A as in Anaphylaxis, All About Allergies, Egg allergy

The Sniffle Study-why it is essential to take part in research

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Last week, we had the opportunity to take part in the SNIFFLE study, a multicentre study researching the now in the UK available flu vaccine. It has been used in the US for years and no severe allergic reactions to its content (among other ingredients, it contains egg) have been observed. The aim of the study here in the UK is to proof the safety of the vaccine for egg allergic children. The new thing about the vaccine is that it is given via the nostrils. No more needles, no more tears? We were especially looking forward to a needle free day at hospital (since it is a research project, vaccines are administered under supervision with easy access to emergency treatment).

So we happily decided to take part with our now 3 year old allergyBabe. We were welcomed with a friendly #hellomynameis, allergyBabe went straight for the train track and mum was seated in a comfy armchair. So far, so good.

After the usual observations (blood pressure, oxygen level, pulse, temperature) we were informed, consented and told that there would be a couple of skin prick tests prior to the administration of the vaccine. SKIN PRICK TEST. That means needles. So despite the fact that the vaccine is given as a spray, we still had to undergo the nasty procedure of skin pricking. Despite allergyBabe’s earlier statement not to want any needles, he was very brave and underwent the to him so familiar procedure without a big fuss. The test confirmed his egg allergy.

The vaccination itself was a walk in the park. 1 puff in each nostril, followed by one sneeze, and it was over. To make sure no delayed reaction would occur, we stayed for an hour afterwards, happily engaged in the play area. AllergyBabe showed no adverse effects whatsoever.

Around the third day, he complained about joint paint in his knees, which were gone after one dose of paracetamol. He also developed a slight head cold. Nothing else.

It was a very pleasant experience, from the initial call prior to our appointment to the courtesy call 3 days after the vaccination.

Thinking of taking part? You may think about the following:

If the aim of this study (to proof that the egg containing nasal vaccine is safe for egg allergic children) is achieved,

– egg allergic children will be able to be vaccinated with an easy and painless procedure

– GPs in Primary Care will be confident to administer the vaccine to egg allergic children

– parents will have proof that this vaccine is safe

It the above mentioned points can be achieved, it was worth the inconvenience of traveling to hospital, staying there and getting pricked.

After all, every vaccination that is performed is not only protecting the individual, but also the community in which they live and thrive.

Further reading:

Parent information sheet Oxford Groupdiscussion of the subject on mumsnet.com

WHO study listing

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A as in Anaphylaxis, All About Allergies

Sooner rather than later…

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Maybe the most raised question in the allergy community: when is the right time to apply the epipen? No doubt it is the only drug able to break the vicious cycle, and its benefits outweight the risks. But actually when is the right time for it?

Even experts discuss the issue widely and have not come up with a formal consent. Based on experience, literature and recent incidents, this is one of the most sufficient answers I have encountered yet. So please take five minutes of your precious time and read this excellent advice by M.D. Phil Lieberman.

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A as in Anaphylaxis, All About Allergies, What allergybabe wants

Food allergies and emotions – a bumpy ride

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Bona fide of dealing with a food allergy

I have been sitting over this post for quite a while now.  Doing some proper thinking and finding the right arguments takes some time, and after completing the post, reality once more caught up with me, and had forced me to gradually adapt my wording, my thinking and my opinion.

This was supposed to be about how to deal with food allergies in a calm and rationale manner. It turned out to be quite different, as you may notice when reading further on. I was all convinced how stupid it is to get hysterical about foods allergybabe is allergic to, but, I admit, I adjusted my point of view. It is now a more complex approach I laid out and if you agree, I am happy. If not, I would love to hear about your views.

As a mum of an allergic child who had 6 anaphylactic reactions by the time he was 7 month old, not knowing what had caused his extreme reactions, I consider myself to completely understand the emotions and thoughts that constantly run in a parent’s head when taking care of an allergic child.

To any of you reading this from an outsider’s perspective (a friend of a friend with allergies, a care nursery teacher, a parent of a friend of an allergic child etc.) just let me try to explain why we are the way we are. Why we are so apprehensive about foods our children are allergic to, especially with peanuts.

The rationale behind the emotions involved in food allergy or: why we are entitled to occasionally freak out…

Anyone witnessing a proper anaphylactic reaction of his child will by any means avoid it to happen again. It is a very daunting and frightening experience.

