House CallDec/Jan 2011 Issue

Pediatric Allergies Q & A - Puppy Love, Allergy Bully, Flu Vaccine Safety & More!

A pediatric specialist answers your questions about allergies and sensitivities

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Puppy Love

Our food-allergic son develops a bad rash whenever the neighbor’s dog licks him. Does this mean he's allergic to dogs? We want to surprise him with a puppy for Christmas but now we’re wondering if that’s a good idea.

Dr. Leo Dog saliva contains canine allergens, which are also present in the animal’s fur, body oils, urine and feces. If your child breaks out in hives or a rash within a few minutes of being licked, he’s either sensitive to dogs or to something this particular animal has eaten or carried in its mouth. A lick from a pet that’s ingested a peanut butter treat, for example, can prompt a reaction in a peanut-allergic person.

Check the label on the dog’s food. Does your son have allergies to any of the ingredients listed?

If your child reacts with a rash after similar contact with other dogs, he likely has a canine allergy. If that’s the case, extensive exposure to a dog, such as a new puppy in your home, could escalate into more serious symptoms (coughing, wheezing, etc.).

A pet is a long-term commitment. The decision to own one requires very serious consideration, particularly when there’s the possibility of allergy, as is the case with your son. Testing can offer information about the potential for reactions but a negative test result doesn’t guarantee that your child won’t develop an allergy. Parents in this situation often seek out a so-called hypoallergenic breed but anyone with a significant sensitivity could still have some reactivity.

Frequent bathing of the pet and limiting its access to bedrooms or high-traffic areas can aid in controlling symptoms. Frequent vacuuming with a HEPA filter can sometimes be helpful but often the act of vacuuming stirs up pet dander. As a last resort, immunotherapy (allergy shots) is an option but administering this treatment to a child solely for the sake of bringing a pet into the home remains controversial among medical professionals. Frankly, most allergists would recommend avoidance in your case and advise against buying your son a dog for Christmas.

Allergy Bully

Our 8-year-old daughter is allergic to milk. We heard from one of her friends that another child has been threatening her with yogurt in the school cafeteria. Do you have any advice?

Dr. Leo Children with food allergies can become targets for school bullies. According to a study published in Annals of Allergy, Asthma & Immunology, nearly 35 percent of food-allergic kids over the age of five report being harassed or teased because of their allergies. Most of these events occur on school grounds and over half of those surveyed said their allergen was physically used to bully them. Eighty-six percent of those bullied reported repeated episodes.

This issue should be taken very seriously. Threatening a food-allergic child with an offending food can be considered a life-threatening act akin to assault, whether it’s intentional or not.

I know that some parents consider bullying a normal part of growing up, that a kid should learn to “stick up for himself.” But youngsters don’t have the emotional or physical means to defend themselves appropriately. Those left to “do it on their own” often make bad choices, which can lead to dangerous situations now and damaging self-esteem issues later.

In your case, I strongly recommend you speak immediately with both your child’s teacher and the school principal so that the harassment is quickly halted and not allowed to occur again. Use your best judgment about including your daughter or the young culprit in early discussions, as putting children in the middle can increase their stress levels and contribute to an antagonistic environment in the school. Most schools address the bullying issue with the parents first and conduct an intervention with the children afterwards.

The bottom line is that adults should take control of the situation immediately to make certain the bullying is stopped. In addition, the school should maintain a policy of zero tolerance when it comes to bullying behaviors. Educational programs on this issue should include information about food-allergic children as a vulnerable group.

Flu Vaccine Safety

I've heard the flu vaccine is now available in a nasal spray. Is it safe for someone who's egg allergic? My child is allergic to eggs.

Dr. Leo In the United States, the influenza vaccine is produced in hens’ eggs. Although amounts vary from bottle to bottle, measureable egg protein can remain in the vaccine. This is also the case with the intranasal vaccine.

Several studies have suggested that under appropriate conditions and when administered by trained allergists, many egg-allergic children can safely be given the influenza vaccine. There are no published studies regarding the safety of the intranasal influenza vaccine for egg-allergic children. I’m hopeful that the Food and Drug Administration will approve an egg-free vaccine in the near future for both injection and intranasal use but it hasn’t happened yet.

The American Academy of Pediatrics and the Centers for Disease Control recommend that all persons 6 months or older receive the influenza vaccine regardless of health status. I encourage all families with egg allergy to consult with their primary care physician or allergist regarding the safety of the vaccine.

A New Look

The doctor gave me EpiPens for my 5-year-old son who has a peanut allergy. These look different from the ones we got last year. Is the medicine the same?

Dr. Leo The EpiPen device has undergone a significant design update. The outer structure and shape are different but the major change is that the EpiPen now has a built-in needle guard that activates after the device is used. Trainers to show you how to use this new version are offered at your doctor's office or your pharmacy. Instructions are also available at epipen.com. Generally, the dosage of epinephrine is the same as before.

To avoid confusion in an emergency, I suggest you keep just one type of self-injector epinephrine device on hand. In addition, make certain that your child’s caregivers and teachers know how to use the new device.

Harvey L. Leo, MD, is a pediatric allergist with Allergy and Immunology Associates of Ann Arbor and an assistant research scientist with the Center for Managing Chronic Disease at the University of Michigan.
Do you have a question for the doctor? Send it to editor@LivingWithout.com
Food allergies affect more than 12 million Americans, including 6 percent of children under the age of three. Allergic reactions can range from mild to anaphylaxis, a serious condition that can cause hives, swelling, nausea, closing of breathing passages and even death. There is no cure, just the strict avoidance of the offending foods. Ninety percent of all food allergies are caused by eight foods: wheat, milk, peanut, tree nuts, egg, soy, fish and shellfish.

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