February 2007

Milk Allergy or Milk Intolerance?

2007-02-23T19:33:37Z

Milk allergy is the number one concern in young children that develop skin rash, eczema, hives, diarrhea or vomiting. Children that have these problems after drinking milk should be evaluated for possible milk allergy. If other foods or beverages are being consumed milk may or may not be the problem. In young children (less than 1 year old) the prevalence is much higher simply because milk is their main if not sole food source. Young children tend to be more vulnerable to milk and other food allergies.

Older children and adults of course consume many other products in addition to milk or other dairy products. Whether milk allergy is a reason for itching, swelling, skin rash, abdominal pain, bloating, flatulence (stomach gas), stomach cramps or diarrhea, should be determined by evaluation. Milk allergy is diagnosed in my office, by getting a detailed diet and symptom history as well as overall medical history and physical exam. Milk or allergy to other foods may be confirmed by skin test or blood test (serum test for IgE specific to cow's milk).

Lactose intolerance (milk intolerance) is more common in older children and adults who complain of stomach upset, diarrhea or bloating after drinking milk or eating dairy products. This is not an allergy. Allergy skin test and blood test are negative in people that have lactose intolerance as the reason for their discomfort. Generally, I diagnose lactose intolerance by the history and negative milk allergy test, but there are other more specific tests available to confirm lactose intolerance.

As mentioned, young children more commonly have milk allergy. It should be confirmed by your physician for proper dietary adjustments. Sometimes the alternatives (such as soy based milk or formula) may also be a problem because of allergic sensitivity. Knowing whether the problems a child is experiencing is from milk or other foods may be be important in order to consider whether other diseases or disorders should be considered.

Fortunately many young children will grow out of their milk allergy over a course of one or more years (with cows milk restriction). Re-testing is important to confirm the milk allergy status before re-introducing it into the diet.

People with lactose intolerance should talk with their doctor about diet adjustments. Some people simply drink milk that has lactase enzyme added to it. Others take lactase pills (over the counter) just before drinking regular milk, eating ice cream or consuming other dairy products.

It is important to know what you have in order to establish a good treatment plan. If you suspect that you or your child has a problem with milk or another food, consult your doctor. You may require referral to a board certified allergist.

Oral Allergy Syndrome

2007-02-21T13:43:40Z

Have you heard of Oral Allergy Syndrome? (OAS)

Some people with hay-fever (seasonal allergic rhinitis) have symptoms of itching or burning in the mouth, inside of the lips or cheeks and/or throat, after eating watermelon, cantaloupe, apples, bananas, tomatoes or certain seeds (sunflower seeds). Symptoms are limited to the mouth, throat and /or ears and tend not to be progressive or prolonged (usually lasts minutes but not hours). Although this often represents a reaction to one of the above foods it is not considered an allergy to the food.

People allergic to ragweed may experience this reaction after eating bananas or any kind of melons (watermelon, cantaloupe...). Some people allergic to birch tree pollen may have OAS associated with eating raw apples, kiwi or celery. People with such allergies to pollens, with OAS do not make IgE antibody to the fruits. Their pollen related IgE antibody cross reacts (similar structure of allergen on the fruit and particular pollen) with the above mentioned foods.

OAS is not thought to represent a food allergy. People that experience this reaction often think they are allergic to the food. I allow my patients to continue eating the food if symptoms are very mild and limited to the mouth area. I caution them about eating these foods during the active season of the pollen. For example, ragweed season is mid-August through September. Patients with OAS from bananas or melons should avoid these fruits during ragweed season. Symptoms may be more bothersome when the specific pollens are in the air.

Many of my patients choose to avoid foods that cause OAS all together. I thinks this is the safest approach. I have had concerns about whether one may transition from OAS to food allergy over time (but this has not been reported). The natural course of OAS (what happens over time) is not clear.

OAS should be diagnosed by an allergist. One should not assume they have this problem on their own. Food allergies, which may be fatal, often are associated with the same symptoms, early on. Life threatening throat swelling, breathing problems or shock (severe drop in blood pressure) may occur in severe food allergy reactions.

If you think you have OAS get a consultation from a board certified allergist.

Find more information on my practice site: www.allergists-asthma.com

Antihistamine or Decongestant or both?

2007-02-18T21:57:17Z

Many medications are available over the counter (without need of a prescription) for treating allergy symptoms. The majority of them have significant potential side effects, often ignored. Many times these medications are used for symptoms of the common cold. Antihistamines and decongestants top the list of medications filling the shelves of drug stores all over the country. Many times brands are chosen without being aware of what they particularly do. Antihistamines are drying agents that most often reduce symptoms of itching, sneezing, runny nose and postnasal drip. There is minimal effect on nasal congestion (stuffy nose and sinus pressure). Decongestants (for example Sudafed) tend to reduce nasal congestion and sinus pressure. Many over the counter cold and allergy medications have both antihistamines and decongestants in them. Unfortunately some people choose the combination drugs (antihistamine/decongestant) when they only need one of them. If you only have some annoying sneezing and runny nose, you do not need the decongestant. If you have a mild stuffy nose but no sneezing or dripping, you may not benefit from the antihistamine. Some people choose one agent but make the wrong choice. They may be going through boxes of tissue, constantly rubbing and blowing but get a decongestant instead of an antihstamine. Selecting an antihstamine (such as Benedryl) for relief of a stuffy nose is unlikely to work.

Patients seen in my office are oriented to the differences between the prescribed and over the counter antihistamines and decongestants. Potential adverse effects are also addressed. Antihistamines may cause over drying of the mucus membranes (eyes, throat, mouth and nasal passages) that may be even more of a problem during the winter. Older people may have further aggravation of constipation, bladder emptying (especially males with prostate problems) and glaucoma. There is only one available non-drowsy antihistamine over the counter and that is Loratadine (brands of Claritin, Alavert, and others). All other antihistamines over the counter may cause drowsiness. Studies have shown that more than half the number of people taking over the counter antihistamines (other than Loratadine) that claim not to experience sedation (sleepiness) or fatigue, do in fact have some impairment.

Oral decongestants may raise your blood pressure, speed up the heart rate, cause tremor,heart palpitations and insomnia. They may also worsen constipation and effect bladder control (especially in the elderly) and interact with other medications. Strong, or high dose decongestants (available without prescription and in many combination allergy and cold medications) are more often associated with side effects.

It is important to consult your doctor before taking over the counter cold and allergy medications if you are on other medications, have other medical problems, are over 50 or under 6 years of age, or have any uncertainty about safety. Read the package insert (or label) of any new drug.

You should see an allergist if your problems are multi-seasonal or not adequately responsive to treatment. The trigger factors should be identified and a comprehensive program focusing on environmental controls as well as medications should be formulated.