Archive for February, 2010

Peanut Allergy Desensitization: Not Ready For Prime Time

February 23, 2010

There has been a great deal of press over the last few days about a study out of England researching the effectiveness of oral immunotherapy at reducing the allergic sensitivity of children with peanut allergy.  In this study children with peanut allergy were given increasing oral dosages of peanut protein in a controlled way over time.  The technique is called oral immunotherapy and is an oral version of standard allergy shots used to treat allergic sensitivity to things like dust mite and pollen.  Researchers found that 21 of 23 children receiving oral immunotherapy in the study were able to eat at least five peanuts a day without developing a reaction to them.

This is really great news, though this is not the first study to look at oral desensitization therapy for peanut allergy.  Other similar studies have been done in the past several years.  One study out of  Duke University was presented at the annual meeting of the American Academy of Allergy, Asthma and Immunology last March.  It showed that 4 of 9 children receiving controlled amounts of peanut protein on a daily basis for 2 1/2 years could safely eat peanuts in an uncontrolled way without developing any reaction.

It is important for parents and children to understand that this form of therapy for peanut allergy is still experimental and should not be done outside of a research setting in a hospital.  Not all studies researching this approach have been successful, and there is a real potential for severe allergic reactions utilizing this approach.  We still need to understand more about how this technique works and what aspects of the exact protocol used in the above study are responsible for its success.  There is a lot more research that needs to be done before even the most highly trained and experienced allergist can consider doing this out of his office.  And, a parent should absolutely not do this at home.  It is simply too dangerous and there are too many unknowns.

For now, people with peanut allergy need to avoid peanuts at all times.  That is the most appropriate treatment.  Ten to  20% of children with peanut allergy do outgrow the allergy and there are tests available to determine if your child has potentially outgrown peanut allergy.  You can work with your allergist to determine if this is the case and discuss whether or not your child is a candidate for an oral peanut challenge in the controlled setting of the doctor’s office or hospital.

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Acetaminophen And Asthma

February 11, 2010

Over the past 10 years there have been a number of studies published in the medical literature showing an association between the use of acetaminophen and an increased incidence of asthma. 

There are studies that report that the frequent use of acetaminophen in pregnancy is associated with an increased risk of asthma in childhood.  There is a study that reports that the use of acetaminophen in infants is associated with an increased incidence of asthma at 6-7 years of age.  And, there are studies that show that frequent use of acetaminophen in adults is associated with an increased risk of asthma. 

The incidence of asthma has been rising over the past few decades, and the reason for this has been an ongoing area of medical research.  There are several theories for this rise.  The association between acetaminophen use and asthma as shown through these various studies, is particularly interesting in light of the fact that it was in the early 1980’s that acetaminophen and ibuprofen replaced aspirin as therapy for infants and children with fever.   Infants and children stopped receiving aspirin because of an association between aspirin use and a rare, but severe, neurologic and liver disease called Reye’s Syndrome. 

And so, there is evidence that suggests that the use of acetaminophen might be an important risk factor for asthma development.   I think there is a need for more research in this area to both confirm this apparent association, and help explain it.  A better understanding of this is likely to shed significant light on asthma itself and perhaps impact future therapies.

HELPFUL HINTS FOR THE TREATMENT OF ATOPIC DERMATITIS/ECZEMA

February 9, 2010

1. Do not bathe more than once a day. Take short, warm baths. Do not use very hot or very cold water. Pat dry after bathing. Do not rub.

2. Use unscented moisturizing soaps or cleansing lotions.

3. Recommended soaps and cleansers:

  • Aquaphor Gentle Wash Cetaphil Gentle Cleansing Bar
  • Cetaphil Gentle Skin Cleanser
  • Dove Sensitive Skin Beauty Bar
  • Dove Sensitive Skin Body Wash
  • Free and Clear Liquid Cleanser
  • Vanicream Cleansing Bar

4. Apply unscented, fragrance free, moisturizing lotion, cream or ointment frequently throughout the day. Most importantly apply immediately after bathing (within three minutes of completion of bath or shower) while skin is still moist. The type or brand of moisturizer you use is not as important as using it consistently and frequently. Purchase small samples of several different moisturizers and determine which is most healing to your skin.

5. Recommended moisturizers:

  • Aquaphor Healing Ointment
  • CeraVe Cream or Lotion(Ceramide containing)
  • California Baby Super Sensitive Everyday Lotion
  • California Baby Calendula Cream (patch test first)
  • Cetaphil Moisturizing Lotion or Cream
  • Cetaphil Therapeutic Hand Cream
  • Curel Continuous Comfort Fragrance Free Lotion
  • Eucerin Original Moisturizing Cream or Lotion
  • Lubriderm Daily Moisture Lotion- Fragrance Free
  • Lubriderm Sensitive Skin Therapy Moisturizing Lotion
  • Mustella moisturizing cream
  • Neutrogena Norwegian Formula Fragrance Free Body Moisturizer
  • Neutrogena Norwegian Formula Fragrance Free Body Emulsion
  • Neutrogena Norwegian Formula Fragrance Free Hand Cream
  • Vanicream Moisturizing Skin Cream
  • Vaseline Intensive Care Derma Care
  • Vaseline Petroleum Jelly 

6. Use hypoallergenic unscented laundry detergents such as All Free Clear or Tide Free. Do not use dryer-sheets or fabric softeners.

7. Avoid wool clothing or synthetics directly on skin. Avoid wool carpets directly on skin. Wear 100% cotton clothing as much as possible. Anything that feels irritating will make your atopic dermatitis worse.