• Intentional Food Allergy Exposures: Researchers have revealed the reasons that a concerning number of parents are knowingly giving their allergic children food that they are allergic to.
• Pollution Changing Genes: Researchers found that a certain type of air-pollution may be causing a DNA change which results in worsened asthma symptoms, and potentially even new cases of asthma.
• Milk Therapy Lacks Staying Power: Editor Gwen Smith on the study that showed a surprising reversal among patients who had been successfully treated for milk allergy.
• Alcohol, Asthma and Aspirin: A group of people with asthma are experiencing respiratory reactions when drinking alcohol. But how does Aspirin fit into the equation?
• Allergic Children Underweight: Children with multiple food allergies or milk allergy appear to be underweight when compared with their non-allergic peers.
• A New Spot for the Shot: Investigators discovered that there may be a more effective location for an epinephrine shot in obese patients.

Researchers have discovered that most adults with asthma who are sensitive to Aspirin also get mild to severe respiratory symptoms when drinking alcohol.

Dr. Tanya Laidlaw, of the allergic disease research center at Boston’s Brigham and Women’s Hospital, explained that Aspirin Exacerbated Respiratory Disease, or AERD, is a condition that involves three things: asthma, nasal polyps and a sensitivity to Aspirin (and other non-steroidal anti-inflammatory drugs or NSAIDS). AERD affects 10 to 20 percent of those with adult asthma.

She says her research team has now found that “three-quarters of all AERD patients do have respiratory reactions when they drink alcohol. For many of them, it’s within several sips of a single glass.”

Seventy-four percent were found to react to alcohol with an upper respiratory reaction, such as a runny nose or congestion, compared to 34 percent of a group with asthma who tolerate Aspirin.

Lower respiratory reactions, such as sometimes severe wheezing and shortness of breath, occurred in 51 percent of AERD patients after drinking alcohol, compared to 24 percent of the Aspirin-tolerant asthmatics.

What Causes Your Reaction to Alcohol?

The alcohol association arose initially from patients themselves. Laidlaw says patients at the AERD clinic at Brigham and Women’s Hospital were often mentioning symptoms like wheezing and coughing, signs of an asthma attack, when they drank alcohol. “They began asking: ‘Did we know why it was that when they had a glass of wine or a couple of beers, they would also have a very similar and often very severe respiratory reaction to the alcohol,’” she told a news conference.

She and her colleagues didn’t know, but were intrigued and decided this warranted study. The Brigham and Women’s center collaborated with the Scripps respiratory clinic in San Diego to send out a survey study to four groups: diagnosed AERD patients, patients who had asthma but are aspirin tolerant, patients with chronic sinusitis who don’t have asthma and to healthy patients with no asthma or sinus issues.

Among the patients reacting to alcohol, red wine emerged as the most likely to provoke symptoms (29 percent of patients), followed by beer (9 percent) and white wine or liquor (6 percent). However, for half of the patients, any kind of alcohol triggered symptoms.

This study of AERD patients and alcohol is continuing. So far, 132 patients have been recruited into the study, but researchers hope to expand this number to 320 before they finish.

Laidlaw notes that many AERD patients have had to stop drinking alcohol. The next step will be to examine what the mechanisms through which alcohol triggers such symptoms. Laidlaw says the relationship should also be useful in the diagnosis of AERD, which is not always obvious, as the sensitivity to Aspirin can be mild and is often overlooked.

See more news from the AAAAI 2013 conference here.

Read more about wine reactions here.

The CNRC thanks GlaxoSmithKline for an educational grant in support of this consumer health publication.

Currents Summer 2012

Asthma can be tricky for a doctor to diagnose, especially in young kids. Symptoms can mimic other diseases and spirometry, the breathing test to diagnose asthma, requires the patient be able to breathe into a tube, which isn’t possible for most small children.

“The hypothesis has been that people with airway disease will have different metabolism compared to those without disease,” says Dr. Darryl Adamko, head of pediatric pulmonary medicine for the Saskatoon Health Region.

That is, the chemicals in their urine will have a unique compound that could be tested for. His team, based at the University of Alberta where he used to work, is using a technology called nuclear magnetic resonance (NMR) and they believe they have pinpointed what the metabolism of an asthmatic looks like in urine.

