It’s a gorgeous time of year when things are abloom. Many of us suffer from irritation and allergies to these months as pollens and particles float around and trigger allergic response. Not so beautiful when our families (over)react to pollen. Thing is, there’s also the fact that cold season isn’t quite over and the exact cause of that runny nose your child is dealing with may be hard to decipher. One hint that it’s allergies and not a cold: do you, your spouse or any of your other children suffer from seasonal allergies? Unfortunately if so, there’s a 25% chance your child will too. That said, the likelihood more than doubles when both parents deal with allergies on a seasonal basis. Watch the video above for tips on telling the difference between hay fever & the common cold and when to be on the lookout for the former. Read more »
It’s the time of year for seasonal allergies. It’s also still, unfortunately, the time of year for “colds.” Although it may be intuitive for many parents to decipher the causes of symptoms in their child during the month of May, some of us have a hard time determining what’s causing our children to wipe their nose!
In general, it’s time unfolding that helps us know if our children are beginning to suffer from allergies as opposed to another cold. If steady,unwavering symptoms of runny nose, coughing, sneezing, and/or itchy eyes persist longer than a week this time of year, allergies to pollens are likely be blame –with one caveat– if your child is a toddler seasonal allergies are far less likely. Although there are exceptions to every rule, most children don’t start to develop hay fever symptoms until around age 3 or 4 years of age after their bodies have been exposed to a few seasonal changes and pollen counts and their body starts to mount an over-reaction. Allergy symptoms are created when the body basically over-does-it to triggers (allergens) and starts an immune response to a normally harmless particle. Instead of having no response to a dandelion, for example, allergic people rapidly release a series of chemicals (including histamines) after encountering the flower that cause their eyes to itch and run, their mucus membranes to swell, and their airways sometimes to cough. There’s no sure-fire, singular way to know at first glance if your child has seasonal allergies when they start sneezing in the spring (or fall) but in general children will suffer from a constellation of symptoms and a set of circumstances: Read more »
One of the most important forms I fill out in the office is the allergy action plan. The action plan is a spelled-out, step-by-step instruction form on how to care for a child who has a food allergy in the event of an accidental ingestion. Food allergies can be serious, even life threatening, yet adults are often unprepared to respond with speed and confidence. We know that 16-18% of children with food allergies have an accidental ingestion at school.
This past weekend a friend and pediatrician showed me how she is protecting her son at his new school. Instead of only filling out the paper forms for his severe food allergy, she and her son created a Youtube video action plan. Turns out, it worked. Not only was it viewed by the teachers who may need to support him in the case of an accidental ingestion, it was broadcast throughout the school. This is the new world in which we are lucky enough to live.
If your child has food allergies, consider bringing the paperwork to life. Not only can you inform caregivers on proper use and timing of antihistamines or Epipen injection, you can confirm and review the plan with your child. All you need is a smart phone and some time on Youtube. Every child’s allergy action plan is unique. If you’re confused about when to give your child diphenhydramine (Benadryl), when to use an inhaler (albuterol), or what symptoms demand injection with an Epipen (epinephrine), don’t hesitate to call the doctor now to review.
Bringing School Paperwork to Life:
Allergy Action Plan Form courtesy of Food Allergy & Anaphylaxis Network (FAAN). The form is fantastic–there’s even a spot for your child’s photo, decreasing chances for confusion.
Pediatrician-mom Dr Lee goes behind the scenes in the making of the above video
Food allergies have more than doubled in the developed, Western World over the last 50 years and the reasons remain unclear. Yet recent data finds 8% of children in the US with a food allergy with 1/3 of those children at risk for severe or life threatening reactions. A Pediatrics study published today has some sobering news about our ability to protect children from allergic ingestions. When it comes to allergies and deadly reactions 2 things are necessary:
- Avoidance of known triggers/allergens.
- Treatment of anaphylaxis (severe reactions) promptly with epinephrine.
Trouble is, children get exposed to known allergens by mistake and people are often nervous or unsure about how and when to use an Epipen (epinephrine in a pre-measured syringe). All parents/caregivers/teachers/coaches need to practice use of an Epipen & refresh why/when to administer it to an allergic child.
- Researches followed over 500 infants and young children allergic to milk and eggs (and many to peanuts) between 3 and 15 months of age. During the 3 years of the study, the majority of children (72%) had an exposure to an allergen that caused a significant reaction. Of the allergic reactions, 42% were reactions to milk, 21% to egg, and just under 8% to peanut. Reactions were most severe when a child was exposed to peanut, followed by milk, and then egg.
