No need to delay introduction of food allergens to high-risk babies

Joint statement by the Canadian Pediatric Society and the Canadian Society of Allergy and Clinical Immunology

Babies who are at high risk of developing a food allergy can be exposed to potential food allergens as early as 6 months of age, according to a joint statement by the Canadian Paediatric Society (CPS) and Canadian Society of Allergy and Clinical Immunology (CSACI).

“Delaying dietary exposure to potential allergens like peanuts, fish or eggs will not reduce your child’s risk of developing a food allergy,” said Dr. Edmond Chan, paediatric allergist and co-author of the statement. “However, once a new food is introduced, it is important to continue to offer it regularly to maintain your child’s tolerance.”

Babies are considered at high risk of developing a food allergy if they have a parent or sibling with an allergic condition, such as atopic dermatitis, a food allergy, asthma or allergic rhinitis. The statement says that while these foods can be introduced to high-risk babies, the decision about when should be individualized and based on the parents’ comfort level. The CPS advises parents who are unsure to talk to their physician.

“We also don’t recommend avoiding milk, egg, peanut or other foods while pregnant or breastfeeding,” said Dr. Carl Cummings, co-author of the statement and chair of the CPS Community Paediatrics Committee. “There is no evidence to support the theory that avoiding certain foods during this time will prevent allergies in children.”

Food allergies affect approximately 7 per cent of Canadians. Some research suggests food allergy in babies is increasing, affecting over 10 per cent of one-year-olds.

Note: This refers to infants who have not yet developed a food allergy.  Complete avoidance of the food remains crucial if the child has a confirmed allergy. Allergic children should always have immediate access to an epinephrine auto-injector to treat symptoms of anaphylaxis.

Click this link to read the complete  position statement: http://www.cps.ca/documents/position/dietary-exposures-and-allergy-prevention-in-high-risk-infants 

The Canadian Paediatric Society is a national professional association that promotes the health needs of children and youth. Founded in 1922, the CPS represents more than 3,000 paediatricians, paediatric subspecialists and other child health professionals across Canada.

The Canadian Society of Allergy and Clinical Immunology works to advance the knowledge and practice of allergy, clinical immunology, and asthma for optimal patient care. The Society is also dedicated to improving the quality of life of people with allergies through research, advocacy, and continuing professional development and public education.

Last updated: Dec 2 2013

Dr. Becker explains the CHILD Study

Click on the link below for an excellent explanation of today's allergy related questions and the goals of the CHILD Study.

http://www.youtube.com/watch?v=SIHtECA2PFg&feature=youtu.be

e-Cigarettes, Hookahs Increasingly Popular Among Teens

Caroline Cassels

Electronic cigarettes (e-cigarettes) and hookahs are gaining popularity among teens, but there has been no decline in students' cigarette smoking or overall tobacco use, new research shows.

Data from the 2012 National Youth Tobacco Survey show that recent e-cigarette use rose among middle school students from 0.6% in 2011 to 1.1% in 2012; among high school students, it rose from 1.5% to 2.8%. Hookah use among high school students rose from 4.1% to 5.4% from 2011 to 2012.

The findings are published in the November 15 issue of Morbidity and Mortality Weekly Report.

The authors of the report suggest that the rise in the use of e-cigarettes and hookahs may be due to increased marketing, availability, and visibility of these products and the perception that they may be safer than traditional tobacco products.

The report authors also note that e-cigarettes, hookahs, cigars, and certain other types of new tobacco products currently are not subject to US Food and Drug Administration (FDA) regulation.

The FDA has stated that it will issue a proposed rule that would deem products meeting the statutory definition of a tobacco product subject to the Federal Food, Drug, and Cosmetic Act.

"This report raises a red flag about new tobacco products. Cigars and hookah tobacco are smoked tobacco ― addictive and deadly. We need effective action to protect our kids from addiction to nicotine," Tom Frieden, MD, MPH, director, Centers for Disease Control and Prevention (CDC), said in a statement.