They are now working with groups in the United Kingdom and Canada to see how well testing urine for this compound predicts asthma. (Adamko is also testing the theory with COPD, bronchiolitis and allergic rhinitis.)

The researchers are still trying to recruit groups large enough for a robust study, but based on the early results, “it does look like it can differentiate asthma versus COPD or asthma versus no asthma,” says Adamko.

The pediatric respirologist hopes this test will do more than just diagnose. “As you get sicker, your metabolism changes,” he says. That means if someone comes into a clinic or hospital with asthma symptoms, a urine test could tell doctors whether the symptoms will get worse. While Adamko is optimistic his team will be successful, he says it’s at least five years before such a test is used in common practice.

First published in Allergic Living magazine.
To subscribe or order an issue, click here.

The CNRC thanks GlaxoSmithKline for an educational grant in support of this consumer health publication.

Currents Spring 2012

First published in Allergic Living magazine.
To subscribe or order an issue, click here.

© Copyright AGW Publishing Inc.

First tip: The great thing about asthma is that if you learn to control it, asthma  won’t control you. Some kids ask us why they have to take the controller inhaler when their asthma doesn’t seem to be acting up. This is because using that controller every day is the best way to get a “handle” on asthma; it keeps swelling and mucous away.

Grief Relief: With that control, you shouldn’t have to get out your reliever inhaler as often. But when you do need it, don’t be embarrassed. After all, it really is a relief. And consider: almost 1 out of 10 kids have asthma; you aren’t alone!

Friends: Talk to close friends about your asthma and why you take medication. In your class, you may also be surprised to discover how many kids have medication for asthma or other health issues.

Puffer: If you do need your reliever inhaler, it will work best if you use a spacer. Why? More medicine will get down into your lungs. If you’re not comfortable with your current inhaler/puffer, speak to a parent about seeing an asthma educator and your doctor, and possibly switching to a different medication. There are dry powder inhalers available that work without a spacer. Remember, getting the medicine into your lungs helps you control the asthma with the goal of using less medication. Control means you are active and doing things you love – hanging out with friends, playing sports – or maybe a guitar.

*Certified Respiratory Educators and Certified Asthma Educators help patients gain control of asthma, and COPD. For more information about the educators, visit the Canadian Network for Respiratory Care (CNRC) at www.cnrchome.net. Ingrid Baerg, RN, CAE and Angela Alexander, RN, CAE work at the Asthma Education Clinic at B.C. Children’s Hospital.

Dr. Watson: There are many factors that contribute to the development of asthma in children. Having a mother or father with asthma is only one of the risk factors.

There are studies looking at an index called the Modified Asthma Predictive Index. In children with three or more wheezing episodes, one of which is documented by a physician, major risk factors include family history, personal history of allergy and allergies to inhalant allergens.

You also ask whether taking precautions will prevent asthma. There isn’t enough evidence to support any recommendations. For example, exposure to pets in children has been  protective in some studies, yet contributed to the onset of asthma in other studies. For children who developed asthma or hay fever, month of birth seemed a risk factor.

The bottom line is that these are things you really cannot control. If you have pets, there is not enough evidence to say to keep or get rid of them. The only option would be if your child develops symptoms around the pets, then you should give them away.

As far as the springtime, there are no special precautions to protect your child. Watch instead for early symptoms and, should you have concerns, speak to your doctor. As a father of an 18-year-old and a 22-year-old (and an empty-nester), the most important piece of advice I can give you is to relax and enjoy your child.

We welcome your question to Allergic Living’s Ask the Allergist. Thank you for understanding that the specialists aren’t able to answer every question received.

Dr. Wade Watson is a pediatric allergist and Professor of Pediatrics at Dalhousie University. He is also the head of the Division of Allergy at the IWK Health Centre in Halifax.

But a new study could change that. Researchers at Monash University in Australia are working on a dust-mite vaccine that, if successful, would have the potential to cure sufferers in just two to three doses. Professor Els Meeusen is applying her experience in infectious disease vaccines to the world of allergy. She believes the addition of a new ingredient into the vaccine could be the magic bullet allergy sufferers have been waiting for.