- Over 1/2 of the ingestions occurred after a non-parent adult offered an allergic food. Read more »
I was interviewed this week on TV about food allergies. I’ve pushed all my inner-Cindy Brady moments aside. Watch the video below…
When F was about 13 months old his face turned bright red after he ate breakfast one morning. I eliminated all the foods he had eaten that morning– milk, oatmeal, banana and berries. He’d had all those foods many times but I was concerned he’d developed an allergy. Gradually, I introduced them back, one food at a time. Mild reactions returned (his face looked like a work of art, his ears turned red), but inconsistently, so I was confused. After strict re-introductions, I finally figured out cinnamon was causing his facial flushing. Turns out, regular oatmeal did nothing, but eating apple and cinnamon oatmeal he got all red goofy faced. To this day, F doesn’t complain when eating cinnamon, I just know he has ingested it when his face is covered in artful red spottiness.
We were lucky; F’s reaction was mild and limited to cinnamon. It’ still unclear to me if it is a true allergy. I consider him sensitive to it so I avoid serving him cinnamon whenever I can.
But I had a dagger of fear in my heart while trying to determine what was causing his facial rash for a few weeks. Like most parents who have children with allergies, I found the not knowing what was going to happen absolutely unnerving.
Allergies can be scary. Read more »
Let’s make things easier for children with life-threatening allergies. How we communicate what a child needs matters and can be essential to protect their safety but also reduce stress and anxiety for parents who worry. This week, experts in allergy and immunology at The American Academy of Pediatrics did us a favor and sorted through various allergy emergency plans living online and in doctors’ offices. Through experience with years of research on asthma action plans, the team created a Clinical Report that showcases a single, comprehensive and universal emergency plan to help ensure that parents and caregivers are ready to manage a life-threatening reaction called anaphylaxis. If you have a child or care for a child with food allergies, allergies to insects or a known risk for anaphylaxis, print one out, put it on the fridge and make sure your child’s school has it on file! The goal is to start having all families use the same form so schools, communities, sports teams and parents everywhere all get familiar.
What Is Anaphylaxis?
- Anaphylaxis is a potentially life-threatening, severe allergic reaction. I like how Food Allergy Research & Education defines it: “During anaphylaxis, allergic symptoms can affect several areas of the body and may threaten breathing and blood circulation. Food allergy is the most common cause of anaphylaxis, although several other allergens – insect stings, medications, or latex – are other potential triggers”.
- Typically, children or adults with anaphylaxis have symptoms include itchy skin, hives, shortness of breath, swelling of lips/tongue, or wheezing. Some children vomit soon after eating a food they react to and some children get diarrhea.
- Epinephrine should be given right away, in the thigh. If you ever feel you might need it, use it. Then call 911.
Strong evidence continues for babies getting peanuts before a year of age. Now, more than ever, I believe parents to babies at risk for allergies need to pay close attention during the first 6 months. Although the pendulum has swung about how, when and why to introduce peanuts to babies over the past years, more and more experts agree. There are 3 categories and 3 specific recommendations for babies. Babies at risk for allergies should get peanuts by 4 to 6 months of age, although there are conditions and specific recommendations, based on a baby’s family history and health, so read the 3 tips below carefully.
I’ve noticed with the advice swirling and moving the last decade, parents remain a bit shy about starting peanuts before a year of age. I have a comprehensive blog post, Peanuts During Infancy To Prevent Peanut Allergy, detailing the ground-breaking study (I truly don’t think I’m overstating the ground-breaking part) that came out last year. Basically, researchers found that babies at higher risk for allergies (eczema, family history of allergies, egg allergy) had less peanut allergy in life when given peanuts as babies compared to babies who waited to have peanuts. Since that time more data has unfolded that points the same direction.
Even as the data mounts, I think the shyness to introduce peanuts continues for some families. Simply because we’ve heard the opposite advice for previous years. Read on and please share this. Over the next decade we may turn some of the tide on peanut allergy.
Science shifts its weight a lot so it’s hard to register immediate trust in shifting advice. The shyness makes sense but I hope this post helps combat it. This New York Times article about why advice changes, by pediatrician Dr. Aaron Carroll, is worth your time if you’re curious about the rationale and reason for shifting medical advice. When it comes to peanuts I feel good about early introduction for nearly all children. Here’s why:
An expert panel published new guidelines in the Journal of Allergy and Clinical Immunology this month about when to introduce children to peanut-containing foods to help prevent food allergies. Here’s a summary of the panel’s report written for parents. The science, as detailed in the post I wrote last year was strongly influenced by previous research. The panel says, “recent scientific research has shown that peanut allergy can be prevented by introducing peanut containing foods into the diet early in life. Researchers conducted a clinical trial called Learning Early About Peanut Allergy (LEAP) with more than 600 infants considered to be at high risk of developing peanut allergy because they had severe eczema, egg allergy, or both. The scientists randomly divided the babies into two groups. One group was given peanut-containing foods to eat regularly, and the other group was told to avoid peanut-containing foods. They did this until they reached 5 years of age. By comparing the two groups, researchers found that regular consumption of peanut-containing foods beginning early in life reduced the risk of developing peanut allergy by 81 percent.”