Peanuts are one of the eight most common food allergens and are one of the foods that cause anaphylaxis, the most severe form of allergic reaction, which can lead to the individual’s death. And it does not matter how rare this event may be, if it could be your child.

Peanuts can hide every where, small amounts, invisible to the eye, can stick to a door handle, a toy at nursery, a food tray, a table cloth, a takeaway and can hide within an innocent looking biscuit. Tiny amounts can harm, and it is a natural reaction to be extra cautious about it.

Media and charity groups are covering the issue extensively, constantly reminding how lethal a tiny amount can be.

Twitter and other social media tools easily amplify and distribute an individual’s biased opinion.

As it is difficult to predict the likely severity of food-induced allergic reactions, parents and sufferers are on constant alert mode to avoid the allergen.

Statistics help to judge the likelihood of a reaction within a wider population, though they cannot predict an individual’s risk profile.

Is it in any way helpful to get hysterical over a legume?

Impartiality is the widely accepted approach to any medical issue.If doctors would panic, we would not get the appropriate care. That is why there are doctors, nurses and other professional medical staff. It is not the parent who has to act as a medical professional. But what to do if the parent happens to be a trained doctor? Who has had several encounters with life threatening situations, who quite routinely ran to a CPR when the telephone rang in that all to familiar high pitched sound, listening to a computer animated voice which told you where in the hospital the patient is about to depend on your skills and professionalism to get back to life? Doctors are trained to stay calm, not to emotionally get involved, to forecast what could happen next and decide how to proceed. As a professionally trained parent, you try to stay calm and still provide the emotional support for your child without overseeing best medical care.

Others may say as long as you do the right thing, nothing seriously can happen. And I believed it, too. And than, a young girl dies in a camp in California.  A young child who knew about her allergies, who did not take changes, who was very aware of the dangers.

Once I read a mother’s comparison of her child’s food allergies: Imagine a chef would prepare your meal, and just before doing so, he filled a rat trap with poison. He did not wash his hands afterwards, he used the same equipment, he used the very same plates etc. You would be horrified because there would be that real danger of getting severely poisoned.  See the picture. That is how we, the parents, see food allergies. We are on high alert. Always. Every single day. Because you just know, that one day, out of the blue, your child will have a reaction.

We all agree now that we have to avoid all contact with allergens. Do we have to avoid it by all means? I strongly believe in an individual’s right of freedom. Do not do anything for your own sake that involves restricting anyone else’s freedom. That is part of Germany’s Grundgesetz (German Constitution) and I am a strong believer in its profound value. How can it be applied to protecting food allergy sufferers? Where does individual safety and freedom end? Is society to be restricted for the sake of an individual’s health? Should the majority of people be denied to enjoy food because of a minority getting uncomfortable being surrounded by it? Where do we stop to demand and support from society? Is it ok to ban peanuts and other nuts from school halls and nurseries? Should the majority of people be denied to enjoy food because of a minority getting uncomfortable being surrounded by it? Do food allergic people have a right to ask for peanut free buffer zones on a plane? The questions do not stop here.

Can we allow grocery stores to sell peanuts? Is it ok to deny a child to feed the squirrels a handful of peanuts on the playground? Can we accept that other children will have a snack while playing on a common ground? Can a fellow tube rider have a guilt free snicker?

If you expect an answer, you are mistaken. I do not have an answer. But if you have ever witnessed a life threatening reaction, you will do anything to avoid it a second time.

You will do anything not to risk your child’s life ever again. Full stop.

I guess in the future, society will have to decide how high on a pedestal they put the individual’s needs and how much we are willing to limit freedom of the majority.

*This post was inspired by all the brave parents who care restlessly for their food allergic children and the following two articles:

http://www.princeton.edu/main/news/archive/S37/46/79G28/index.xml?section=topstories#top

http://www.sciencedirect.com/science/article/pii/S0277953613002657

This blog and its entire content is by no means intended to represent professional medical advice. Please contact your medical professional for any medical concerns you may have.

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All About Allergies

Which came first – the chicken or the egg?

This commonly known causality dilemma is one of the most fundamental philosophic questions evoking investigations about the beginnings of life and the universe in general since ancient times. So I found it quite interesting that latest research seemed to have found the solution to another, not so much philosophical but more immunological, interrogation:

“Which came first, eczema or food allergy”?

Or, in other words, is eczema the result or the cause of food allergy in infants?

Carsten Flohr, Gideon Lack et al. from King’s College London published their findings this July Journal of Investigative Dermatology .

