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Author: Stephen J. Klemawesch, MD

True food allergy or not, baby tummies still hurt

True food allergy or not, baby tummies still hurt

 Uppercase terms for longer names of ailments are very common. The ones mentioned here are the two most common mimics of true food allergy in infants.

Symptoms of FPIES (food protein-induced enterocolitis syndrome) are vomiting/reflux with diarrhea, and of FPIAP (food protein-induced allergic proctocolitis), colic and diarrhea. Blood (either visible or microscopic) in the stool is common with both.

FPIAP tends to occur at younger ages, often in the first two weeks of life, and occurs in infants who are exclusively breast-fed and those receiving formula. FPIES emerges later at around 5-8 months.

The allergic antibody IgE, which is the driving force for traditional food allergy and other allergic conditions, apparently isn’t involved.

The leading cause for both conditions is cow milk protein, accounting for 71% of FPIAP, and 79% of FPIES. The next most common cause is soy. This is especially problematic when the infant is bottle-fed as the next common protein base for infant formula (after cow milk) is soy. Much less common causes include eggs, lentils, grains, fish, meat and nuts.

Diagnosis confirmation can be obtained in a clinical setting by doing an oral food challenge where the suspected food is purposefully given after a period of avoidance, and then observing for the symptoms.

For a mother who is exclusively breastfeeding her baby, removing the food from the mother’s diet cures the problem.

Some good news is that more than 90% of children outgrow these problems by age 2. Unfortunately, about 20% of these afflicted children will go on to develop traditional food allergies.

 

Possible swelling misery relief from hereditary angioedema

Possible swelling misery relief from hereditary angioedema

Many people among us contend with unknown-to-us dreadful conditions. Periodically in this newsletter, we highlight new research that could lead to a truly better life for some of our neighbors.

One such challenge is hereditary angioedema (HAE) – a genetically inherited disorder that leads to severe, and sometimes life-threatening, swelling throughout the body. Often-affected areas are the extremities, gut, face and airway. A deficiency of the protein C-1-esterase inhibitor is the culprit. Lack of this protein allows a build-up of kallikrein, kininogen and bradykinin, causing the tissue swelling.

Fairly early-stage research reported recently in the New England Journal of Medicine into the use of Lanadelumab in treating HAE revealed startling positive results. These monoclonal antibodies removed kallikrein through bi-weekly administration by subcutaneous injection. The result showed almost complete cessation of the swelling attacks.

Additional studies will be required before the FDA approval can be forthcoming, but if use of Lanadelumab proves to be safe, it will be a major improvement in preventive therapy for HAE.

 

This genetic deficiency often brings long-term threat of lung damage

This genetic deficiency often brings long-term threat of lung damage

Alpha-1 Antitrypsin Deficiency (AATD) is an uncommon – but not rare – genetic disease that seriously affects the lungs, occurring in about one of every 3,000 people.

Alpha-1 Antitrypsin (AAT) is an enzyme that protects our lungs from protein damage and neutrophil elastase. Neutrophils are one of the white blood cells in our blood stream that migrate into our lungs to help kill microbial viruses and bacteria. In the normal state of affairs the neutrophils release elastase and other chemicals that kill the microbes – which then need to be “mopped up,” so as not to hurt lung tissue.

This is the job of AAT; but if a person is deficient in AAT, the clean-up doesn’t occur, which leads to gradual chronic damage to the lungs. Neutrophils also respond to counter cigarette smoke and pollution.

The most common indicator of disease is onset of emphysema in younger adults. It can also play a role in COPD (Chronic Obstructive Pulmonary Disease), and some forms of asthma. In asthma that is difficult to control or poorly responsive to the usual therapies, AATD should be considered. It can also be a cause of bronchiecstasis (a difficult condition in which the airways slowly lose their ability to clear out mucus, leading to chronic damage and serious lung infections.)

The severity of the AAT deficiency and, thus the disease, can vary depending on inherited alternative forms of a gene. The level of AAT ranges from totally absent, to severely reduced to moderately reduced.

Patients whose level of AATD is below 11 micromoles can benefit from intravenous replacement therapy of the Alpha-1 enzyme.

 

Hand sanitizer: Easy, but too much of a good thing?

Hand sanitizer: Easy, but too much of a good thing?

Dear Dr. K: I have red, itchy, peeling eyelids and my dermatologist said it’s most likely due to using hand sanitizers. But I don’t use the sanitizers on my face, so how can that be true?

Your dermatologist is probably right. The hand/face connection is an interesting dichotomy. The skin on our hands is some of the thickest and toughest on our bodies; while the skin on our faces – especially on the eyelids – is among the thinnest and most sensitive.

