NEWS TIPS FROM THE 2008 ANNUAL MEETING OF THE AMERICAN ACADEMY OF ALLERGY, ASTHMA & IMMUNOLOGY, March 14–18, PHILADELPHIA

EASE MILK ALLERGY BY – SURPRISE! – DRINKING MORE MILK

Oral immunotherapy study at Hopkins Children’s suggests it may be true, but don’t try this at home

Feeding children with milk allergies increasingly higher “doses” of milk might help them overcome, or at least ease, allergic reactions over time, according to results of a small study led by Johns Hopkins Children’s Center researchers.

Researchers compared allergic reactions to milk in 11 children ages 6 to 17 with known milk allergies. Five of the children were given increasingly higher doses of milk powder, starting at less than .001 ounces, slowly working their way up to .01 ounces over several months, and eventually consuming anywhere between .08 ounces and .2 ounces. The other six children received a placebo that tasted and looked identical to milk powder.

After six months, both groups were given milk products in a medical setting. The five children who received regular doses of the dairy substance were better able to tolerate the foods with fewer symptoms, such as hives and upset stomach, compared to the six children who took the placebo. Even though the children who increasingly consumed milk during the study had more antibodies against it in their blood, they ultimately processed the foods better than those who took the placebo. 

“Oral immunotherapy appears to slowly retrain the immune system to tolerate the allergens in milk that previously caused allergic reactions,” says Robert Wood, M.D., senior investigator on the study and director of Allergy and Immunology at Hopkins Children’s.

Food allergies have been steadily rising in the last decade and are becoming harder to outgrow, research shows. An estimated 2.5 percent of U.S. children under the age of 5 have milk allergies.

Wood cautions that the findings are preliminary, and parents and caregivers should not try to conduct oral immunotherapy without medical supervision.

SMOKING PARENTS OF ASTHMATIC CHILDREN MAY UNDERREPORT THEIR CIGARETTE HABIT

A Johns Hopkins Children’s Center study has found that the parents and caregivers of children with asthma often underestimate and underreport how much they smoke at home and around their children, giving pediatricians a skewed idea about their asthmatic patients’ exposure to secondhand smoke. Because self-reporting inaccurately gauges exposure, pediatricians caring for children living in smokers’ homes should use more reliable measures such as obtaining urine samples from children to check for secondhand smoke inhalation, researchers say.

In a study of 81 children with persistent asthma who lived with a smoker, researchers measured nicotine and particulate matter in the home, obtained urine samples from children and then compared the results to the parents’ or caregivers’ reports of how much they smoked. 

Researchers found wide discrepancies between objective tests and parental reports, and self-reports rarely matched the actual evidence. In addition, nearly one-third of parents and caregivers reported smoking in the car in the child’s presence, a red flag that exposure to secondhand smoke occurs outside of the home.

“We want pediatricians caring for children with asthma who live with smokers to be aware that parents underestimate their own smoking and to keep in mind that a child’s symptoms could be brought on by secondhand smoke,” said lead investigator Arlene Butz, Sc.D., R.N., an asthma specialist at Hopkins Children’s.  

TEENS WITH FOOD ALLERGIES TAKE RECKLESS RISKS, STUDY SHOWS

Fear of being “different,” embarrassed, isolated or teased drives teens with potentially fatal food allergies to eat problem foods anyway, and to forego carrying life-saving injectable epinephrine, according to results of a small study led by investigators at Johns Hopkins Children’s Center.

In a study of 20 teens with severe food allergies, nine reported intentionally eating foods to which they are allergic. Among 13- to 16-year-olds, only half reported always carrying an injectable epinephrine, while only one-third of those over 16 years of age said they carried the life-saving drug at all times.

“We are seeing more risky behaviors than we thought we would, and it’s troubling,” says investigator Hemant Sharma, M.D., an allergist at Hopkins Children.

Other reasons cited for the risk-taking included annoyance with food restrictions, lack of good food labeling, fashion concerns and the inconvenience of carrying an epi-pen. Children and teens who were aware of and sensitive to life-threatening reactions were more likely to carry epinephrine at all times.

“The bad news for pediatricians and parents is that children and teens with severe food allergies are doing things that put them at risk for severe, sometimes fatal, reactions,” said study investigator Hemant Sharma, M.D., an allergist at Hopkins Children’s Center. “The good news is making patients aware of the grave threat of anaphylaxis may steer them away from unnecessary risks.”

Senior investigator on the study: Robert Wood, M.D., director of Allergy and Immunology at Johns Hopkins Children’s Center.

ORGAN TRANSPLANTS CAN TRIGGER MULTIPLE FOOD ALLERGIES IN CHILDREN

Children who undergo organ transplantation often develop allergies to multiple foods within a year of receiving the new organ, and may stay allergic to some foods for several more years, according to results of a study by researchers at the Johns Hopkins Children’s Center and the Mount Sinai School of Medicine.

“Our findings show that food allergies must be on the radar of all parents and pediatricians of children who receive new organs,” says study investigator Pamela Frischmeyer-Guerrerio, M.D., Ph.D., an allergist at Hopkins Children’s. “If a child with a recent organ transplant develops gastrointestinal symptoms, a food allergy should be high on the list of suspects.”

In their study of 24 children who underwent transplantation of solid organs – heart, kidney, liver and lung among others – and were later diagnosed with food allergies, most developed the problems within the first 10 months following surgery. The most common allergies were to egg, milk, peanuts and soy. Children tended to develop several allergies – four on average – at a time. Most children (17 out of 24) were able to resume eating some foods after 14 months. However, only two out of 24 were able to resume eating all foods.

The mechanisms are unclear, but investigators suspect that immunosuppressive medications that are routinely used to prevent organ rejection may tweak the immune system causing it to attack harmless food proteins, leading to an allergy. Another possibility is that antibodies to certain foods are transferred with the new organ from an allergic donor to the patient, causing an allergy in the organ recipient.

Other Hopkins investigators in the study: Robert Wood, M.D., director of Allergy and Immunology at Hopkins Children’s.