The report also points out that tobacco products characterized as cigars include little cigars, many of which look very similar to cigarettes but are taxed at a lower rate and can be sold individually rather than by the pack and therefore are more affordable for teens.

Little cigars, the authors note, can also be made with fruit and candy flavors that are banned from cigarettes. CDC data show that more than 1 in 3 middle school and high school studies who smoke cigars use flavored little cigars.

"As we close in on the 50th anniversary of the first Surgeon General's report on the dangers of smoking, we need to apply the same strategies that work to prevent and reduce cigarette use among our youth to these new and emerging products," Tim McAfee, MD, MPH, director of the CDC's Office on Smoking and Health, said in a statement.

MMWR. 2013;62:893-897. Full article

Great Food Allergy Blog for teens by a teen!

Are you the proud owner of a teen with food allergies?  Have them check out this great blog designed by a food allergic Winnipeg teen.  Through the blog, the teen shares her struggles and successes as a high school student with allergies.  Click the link below to read positive and funny food allergy stories and find delicious recipes.  

http://nevernuts.tumblr.com/post/59495372461

An Emerging Epidemic: Food Allergies in America

The statistics are startling. 15 million Americans have food allergy, a potentially life-threatening disease. Almost 6 million of them are children. Every 3 minutes, a food allergy reaction sends someone to the emergency department.

Right now, there is no cure – and the smallest amount of the wrong food can have tragic consequences.

In this powerful but heartwarming documentary narrated by Steve Carell, Discovery Channel examines the struggles of families and individuals with life-threatening food allergies, their journey to navigate the dangers around them, and the growing hope for a cure.

Watch the show!

http://www.discoverychannelcme.com/patient-education/food-allergies

An Emerging Epidemic: Food Allergies in America

In this powerful but heartwarming documentary narrated by Steve Carell, Discovery Channel examines the struggles of families and individuals with life-threatening food allergies, their journey to navigate the dangers around them, and the growing hope for a cure.

Watch a preview of the show!

http://www.discoverychannelcme.com/patient-education/food-allergies

Premiering Saturday, September 7 AT 8AM ET/PT (7 AM in Winnipeg)

Sucking on Your Baby's Soother...Good Practice or Bad Habit?

Introduction: 

Allergies are very common in industrialized countries. Children in industrialized countries typically live in cleaner environments and are exposed to less bacteria. Researchers believe that exposure to bacteria helps protect children from developing allergies.  Researchers are interested in what families do that may affect the development of their baby’s immune system. Some parents clean their baby’s soother by putting it in their own mouth before giving it back to the child.  Is this healthy for the child?

Research question:  Does a parent sucking on their baby’s soother to clean it have an affect on the development of allergies in the baby?  

What was done:

Researchers in Sweden followed 184 children from birth to 3 years. 80% of the children had at least one parent with allergies putting the children at higher risk for also developing allergies.

Families were interviewed at birth and again 6 months later.

Researchers collected the following information:

·         the baby’s use of soothers (pacifiers)

·         method of cleaning the pacifier (tap water, boiling or the parent putting it in their own mouth)

·         information about the child’s health, diet and medication use for the first year

·         how the baby was born (vaginally or by cesarean section)

·         type and amount of bacteria in the baby’s and mother’s saliva

A pediatric allergist assessed the children at 18 months and at 3 years to see if they had developed environmental or food allergies, eczema or asthma.

Children were divided into 2 groups:

·         Parents who cleaned the pacifier by boiling it or with tap water

·         Parents who cleaned the pacifier by sucking on it before giving it back to the baby

Results: 

Being born vaginally offered some protection against the development of asthma.

Parents sucking on the baby’s soother also offered some protection against the development of asthma.

These two factors together offered the most protection.

Viral infections, such as colds, did not seem to get passed on to the child by the parents putting the pacifier in their own mouth.

Children whose parents sucked the pacifier were three times less likely to have eczema and asthma at 1.5 years of age, as compared with the children of parents who did not do this.