Hence, using the “miners’ canary” analogy, the face will show an irritant or allergy much sooner than the hands. Thus, you don’t get the clue that your hands are the source of your facial rash via secondary contact.

Thirty years ago a social biologist studied how frequently human beings touch their faces. It’s an amazing number of times during the day, yet if you ask people how often they do it, they grossly underestimate the frequency.

Hand sanitizers have leapt ahead of other causes for dermatitis in the past few years. From their use on entry into grocery stores, to purse-sized sanitizers to baby wipes and personal hygiene products.

The American Board of Dermatologists recently found that more than 50% of nurses in the United States have experienced dermatitis due to hand sanitizers. The ethyl-alcohol that is a common component of many products is very drying. This produces microscopic fissures in the skin which then destroy the protective barrier, allowing other chemicals in the sanitizer to penetrate and cause irritation and/or allergy.

Other common causes for eyelid dermatitis via the hand include artificial nails, nail polish, nail hardeners, hand lotions and metal jewelry (rings). Gardeners often experience similar eyelid rash from handling certain flowers. The most common culprits: tulip, lily, chrysanthemum, daisy, marigold and sunflower.

Bakers can also get eyelid dermatitis from touching flour and yeast.

 

Q – Tips: fish oil during pregnancy

Q – Tips: fish oil during pregnancy

· Having pregnant women take cold-water fish oil during pregnancy reduced the risk for asthma in their children by 30%. So showed research at the University of Copenhagen. In general, modern diets tend to run low in the n-3 polyunsaturated fatty acids found in fish. These oils are known to reduce inflammation.

 

Q – Tips: Peanuts

Q – Tips: Peanuts

·  The National Institutes of Allergy and Infectious Disease recommends the introduction of peanut to infants of allergic parents between the ages of 4 and 11 months, as a proven strategy to avoid the development of severe peanut allergy later in childhood.

 

Our intestinal microbiodome — so crowded; so constantly busy

Our intestinal microbiodome — so crowded; so constantly busy

A recent article in The New England Journal of Medicine points out that the human GI tract contains up to 10-million different microbial species. This review of the human intestinal microbiome found bacteria, fungi (yeast), viruses, archaea (specialized bacteria with a resistant cell wall) and algae. More than a billion years of co-evolution of mammals and their gut flora has led to a complex interdependency of the mammal and the microbes, and the microbes with one another.  Humans today are dependent on their gut flora for  important biologic functions including: development of normal immunity, protection against pathogens, elimination of various toxins, regulation of intestinal function, neurologic signaling, bone-density maintenance, synthesis of essential vitamins and neurotransmitters, plus providing 10% of our daily energy requirements. Studies of abnormal gut flora in humans and mouse models have shown a correlation with a variety of Alist serious health issues: cancer, diabetes, asthma, atherosclerosis and autism. The studies also cited improvement through use of specific probiotics. Two bacteria with long names (Christensenellaceae and methanogenic orchaea) are found in lean people with healthy metabolism, but are absent in obese persons with Type II diabetes and insulin resistance. In a study of genetically predisposed infants for Type I diabetes, the introduction of probiotics in their first month of life reduced their risk of developing diabetes by 60%. In studies of people with atherosclerosis, they were found to have a gut flora that broke down the protein in their diet to a chemical that speeds up plaque deposits in arteries.  Research in children of asthmatic parents found that early introduction of probiotics in infancy reduced the risk for developing childhood asthma by 30%. In a mouse model of autism it was found that abnormal gut flora led to an increased production of 4ethylphenylsulfate (4EPS). Improving gut flora with a countering bacteria reduced the 4EPS by 50% and led to a marked improvement in the mouse behavior. Finally, in human cancer studies it was found that taking a probiotic with bifidobacterium improved the response to chemotherapy for melanoma. Also, the probiotic Lactobacillus casei was shown to inhibit progression of colon cancer.

Heavy metals in blood increase asthma

Heavy metals in blood increase asthma

Having elevated levels of the heavy metals lead and cadmium does result in an increased incidence of asthma, as demonstrated in recently published research from Brown University.

Elevated lead levels can be seen in children living in homes with old-fashioned lead paint, and in adults with workplace-exposure to lead fumes.

Elevated cadmium levels are typically only seen due to industrial workplace exposure.

The heavy metals cause a shift in TH1/TH1 response, thus leading to much greater production of IgE, the allergic antibody that causes asthma.

The next phase of the research at Brown University if to see if reduction in the heave metals in the blood stream leads to amelioration of the asthma.