to being quite normal. Therefore, I really do believe that the food was causing his problems. I just wish I knew which ones exactly. Maybe it is indeed all of them, but it would be nice to find out for sure which ones so we have more choices to feed him. Is there any testing that can be done for this? We would love to be part of the clinical trial--if you get to do one--for the peanut allergy. I realize a lot of information would have to be gathered and collected to see who would be able to participate. If anything does open up in your office, please let us all know. Thank you for your reply. :) I do enjoy reading your blog containing the food allergy posts. Thank you for your reply. Yes, it is hard to know when you get back the positives, when it is multiple foods, if it is all the foods. We obviously cut out all the foods and his skin is no longer bothering him and the stools are normal. This was after months of skin and stool problems (all other testing from the GI were normal). However, since so many things came back positive, I wish there were a way to know if it is indeed all the foods or just one (or two). We had months on end of the mucusy loose stools along with the eczema. After testing, we cut out the foods, and his skin and stools improved to being quite normal. Therefore, I really do believe that the food was causing his problems. I just wish I knew which ones exactly. Maybe it is indeed all of them, but it would be nice to find out for sure which ones so we have more choices to feed him. Is there any testing that can be done for this?

We would love to be part of the clinical trial–if you get to do one–for the peanut allergy. I realize a lot of information would have to be gathered and collected to see who would be able to participate. If anything does open up in your office, please let us all know.

Thank you for your reply. :) I do enjoy reading your blog containing the food allergy posts.

]]> By: fleickly http://www.pediatricallergyindy.com/2009/03/23/highlights-from-the-2009-allergy-meeting/comment-page-1/#comment-92 fleickly Thu, 23 Apr 2009 21:11:13 +0000 http://leicklystory.wordpress.com/?p=259#comment-92 Thank you for your comments. I am glad we got the milk issue settled with the food challenge. Historically, we have been doing food challenges when the specific IgE for that food is below a critical level. This gives us a margin for safety. For some of the foods, these critical levels have not been established. In the past we have done these food challenges to see whether or not a child has outgrown a food allergy (IgE-mediated). At the AAAAI meeting, we were introduced to a study (abstract) where a food challenge was performed to help sort out if the positve specific IgE was relevant. Sometimes panels of foods are done and results are positive yet the food was never suspected to bother the child. In some panels foods that the child was never exposed to are also done. Today we had an infant who was specific IgE tested to shrimp, scallops, walnuts all because it was part of a panel offering by the laboratory. So when a test is done and there is no history of reactions, a food challenge helped open a door . We also have to have a reaction to the food that is immediate- remember some reactions to foods are not always due to IgE. Diarrhea, pain, mucus can easily be due to a number of reasons. The exciting work with peanut is still a research protocol. I do not know where it stands regarding FDA approval. We have a large number of children with peanut allergy and I would relish the opportunity to be a part of a large clinical trial. We retest about every year. We also are careful about the age of the child who undergoes a food challenge. FEL Thank you for your comments. I am glad we got the milk issue settled with the food challenge. Historically, we have been doing food challenges when the specific IgE for that food is below a critical level. This gives us a margin for safety. For some of the foods, these critical levels have not been established. In the past we have done these food challenges to see whether or not a child has outgrown a food allergy (IgE-mediated).
At the AAAAI meeting, we were introduced to a study (abstract) where a food challenge was performed to help sort out if the positve specific IgE was relevant. Sometimes panels of foods are done and results are positive yet the food was never suspected to bother the child. In some panels foods that the child was never exposed to are also done. Today we had an infant who was specific IgE tested to shrimp, scallops, walnuts all because it was part of a panel offering by the laboratory. So when a test is done and there is no history of reactions, a food challenge helped open a door .
We also have to have a reaction to the food that is immediate- remember some reactions to foods are not always due to IgE. Diarrhea, pain, mucus can easily be due to a number of reasons.
The exciting work with peanut is still a research protocol. I do not know where it stands regarding FDA approval. We have a large number of children with peanut allergy and I would relish the opportunity to be a part of a large clinical trial.
We retest about every year. We also are careful about the age of the child who undergoes a food challenge.
FEL