Conclusion: 

Children need to be exposed to bacteria to develop a healthy immune system.

Saliva is a good source of viruses and bacteria and sucking on a baby’s soother may be a good way to expose young children to bacteria that is needed.

In the future, will doctors recommend this habit to parents of children at high risk of developing allergies?  More research is still needed to help determine this.

PEDIATRICS, volume 131, number 6, June 2013, Pacifier Cleaning Practices and Risk of Allergy Development. Hesselmar B, Saalman R, Aberg N, Adlerberth I, Wold A.

"The Allergy Epidemic: Are Filipino Children at Greater Risk?"

Allergies have become increasingly more common in Canada and in the Philippines. Are Filipino children at greater risk? 

Please see Dr. Andrea Fong's article published in the Pilipino Express: 

http://www.pilipino-express.com/news/2111-the-allergy-epidemic.html.

Information from the study will help researchers compare the rates of allergic diseases in Filipino children with the information they have on the general Winnipeg and Canadian populations. It will also allow them to compare it with the rates of allergic diseases in children in the Philippines where a similar survey has been done. 

It is important that Filipino parents of all children younger than 18 years old, regardless if they have allergies or not, participate in this survey. Enrolment criteria is one or both parents must be of Filipino ancestry and their child(ren) must be under 18 years of age, with or without food allergies.

The survey the can be accessed online at www.surveymonkey.com/s/filipinoallergy.

Filipino children between the ages of 11 - 17 can also fill out the survey themselves by going to 

www.surveymonkey.com/s/filipinoallergyteen.

ARE WE TOO CLEAN? GERMS MAY BE OUR BEST FRIENDS!

The human body is home to about 100 trillion microbes, bacteria, or organisms. Many of these live on our skin and in our intestines (gut).

A lot of these bacteria are harmless and many are very helpful. Only a tiny number are disease causing germs. Ideally, they live together in a fine balance keeping us healthy and preventing the disease causing bacteria from making us sick.

Researchers at the University of Colorado are learning just how important it may be to our overall health to keep these organisms growing and in balance. A healthy balance means a healthy immune system, which helps to prevent infection, chronic diseases including allergy and asthma, and even cancer.

A baby’s balance of bacteria in its gut begins as it passes through the birth canal.The balance changes with breast feeding and the introduction of food. By age 3, the baby’s gut bacteria is similar to the parents.

The environment we live in influences the balance of the microbes in our bodies. For example, people living on a farm seem to have lower rates of asthma and allergies, possibly because they are exposed to more bacteria in their environment. They may have a greater variety of protective bacteria. People living in the same home tend to have a similar bacterial balance. Exposure to certain animals, such as dogs, sometimes affects the balance in a good way.

Sadly, our bacterial balance is changing because of our diet, lifestyle, antibiotic use, and the cleanliness of our environment. Researchers are starting to think that the increase in chronic diseases such as asthma, may begin in the gut. The bacterial imbalance may affect the health of the lining of the intestines, affecting the immune system.

What are some things we can do to restore or keep our bacterial balance in check?

• Take antibiotics only when needed.
• Maintain a healthy diet: by avoiding processed foods, eating more whole grains and complex carbohydrates, eating lots of fruits, raw or lightly cooked vegetables, as well as fermented foods such as kimchi, yoghurt and sauerkraut.
• Be reasonable about cleanliness. Allow children to get dirty, play with pets and play in the great outdoors. Children need to be in contact with all kinds of germs in our environment in order to develop a healthy immune system.
• Hug, kiss, and get close to your baby. Smothering them with love AND germs will do them good!