How To Reduce Peanut Allergy Risk For Your Baby:
We do have to pick our battles at home. As a pediatrician I’ve never gotten too excited about advising parents to spend a lot of energy trying to rid your child of the thumb-sucking or nail biting habit. In general parents aren’t successful — peers are. Often it’s when friends or peers bring the habits up that children are motivated to stop. We can help support them by reminding them when hands are in their mouth or even having them place socks on their hands while watching television as that’s a common time for the behavior. Although many parents worry about their children sucking their thumbs and fingers, it’s a common habit, with some studies finding almost 25% of children do. Much time is spent thinking about ways to help our children quit, worrying whether germs on their hands will translate to illness and hoping it doesn’t affect their teeth. A new study today this week in Pediatrics highlights perhaps a positive effect of thumb sucking. It’s worth a mention.
Allergy Protection From Thumb-Sucking And Nail-Biting?
The study evaluated children between age 5 and 11 and their later diagnoses of hay fever, allergy skin prick testing and asthma. The premise of the study builds off the somewhat controversial concept of the hygiene hypothesis. The basic premise of the hypothesis is that germ exposure early in life can contribute to how our immune system responds as we grow and develop. We may build up tolerances and immunity that conform us into less allergic people if we have different bacteria and germs around. Basically, living in a sterile environment may not be “safer” as some believe lots of dirt, bacteria, and germs early and maybe not so many sensitivities later…
In the past theories for the hygiene hypothesis have supported a decrease risk of asthma (dirt and germs coming in from and on pets may decrease allergies or asthma later) and a small 2013 study a couple years back found those children who had parents who “cleaned” the pacifier with their own mouth may be less likely to develop allergies (theory was the bacteria transfer from mom/dad’s spit to baby changed their pattern of exposure to bacteria and possibly a tendency away from allergies and asthma later). So some researchers looked a the effects of children who have their hands in their mouths more to see if any protection comes of it — they evaluated data spanning from childhood to adulthood. Read more »
Spring has sprung and many of us are feeling that familiar itch to tidy and purge our homes & closets. One more chore to add to the spring cleaning list: clean out your household supply of over-the-counter (OTC) medicines.
Just like the dosing instructions and additional information on the label, the expiration date on the packaging is there for reason. Once a medicine has reached its expiration date, it may not provide the treatment that you need. Smart to refresh the cabinet annually. Now is the time and this weekend, ideal!
To ensure the medicines you take are both safe and effective, keep an eye on the expiration dates and safely dispose of any expired or unwanted medicines. I talked with my friend and colleague, Dr. Suzan Mazor who is an expert in toxicology and emergency medicine about expiration dates and here’s what she had to say:
Drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.”
Traditionally, I counsel families to be really careful with life-saving medicines. Injected epinephrine (for life-threatening allergies) is a perfect example — after expiration it’s less effective. So it’s a MUST to replace those injectors at home and school after expiration as they are used in acute/urgent/life-saving situations (and I’m not exaggerating). Other products like sunscreen are less effective after expiration, too. Not life-threatening but what chore to use it wisely and well and then be using an inferior product. Read more »
Having food allergies (specifically to peanuts) might prevent you and your family from attending certain events, but baseball in Seattle hopefully won’t be one of them. The Seattle Mariners are offering 5 “peanut-controlled” games this season at Safeco Field. No peanuts will be allowed in sections 313, 314 and 315 in the view box level during these games. And although fans should note that peanut-controlled does not mean the game will be entirely peanut-free, this does offer a new way to improve safety for children with serious allergies. The Mariners certainly deserve an “Atta Boy!” for this one. (More game information below).
While peanut allergies have doubled in the past decades and are reported to have tripled between 1997 and 2008, they are just one food allergy of the nearly 400,000 school-aged children who suffer from mild to severe reactions if exposed to an allergen. Some food allergies are serious and life-threatening.
One in every 13 children has a food allergy so this isn’t a rare experience for children or their families. How we support our own children and children in the environment, at school, in sports, and at our homes is also changing. We really are perhaps becoming more compassionate and sophisticated (peanut-free tables, thoughtful policies for birthday treats, more open discussions about how best to include children with dietary restrictions). The Mariners games are just a lovely example of how to do things better at scale.
When To Introduce Peanuts To Babies?
Data is still evolving for recommendations for all babies, but about a year ago (March, 2015), new recommendations (comprehensive blog post) were given regarding introducing certain foods to babies. The New England Journal of Medicine found if allergy-prone infants were introduced to peanuts early in life (between 4 and 11 months of age) their risk of peanut allergy at age 5 years significantly decreased. The current American Academy of Pediatrics policy on food allergy introduction (revised in 2008) states there is insufficient evidence to support delayed introduction of potential food allergens to reduce the risk of developing allergies. This means holding back on foods during infancy isn’t recommended! Try introducing things like wheat, egg, soy & fish before 12 months. We’re moving towards not waiting on any foods in late infancy and this data on peanuts is the beginning of understanding creating recommendations to start foods early. More data will help make these recommendations for all babies. Check in with your baby’s doctor with any questions or concerns, especially if food allergies run in the family. Read more »