]]> By: Rachel http://www.pediatricallergyindy.com/2009/03/23/highlights-from-the-2009-allergy-meeting/comment-page-1/#comment-93 Rachel Thu, 23 Apr 2009 20:08:15 +0000 http://leicklystory.wordpress.com/?p=259#comment-93 I am very curious about the possibility of doing more food challenges. We just finished the milk challenge in your office, and passed w/o problems. He outgrew this allergy. We are dealing with SEVERAL food allergies, only peanut and egg with visual (hives, swelling) dangerous reactions. The others (wheat, soy, and the past milk) caused eczema, stomach pains, and mucus/loose stools. However, we've been told by the skin test that he's also allergic to apples, oranges, and beef. It's VERY difficult to feed him, and I'd love more information about challenging any of these foods along with desenitizing the reaction to peanuts. I'm also a teacher, and realize the real danger the kids face going to school. It would be comforting to know he would possibly be able to tolerate up to 12 peanuts worth before he had a reaction. Any additional information on your notion to more food challenges, would be great. Both his skin and blood test agree with one another, except there are obviously things the blood test does not test for that came back on his skin. Do I try these foods at home myself (apples, oranges, beef -- the ones that aren't dangerous) one at a time to see if he has problems? Very interesting, thank you for sharing! I am very curious about the possibility of doing more food challenges. We just finished the milk challenge in your office, and passed w/o problems. He outgrew this allergy. We are dealing with SEVERAL food allergies, only peanut and egg with visual (hives, swelling) dangerous reactions. The others (wheat, soy, and the past milk) caused eczema, stomach pains, and mucus/loose stools. However, we’ve been told by the skin test that he’s also allergic to apples, oranges, and beef. It’s VERY difficult to feed him, and I’d love more information about challenging any of these foods along with desenitizing the reaction to peanuts.

I’m also a teacher, and realize the real danger the kids face going to school. It would be comforting to know he would possibly be able to tolerate up to 12 peanuts worth before he had a reaction.

Any additional information on your notion to more food challenges, would be great. Both his skin and blood test agree with one another, except there are obviously things the blood test does not test for that came back on his skin. Do I try these foods at home myself (apples, oranges, beef — the ones that aren’t dangerous) one at a time to see if he has problems? Very interesting, thank you for sharing!

]]> By: fleickly http://www.pediatricallergyindy.com/2009/03/23/highlights-from-the-2009-allergy-meeting/comment-page-1/#comment-97 fleickly Fri, 27 Mar 2009 01:23:22 +0000 http://leicklystory.wordpress.com/?p=259#comment-97 The work at Duke by Dr. Burks is exciting and shows great promise. He is an excellent researcher and with the expertise from Dr. Hugh Sampson (Dr. Sampson was Dr. Burks and my mentor during our fellowship together at Duke University back in the last century) and his group, we should be offering something in the very near future to help take some of the fear out of peanut allergy. I see a significant number of peanut sensitive children- it would be great if we could be a site for any early studies of this procedure. As far as the other issue on foods. The history should take the lead. I would hesitate if anaphylaxis was the reason for pursuing allergy tests, however if some of the items were 'tag along' results without any relevent history, there may be a chance to reasses and whittle down a lengthy list of food allergy. In hope of offering some hope and help, FEL The work at Duke by Dr. Burks is exciting and shows great promise. He is an excellent researcher and with the expertise from Dr. Hugh Sampson (Dr. Sampson was Dr. Burks and my mentor during our fellowship together at Duke University back in the last century) and his group, we should be offering something in the very near future to help take some of the fear out of peanut allergy. I see a significant number of peanut sensitive children- it would be great if we could be a site for any early studies of this procedure.
As far as the other issue on foods. The history should take the lead. I would hesitate if anaphylaxis was the reason for pursuing allergy tests, however if some of the items were ‘tag along’ results without any relevent history, there may be a chance to reasses and whittle down a lengthy list of food allergy.
In hope of offering some hope and help,
FEL