Source: Some of my Best Friends are Germs by Michael Pollan, New York Times, May 2013

Early Environmental Determinants of Asthma Risk in a High-risk Birth Cohort

Introduction:

Asthma is a complex disease resulting from both genetic and environmental influences. Some studies have shown that exposure to certain indoor particles (eg from tobacco smoke, dust mites, viruses, pets, etc) early in life seems to increase the chance of developing asthma. Others have found these same environmental exposures have no effect. The CAPPS (The Canadian Childhood Asthma Primary
Prevention Study) researchers wanted to look at environmental factors that influence the development of asthma in children who are genetically at higher risk of developing asthma.  

Children are genetically at higher risk of developing asthma if at least one parent or a sibling has asthma or, at least two of parents or siblings have allergies or eczema. 

Research question:

What factors increase the chances of high risk children developing asthma by 7 years of age?

Can certain changes in the environment protect these children from developing asthma?

What was done:

Researchers followed 380 mothers of high risk children from the third trimester of pregnancy till the child was 7 years old.

The families were randomly assigned to the intervention group or the control group.

Families were from Winnipeg and Vancouver

The intervention group: Researchers helped theses families reduce exposure to house dust mite, tobacco smoke, and pets in the home.  Breast feeding was encouraged and solids were delayed until the child was 6 months old.

The control Group: The control group followed the usual care with advice from their doctors and no input from researchers. 

Both groups' indoor environment was assessed during home visits before the birth of the child, and at 2, 4, 8, 12, 18, 24 months, and at 7 years after the birth. The prevalence of a specific respiratory virus (RSV) was also assessed over the first 2 years of life. At the age of 7 years all of the children were seen by a pediatric allergist for assessment.  Allergy skin tests were done.

Results:

18.7% of children were diagnosed with asthma by 7 years of age.

The following factors increased the chances of a child developing asthma:

• The development of allergies (eczema, food or environmental allergies) in the first few years of life. 
• Having a mother or older siblings with asthma. 
• Being male. More boys than girls developed asthma. 
• Living in Winnipeg. More children in Winnipeg developed asthma than in Vancouver, perhaps because children in Winnipeg had higher rates of allergies (51.1% vs 39.5%).  This may be related to climate differences and the indoor environment. 
• The child having Respiratory Syncytial virus (RSV) infection in the first year of life.
• Owning a dog in the first year of life.

Conclusions:

• What happens in the first year of life seems most important.
• Children in the intervention group, where intervention measures were applied prior to birth and for the first year of life, had a significantly lower risk (14.9%) for developing asthma by the age of 7 years than the control group (23%).
• Having a dog in the home and the child having an RSV infection both in the first year of life are more important than the same exposure in later years
• It is not clear which intervention specifically made a difference.  The first year of life may be a “window of opportunity” for intervention measures to help prevent asthma in high risk children. 
• Inherited risk factors ie: the presence of asthma in the mother, or older siblings, was the strongest predictor that the child would also develop asthma. 
• The intervention measures undertaken (decreasing exposure to house dust mite, tobacco smoke, and pets in the home, increasing breast feeding delaying solids until the child was 6 months old) did not significantly change the effects of inherited risk factors or family history in the development of asthma. 

Pediatr Allergy Immunol 2008: 19: 482–489. Early environmental determinants of asthma risk in a high-risk birth cohort. Chan-Yeung M, Hegele RG, Dimich-Ward H, Ferguson A, SchulzerM, Chan H, Watson W, Becker A. 

Allergy Sufferers Should Mind their Fruits and Vegetables

We all need to eat fruit and vegetables but some of them can cause serious reactions for people with seasonal allergies. Find out which ones. Dr. Allan Becker talks with Marcy Markusa, host from CBC Information Radio Manitoba.  Follow the link below to hear Dr. Becker's conversation.

http://www.cbc.ca/player/AudioMobile/Information%2BRadio%2B-%2BMB/ID/2388307402/

Major Cat Allergen levels in the home of patients with asthma and their relationship to sensitization to cat dander.

Introduction: Many studies have shown that dust mite and cat are the most common indoor allergies.

Allergies, in particular allergies to furry animals, increase the risk of chronic asthma and of emergency visits due to asthma attacks.

