Widely used pesticides and chlorinated water may be contributing to the increased frequency of food allergy. Researchers at Albert Einstein College of Medicine have found a strong correlation between urinary levels of dichlorophenols and the incidence of food allergy. Both children and adults who had measurable levels of the chemicals in their urine were much more likely to have food allergy. Dichlorophenols are commonly found in household pesticides, those used on fruits and vegetables and also in chlorinated tap water. The researchers felt these chlorine chemicals somehow weaken the body’s food tolerance, thus allowing the allergy to develop.
Food protein-induced enterocolitis syndrome (FPIES) has recently been reported to occur from orange juice, a previously unrecognized cause. FPIES mimics food allergy, but it is not mediated by IgE (Immunoglobulin E), the usual allergic mechanism. It is an acute inflammation of the GI tract, caused by a food protein that leads to nausea, vomiting and diarrhea. Frequently, affected children become dehydrated and require IV fluids. The condition is often mistaken for a GI flu until the causal association with a food protein is recognized. The most common cause for FPIES is cow milk. The diarrhea seen with cow milk ingestion is often bloody and, hence, quite startling to unsuspecting parents of infants who develop FPIES.
Other well-recognized causes: rice and soy protein. The newly described cause is fruits (including apple, pear and banana) and most recently, orange juice. Unlike with food allergy, children with FPIES have no rash, angioedema or respiratory symptoms. Also, the reaction (unlike with food allergy which tends to be immediate) is generally delayed two-to-four hours after ingestion of the trigger food. Because FPIES is not a classic allergic condition, it cannot be diagnosed by allergy testing. The best method for diagnosis is recognizing the suspected food as an antecedent to the symptoms. Also, oral food challenge tests can be conducted to confirm the diagnosis.
Food ingestion anaphylaxis caused by mites is a newly described syndrome, as detailed by the World Allergy Organization in this month’s Journal of Allergy and Clinical Immunology. Until recently mite allergy was best recognized as a major cause for allergic rhinitis and asthma via the inhalation of the microscopic mites. Millions of allergy sufferers actually receive allergy shots for this mite allergy. Over the years occasional case reports would appear in the medical literature about airway anaphylaxis; that is, sudden and severe closure of the airways due to an inordinate inhalational dose of mite, such as from spilling a vacuum cleaner bag. But until recently, there had never been reports of anaphylaxis from the ingestion of mites.
The new syndrome has been dubbed oral mite anaphylaxis (OMA), or also “pancake syndrome,” because the primary source of ingested mites is from wheat flour contaminated with mites — and for some reason, this occurs most often in pancake mix. The syndrome occurs primarily in warm, tropical or sub-tropical locations where temperature and humidity favor the proliferation of mites in certain foods. In some cases the wheat itself was mistakenly assumed to cause the reaction because the presence of mites was not initially suspected. Also, the patient may live in a northern clime, but have a reaction from wheat or flour mix produced in a tropical area.
Unfortunately, cooking does not inactivate the mites in terms of allergenicity. Other common foods that have been implicated are pizza dough, beignets, polenta, grits and scones.
Taking precautions in known MRSA environments worth it From football locker rooms to ALF patient rooms, there is a surge in the number of otherwise healthy people developing Methicillin-resistant Staphylococcus Aureus, better known as MRSA. The dreaded MRSA is a difficult- to-treat, multi-drug-resistant staph infection.
One way to protect yourself if your school or your mother’s nursing home is having an outbreak is to practice good hand-washing, and to use Mupirocin (Bactroban), anintranasal prescription topical antibiotic that kills MRSA.
Dear Dr. K: With the massive damage still being shown on TV from the flooding by Hurricane Sandy, what illnesses are those residents facing? A timely study recently released by the medical College of Wisconsin recently reported on a study of patients developing Vocal Cord Dysfunction (VCD), a mimic of asthma, due to environmental exposure in water-damaged work environments. Water-damaged environments have long been recognized as a cause for a variety of respiratory illnesses, including infections, rhinitis, sinusitis and asthma. This is due to the indoor dampness and the attendant mold growth, both of which impact the respiratory system. Until now, VCD had not been described in this setting.
VCD is the inappropriate approximation of the vocal cords during inhalation. That is, the vocal cords move together while breathing in, instead of moving apart the way they are supposed to behave. This results in inspiratory wheezing, coughing, hoarseness and chest tightness. Asthma, on the other hand is an expiratory illness – that is, the wheezing and restriction of air movement is primarily during exhalation, not inhalation. This is an important distinction because the various inhalers and medications that benefit asthmatics don’t help people with VCD.
Other recognized causes for VCD include extrinsic irritants, cleaning solutions, machine fluids, cooling fumes, dust, smoke, eucalyptus, the fixative glutaraldehyde, xerographic toner and other chemicals and scents. It can also occur for psychogenic and neurogenic reasons. It is important to recognize VCD as the correct diagnosis, since the primary effective therapy is avoidance of the provoking environment. Speech therapy directed at improving laryngeal control has additional benefit.
• Bothered by scents or perfumes when at
church or the theater? Try using the over-the-counter
nasal spray NasalCrom. It works by stabilizing the
mast cells in your nose that are stimulated by the scent
• If your ears and sinuses block while flying,
try pre-medicating with oral Mucinex and nasal Afrin
decongestant spray. Also keep yourself well-hydrated
(water, not alcohol) during the flight.
• Updating your international vaccination
record? Recommended adult vaccines:
Flu, pneumonia, shingles and whooping cough.
• This is oak season, so these are timely reminders:
keep windows and doors shut. Leave your shoes outside.
Wipe off pets’ paws before they return inside.
The Mayo Clinic recently completed a long-term study of asthma and other inflammatory illnesses, including inflammatory bowel disease (IBS), rheumatoid arthritis, diabetes and coronary heart disease. They found that asthmatics had a greater incidence of these other four inflammatory conditions than non-asthmatics in their study.
There was roughly a 20 percent greater likelihood for these other four illnesses in asthmatics. This is a very strong association that had only previously been suspected. The Mayo study done in thousands of people indicates just how compelling this association is.
The researchers had two conclusions:
First: Physicians who treat asthmatics should be aware of the greater risk their patients have for other inflammatory diseases.
Second: More basic research needs to be done to ferret out the underlying causes for inflammation as a disease instigator.