]]> By: Melissa Knapp http://www.pediatricallergyindy.com/2009/03/23/highlights-from-the-2009-allergy-meeting/comment-page-1/#comment-96 Melissa Knapp Thu, 26 Mar 2009 22:44:28 +0000 http://leicklystory.wordpress.com/?p=259#comment-96 Sorry, my husband who posted the question meant desensitization that Dr. Burk is doing at Duke. We have two boys with food allergies. I have found your blog very interesting.....especially regarding the RAST test. Our oldest son is 7yrs old and was diagnosed with multiple food allergies...wheat, egg, soy, milk, peanut, and tree nut, with skin test and then the RAST. He went into anaphylasis with cows milk and we did a food challenge last October for Soy hoping the test results were just being skewed due to his peanut allergy. He did not pass and had to be given epinephrine. We have thought of sending him to National Jewish, but have been told that they would not feel comfortable doing a challenge due to his RAST numbers being so high. And, he no longer has eczema since we removed those foods from his diet so the RAST shouldn't be elevated b/c of eczema. What are your criteria for doing a food challenge on a child? We are very hopeful in regards to Dr. Burk's study and are just wondering how long it would possibly be before our son could benefit from it. Thanks much, Melissa Sorry, my husband who posted the question meant desensitization that Dr. Burk is doing at Duke. We have two boys with food allergies. I have found your blog very interesting…..especially regarding the RAST test. Our oldest son is 7yrs old and was diagnosed with multiple food allergies…wheat, egg, soy, milk, peanut, and tree nut, with skin test and then the RAST. He went into anaphylasis with cows milk and we did a food challenge last October for Soy hoping the test results were just being skewed due to his peanut allergy. He did not pass and had to be given epinephrine. We have thought of sending him to National Jewish, but have been told that they would not feel comfortable doing a challenge due to his RAST numbers being so high. And, he no longer has eczema since we removed those foods from his diet so the RAST shouldn’t be elevated b/c of eczema. What are your criteria for doing a food challenge on a child?
We are very hopeful in regards to Dr. Burk’s study and are just wondering how long it would possibly be before our son could benefit from it.
Thanks much, Melissa

]]> By: fleickly http://www.pediatricallergyindy.com/2009/03/23/highlights-from-the-2009-allergy-meeting/comment-page-1/#comment-95 fleickly Thu, 26 Mar 2009 21:46:52 +0000 http://leicklystory.wordpress.com/?p=259#comment-95 My pleasure1 Immunotherapy- I tend to abide by the established guidelines for this from the American Academy of Allergy, Asthma, and Immunology (AAAAI). I will also refer to the World Health Organization as well as to the American College of Allergy, Asthma, and Immunology. I was taught that immunotherapy (IT) is considered for those who have side-effects from medications and they are miserable, for those in who medications do not work and they are miserable, or if someone can't remember to take the medications and they are miserable. So there are criteria, and being miserable helps with the decision. They work best for nasal allergy, the track record for asthma is 50/50 for effect and of note in the recent asthma guidelines, IT is not indicated for the more severe (class 5 or 6) asthmatic. There is no evidence for effect or safety when given to children under age 5 years- in my practice the child has to be at least 5 to consider the program. IT is life-saving for bee sting allergy. It is not indicated for food allergy, nor for atopic dermatitis or hives. It is a commitment on behalf of the physician and the patient. There is a mandatory 30 minute office wait after the injection is given. The duraton of the program is 5 years. IT is usually thought as being injections. There is significant research ongoing regarding other forms of IT, but we do not have the same materials available that are being used in European studies. So, sublingual therapy or drops are a ways off. This is a big topic, probably worthy of a page on this blog. Hmmm. Thanks for the inquiry, I hope this helps, FEL My pleasure1
Immunotherapy- I tend to abide by the established guidelines for this from the American Academy of Allergy, Asthma, and Immunology (AAAAI). I will also refer to the World Health Organization as well as to the American College of Allergy, Asthma, and Immunology.
I was taught that immunotherapy (IT) is considered for those who have side-effects from medications and they are miserable, for those in who medications do not work and they are miserable, or if someone can’t remember to take the medications and they are miserable. So there are criteria, and being miserable helps with the decision. They work best for nasal allergy, the track record for asthma is 50/50 for effect and of note in the recent asthma guidelines, IT is not indicated for the more severe (class 5 or 6) asthmatic.
There is no evidence for effect or safety when given to children under age 5 years- in my practice the child has to be at least 5 to consider the program.
IT is life-saving for bee sting allergy. It is not indicated for food allergy, nor for atopic dermatitis or hives.
It is a commitment on behalf of the physician and the patient. There is a mandatory 30 minute office wait after the injection is given. The duraton of the program is 5 years.
IT is usually thought as being injections. There is significant research ongoing regarding other forms of IT, but we do not have the same materials available that are being used in European studies. So, sublingual therapy or drops are a ways off.
This is a big topic, probably worthy of a page on this blog. Hmmm.
Thanks for the inquiry, I hope this helps,
FEL

]]> By: Michael Knapp http://www.pediatricallergyindy.com/2009/03/23/highlights-from-the-2009-allergy-meeting/comment-page-1/#comment-94 Michael Knapp Thu, 26 Mar 2009 21:21:44 +0000 http://leicklystory.wordpress.com/?p=259#comment-94 I just discovered your blog. Thanks so much. At what point do you feel you might be comfortable doing immunotherapy and will it be limited to certain allergens? Thanks for your response. I just discovered your blog. Thanks so much. At what point do you feel you might be comfortable doing immunotherapy and will it be limited to certain allergens?

Thanks for your response.

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