Cat allergy is very common, even for people who don’t own a cat. Previous studies have shown that cat allergen can be found in the carpets and mattresses of homes where cats are kept but also in homes where a cat has never been present.  

Research questions:

• How much cat allergen can be found in the homes of asthmatic patients? 
• How does having a cat affect the amount of allergen found?
• Does the concentration of cat allergen in a home affect skin allergy tests to cats?
• Does climate affect the amount of cat allergen found in a home?

What was done:  120 adults and children with asthma participated in the study. Participants lived in Winnipeg, Manitoba or in Vancouver, British Columbia.

Questionnaires: Participants answered questions about their asthma control, use of medication, smoking habits and asthma triggers.  They were also asked if there was a cat living in the home or if they frequently visited someone with a cat. 

Home visits: Each home was visited four times (once every season). Dust samples were collected from the bedrooms and the mattresses using a portable vacuum  cleaner and a special filter.

Skin testing: All participants were allergy tested to 11 different environmental allergens, including cats.  Skin testing was done at the beginning of the study.

Results:  90% of the children and 80% of the adults had allergies. Cat allergy was the most common allergy with 60% of the participants being allergic to cats.   Although only 15% of the homes had one or more cats, cat allergen was found in almost all (92%) of the homes. Homes with cats had the highest amount of cat allergen.

           

In Winnipeg, the amount of cat allergen found in homes without a cat was higher in winter and in spring.  In Vancouver, the amount of cat allergen in homes without a cat was the same all year round.

The amount of cat allergen was the same all year round in all homes that did have a cat.   

The incidence of cat allergy was the same for the participants that had a cat in the home as it was for participants that did not have a cat in the home.

The amount of cat allergen in the home did not seem to affect the risk of having a positive skin test to cats.

Conclusions: It is impossible to completely avoid cat allergen. A certain amount of cat allergen is present in almost all Canadian homes.

The amount of cat allergen in a home can be quite high, even if the home is cat-free. Indirect contact with a cat (visiting a friend with a cat) influences the amount of allergen found in a cat-free home. 

This may explain why so many people with asthma develop a cat allergy even if they have never had a cat.

Seasons only affect the amount of cat allergen in homes that DO NOT have a cat. High concentrations of cat allergen are present all year round if a cat lives in the home.

Having a cat free home does not seem to prevent the development of cat allergy but it does decrease the amount of cat allergen in the home. We still don’t know how much cat allergen is needed to develop a cat allergy or allergic symptoms. The amount needed to develop symptoms of asthma differs greatly from one person to another.

It is still very important for patients with asthma who are allergic to cats to minimize their exposure as much as possible.

Ann Allergy Asthma Immunol. 1995 Oct;75(4):325-30.Major cat allergen (Fel d I) levels in the homes of patients with asthma and their relationship to sensitization to cat dander. Quirce S, Dimich-Ward H, Chan H, Ferguson A, Becker A, Manfreda J, Simons E, Chan-Yeung M.

New Educational Video now available on Youtube

The Children's Asthma Education Centre (CAEC) has developed a video to help families better understand asthma and its management. You can now view the video "Asthma Control: Pieces to the Puzzle" on Youtube. Follow the link below to view it or send it to your friends if they have a child with asthma!

http://www.youtube.com/watch?v=tmUk4DFOi0M&list=PL49-VdY5NYWmWAMjg2m_AmimkY9vVgqUa

Congratulations Dr. Becker!

               

Congratulations to Dr. Allan Becker who received the Queen Elizabeth II Diamond Jubilee commemorative Medal in February 28, 2013.

Dr. Becker is one of 60 000 deserving Canadians recognized for their contributions to Canada. Dr. Becker’s work in asthma and allergy research, education and clinical practice has made significant contributions to the health of children in Manitoba, Canada and around the world.

The Chancellery of Honours, as part of the Office of the Secretary to the Governor General, administers the Queen Elizabeth II Diamond Jubilee Medal program.