To find out what causes food sensitization in young infants, they tested more than 600 three month old babies which were breastfed exclusively. The focus of examination was

– existence of atopic dermatitis (‘exzema’)

– severity of atopic dermatitis

– location of atopic dermatitis (flexural vs non-flexural)

– skin gene mutation, known as ‘Filaggrin loss of function’

– skin prick test (cow’s milk, egg, cod, wheat, sesame, and peanut)

Interestingly enough, children with eczema were significantly more likely to be sensitized (adjusted OR=6.18 (95% CI 2.94–12.98, P<0.001) regardless of the other examined factors as Fillagrin mutation and type of eczema. The severer the eczema, the more likely a child was to show a positive skin prick test.

This study shows quite nicely that in non-orally (exclusively breastfed) sensitized infants, atopic dermatitis is a major risk factor for food sensitization. It could mean that the skin and its immune structures (antigen presenting cells) lead to sensitization when affected by eczema.

Interestingly, this study is align with other findings of the group from King’s College London (Dr. H. Brough) which proved dust containing active peanut particles in the home of early sensitized infants.

To sum it up, London research strongly suggests that eczema is one of the key factors to develop a sensitization to foods in early life.

As always, this article does by no means professional advice. Please always consult with your health professional.

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A as in Anaphylaxis, All About Allergies

How to find the right nursery for your allergic child

Even the thought of having someone else taking responsibility for allergybabe gave me goosebumps.

After all we went through together, 24/7, day and night, I was very uncomfortable to leave our well established safety zone, our castle of protection, into a new and dangerous outside world.

On the other hand, allergybabe is our first and so far, only child. He needed to be around other children, other people with different stimuli and a different language (not just english, but british english…).

So I gave it a try. Equipped with a heavy suit of armour, we were ready to conquer the non allergy friendly world and so far, succeeded.

For over a year now, allergybabe (who is 2,5 years now) is at a very caring nursery, playing happily along his peers and learning something new every day. What makes it such a good and healthy experience is, that we constantly talk about anything that occurs. From management to the practicioners and the catering staff, I could not be more pleased.

But how to find the right nursery? Here is some advise that helped me with my decision:

  • Ask if the staff has had any previous experiences with food allergic children. It is always easier to go somewhere someone else has implemented the rules and procedures then to do it all from scratch.
  • Ask as many questions and meet as much staff as possible. A truly caring nursery will always be happy to answer as many questions as possible.
  • Find out if staff get regular emergency training including Epipen (or other adrenalin devices) training?
  • Drop the word ‘cross contamination’. How familiar are they with it? Can they explain their measures to avoid accidental exposure?
  • Ask about an established plan to proceed in case of emergency. If they not have a plan, are they willed to set one up with professional support?
  • Are they comfortable to give emergency medication?
  • Can the catering provide allergy friendly meals?
  • ask yourself if you feel comfortable with the nursery and the responsible people (management, practicioners, etc.). If you do not feel comfortable, do not  proceed.

Once you have found an appropriate place, do not forget you are a team and that you have to continously work together to avoid an allergic reaction:

  • It is very helpful to have one person as the main responsible carer and one person of the management staff you can turn to all the time. In building a trustful relationship, it is much easier to pass on new information or to raise concerns. They will also get used to your child’s individual case, which is important when allergy symptoms occur, when food has to be ordered, medicine has to be applied or other decisions have to be made.
  • Point out, on a regular basis, how important it is to avoid cross contamination and oral allergen contact. The longer the child has not had a reaction, the easier it is to forget to be vigilant at all times.
  • Ask them to show you how an Epipen works by using the trainer pen. Routine is the best friend in emergency situations.

Have you had any experience about finding a nursery, babysitter, nanny or school for your little one? Are you more comfortable with a nanny who is solely responsible or with a nursery, were contamination may be more likely, but a team of people are there to take care? Is it important to have peers to learn and play with? Would love to read some comments.

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All About Allergies

Get out your magnifying glasses!

I foster a strong aversion towards food labels. Microlettered, hidden, inconsistent and constantly changing, they make shopping, even for a confessing shopaholic like me, deeply miserable.

Would there be a list of the most read words in the allergy community, the following two would be heading it:

MAY CONTAIN”

So it is very good news the IRMM (institute for reference materials and measurements) received funding to further investigate methods to minimise cross contamination in factories to reduce the usage of “may contain”.

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