Allergic Living’s Kim Shiffman spoke with Els Meeusen to find out what that ingredient is, and when the vaccine might be available.

Why focus on immunotherapy as a treatment for dust mite allergy?

It’s the only treatment that could be a cure. All the others are just to keep allergic symptoms under control, but they don’t cure anything.

How would your vaccine be different than the one that’s been available for years?

The current house dust mite allergy vaccine is given at continuously increasing doses over a period of years. You have to be very careful giving it – it can be a little bit dangerous to use because it’s not well known how it works, and if you don’t use it properly, it could cause a serious reaction. It’s also not quite clear if or when it’s going to start working, and there are no clear markers to actually assess if it’s working.

What our work will do is try to speed up the vaccine effect, a bit like in the work I do with infectious diseases, where you only have to give two or three injections before you get good immunity. If we can achieve the same immune deviation – changing the immune system by vaccination using the same principles as infectious diseases – then we may be able to have a more effective and quicker vaccination regime for house dust mite allergy.

Next Page: More questions on the vaccine

There’s a lot of work in keeping an allergy-friendly home: regular dusting and vacuuming, cleaning with hypoallergenic products and ensuring low humidity levels to keep moulds away. This regimen is likely to keep indoor allergies in check, unless you have wall-to-wall broadloom. Carpets are heaven for allergy-inducing dust mites, since pile traps skin particles, the mites’ main source of nourishment.

If you’re looking to replace your dust mite settlement with a hypoallergenic floor, there are a number of good options. And esthetic appeal can still be your first consideration, according to Mark Bisbee of GreenFloors, a Virginia-based flooring company that specializes in healthy floors. “Just because it’s good for you, doesn’t mean it has to be ugly.”

Allergic Living sweeps through the following choices for a beautiful, allergy-free floor.

Bamboo

The green alternative to hardwood, bamboo is growing in popularity and dropping in price. Like hardwood, bamboo comes naturally light or dark (and can be stained) and is just as easy to keep clean. Bamboo, though, is actually a member of the grass family. It only takes three years to mature – most hardwood takes between 50 and 100 years – and it flourishes with few pesticides, so the impact of harvesting it is minimal.

Bamboo is kiln-dried and turned into a variety of floor products, from unfinished tongue-and-groove strips that are installed the old-fashioned way, with a hammer and nails, to floating floors that can be glued into place. Bamboo is durable, too, lasting between 30 and 50 years, and can be refinished. However, like any wood product, it’s not suited to a moisture-prone area of the home.

Be careful when choosing your bamboo since some brands are made using formaldehyde (known to irritate the airways), while other brands may emit volatile organic compounds (VOCs). Check also that an installer is using an adhesive that will not give off fumes. Be sure to ask a supplier for an emission-free bamboo: it is available and beautiful.

Cork

This is another great and green alternative. Bark from the cork oak tree is harvested carefully in its natural habitat, the Mediterranean, (Portugal is a major exporter) without doing any damage to the trees themselves – some of which are centuries old. The bark is then fashioned into tiles that are moisture resistant, making it a good choice, even in the kitchen.

Cork flooring products include glue-down tiles and floating-floor systems in which the cork is pre-glued to a core of particle board. Pieces snap together to make a floor. Wicanders is one brand that ensures the particle board in their floating floor is virtually formaldehyde free (less than 1 per cent).

Cork comes in a variety of colors and patterns. While it may feel soft underfoot, it is long-lasting as well as visually appealing.

Natural Linoleum

Just the word ‘linoleum’ may conjure up images of the vinyl flooring popular in 1950s kitchens. Today, the word has been reclaimed and is used to describe floors created from organic materials that are stylish and allergy-friendly.

Natural linoleum, also known by the brand name Marmoleum, is made from wood flour and bound together with flax and linseed oils to produce an anti-microbial barrier. “You can actually eat it – it’s 100 per cent biodegradable,” Bisbee says. Marmoleum comes in an incredible range of patterns and colors, from bright red to mahogany brown. It is durable, lasting about 30 years.

Next: Tiles and Stairs

The CNRC thanks GlaxoSmithKline for an educational grant in support of this consumer health publication.

Currents Winter 2012