Environment and Demographic Risk Factors for Egg Allergy

Egg allergies are one of the most common food allergies among young children.  A recent study of about five thousand infants in Australia looked at the incidence of egg allergies at twelve months of age.

Research Question: 

What are the common factors in egg allergic infants?

Findings: 

Families enrolled in the study were asked to complete a questionnaire about their child’s eating habits and reactions to eggs.  Allergy skin testing was also performed on the children.

Out of 5276 children surveyed, 873 were skin test positive to egg white.  699 underwent an egg challenge (given egg to eat in the doctor’s office to see if they had symptoms of an allergic reaction). This would help to determine who exactly had an egg allergy. 

453 of these children had confirmed egg allergy (8.6% of all children in the survey).

Researchers then looked for factors that the egg allergic children had in common.

Results:

Children were less likely to have an egg allergy at one year of age if they had older siblings and if there was a dog in the house.

Children were more likely to have an egg allergy if someone in their immediate family (parent or sibling) had allergies.

Children whose parent or parents were born in East Asia were most likely to have an egg allergy.  Although the parents themselves are less likely to have allergies, their children are more likely to have eczema and egg allergy.

Conclusion: 

Children who live with a dog and who have older siblings have a lower chance of developing egg allergy. Living with pets and older children may expose a baby to viruses and bacteria that help develop a healthy immune system. 

The childhood environment of a baby’s parents may also play a role in the child’s immune system.  In this study, children whose parents were born in East Asia were at highest risk of having an egg allergy.

Environmental and demographic risk factors for egg allergy in a population-based study of infants. Koplin JJ, Dharmage SC, Ponsonby AL, Tang ML, Lowe AJ, Gurrin LC, Osborne NJ, Martin PE, Robinson MN, Wake M, Hill DJ, Allen KJ; HealthNuts Investigators.Allergy. 2012 Nov;67(11):1415-22. doi: 10.1111/all.12015. Epub 2012 Sep 7.

Caesarean births and formula feeding affect infant gut bacteria.

Many babies in developed countries are born by elective caesarean section and are formula fed instead of breast-fed. This may affect the type and amount of bacteria found in a baby’s gut.

Bacteria in the gut play an important role in human health especially the developing immune system. Disruption of the gut bacteria could increase risk for diseases such as allergies and asthma.

The development of the bacteria in an infant’s gut is not yet fully understood. The first North American study, to look at the infant gut is the Canadian Health Infant Longitudinal Development (CHILD) Study, a birth cohort involving 3500 newborn infants.

Research question: 

Does being born by caesarean section affect the bacteria in the guts of babies? 

Does breast-feeding vs. bottle-feeding affect the bacteria in the guts of babies?

Findings: 

The study looked at data for 24 healthy infants. 

Of this infant sample:

·         25% were born by caesarean delivery, 75% were born vaginally

·         42% were breastfed until 4 months of age, 58% were formula fed

Fecal samples (stool) from each infant were collected at 4 months of age.

The stool was analyzed to determine the kind and amount of bacteria in the gut.  

Results:

• Children born by c-section had a different variety of bacteria, including lower amounts of particular good bacteria.
• Children who were formula fed had a higher amount of less desirable gut bacteria.

These differences found in the gut bacteria, may explain why infants born through caesarean delivery are at higher risk of some childhood diseases, like asthma, allergies and obesity. Breastfeeding helps protect against these diseases.

Conclusion: The method of delivery and the type of feeding can affect a child’s gut bacteria and future health. It is important to take these differences into consideration when parents and doctors make decisions about the mode of delivery for an infant and how to feed in early life.

Check out these links for more related articles.

http://www.rcinet.ca/english/daily/interviews-2012/15-39_2013-02-12-newborn-s-bacteria-differ-according-to-delivery-breastfeeding/

http://www.theglobeandmail.com/life/health-and-fitness/health/c-section-babies-missing-crucial-gut-bacteria-study-finds/article8440728/