House CallJun/Jul 2011 Issue

Pediatric Allergies Q & A - Bee Allergies, Nasel Congestion, And More!

Pediatric specialists answer your questions about allergies and sensitivities

©Rick Barrentine/Alamy

©Rick Barrentine/Alamy

Brother Bee-ware?

My brother is allergic to bees. Does this mean I have a higher risk of having this allergy? Should I be tested?

Dr. Leo For most people, the sting of a hornet, yellow jacket, wasp, honeybee or fire ant causes an uncomfortable, self-limited, local reaction. But for those allergic to it, an insect sting can be life threatening. Anaphylactic episodes, which can include throat swelling, wheezing and cardiovascular symptoms, happen quickly and truly without warning. They can be the most fatal of allergic reactions, which is why your brother should always have EpiPens and other medications readily available during insect season.

Studies have not demonstrated a familial pattern of sensitivity to insect stings so having a bee-allergic sibling doesn’t mean you’re at greater risk than the general population for developing the allergy. Interestingly, it’s often the case that people who have this particular type of life-threatening reaction aren’t prone to other allergies.

If you’re really concerned, get tested. Undergo a graded venom challenge under supervised conditions by a board-certified allergist and immunologist. For those deemed sensitive, subcutaneous injected venom therapy (allergy shots) is considered the gold standard treatment. It consists of desensitization to the offending insect over a course of four to five years.

The Buzz on Honey

Would eating honey produced in my geographic area help my hay fever?

Dr. Jain Eating local honey sounds like a sweet idea to control seasonal or airborne allergy symptoms but there’s no proof that it’s effective.

The theory behind ingesting honey to treat allergies is that you’re exposing yourself to local pollens and thereby desensitizing your immune system to the allergens, similar to the way that sublingual (under the tongue) immunotherapy works.

There’s been only one well-designed study to test whether or not honey is effective at treating allergic symptoms. In this study, published in Annals of Allergy, Asthma and Immunology, hay fever patients were randomly chosen to consume one of three different types of honey: (1) locally produced, unfiltered, unpasteurized honey, (2) nationally produced, filtered, pasteurized honey, and (3) a “dummy” honey consisting of corn syrup and honey flavoring. Participants were instructed to take 3 teaspoons daily over a 30-week period. Those who took the honey showed no improvement in their symptoms compared to those who took the fake honey.

As an aside, although honey allergy is rare, there are several reports in the medical literature of people actually having severe allergic reactions to it. In addition, infants under one year of age should never be given honey, especially unpasteurized honey, due to risk of botulinum toxin poisoning.

Nasal Congestion

I’m allergic to pollen and have a serious stuffy nose all the time. My doctor tells me I have nasal polyps. Are they dangerous? I’m reluctant to take medication and want to avoid surgery.

Dr. Leo Nasal polyps are sac-like outgrowths of nasal tissue that can extend down the nasal passage into the sinus cavities. Common in individuals with seasonal allergies, these nodules can cause chronic nasal congestion and even the loss of taste and smell when they block the nasal cavity.

The polyps themselves consist of granulomatous tissue, protective formations that develop in response to chronic inflammation. They look like small, tear-shaped grapes and can grow to be several millimeters in size. They are not cancerous.

Most cases of nasal polyps can be treated. Doctors often consider a multi-focal approach, depending on the patient. For most people, intranasal steroids can diminish the size of the polyps, thus reducing the nasal congestion. Sometimes immunotherapy (allergy shots) can reduce polyps. In more serious cases, doctors might opt for a course of oral steroids to offer short-term relief. When polyps are persistent and severe, surgery performed by an experienced otolaryngologist (a medical doctor specializing in ear, nose and throat surgery) can be beneficial.

Before deciding on treatment, your doctor should rule out a diagnosis of triad asthma, a disorder that can affect up to 24 percent of those with severe asthma. It’s associated with three conditions: nasal polyps, severe asthma and aspirin sensitivity. Individuals with triad asthma can undergo aspirin desensitization with a certified allergist. This treatment addresses the nasal polyps and reduces their reoccurrence.

© 2011 Thinkstock/iStockphoto

© 2011 Thinkstock/iStockphoto

Birth Order

We’re expecting our second baby. Our first is peanut allergic. Is there an increased risk we’ll have another food-allergic child?

Dr. Leo Your question is asked by many parents. Depending on the data reviewed, the American Academy of Pediatrics and other medical organizations have limited advice on the subject. However, new research presented in March at the annual meeting of the American Academy of Allergy, Asthma and Immunology suggests that birth order may, indeed, affect the chances of having a food allergic child.

In this study, researchers looked at the impact of birth order on more than 13,000 children between the ages of 7 and 15. They noted that the incidence of hay fever and food allergy decreased significantly as birth order increased. The prevalence of food allergy in study participants was 4 percent in first-born children, 3.5 percent in second born and 2.6 percent for children born later. There was no connection seen between birth order and the incidence of asthma and eczema.

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.

Neal Jain, MD, is an allergist and immunologist with San Tan Allergy and Asthma in Phoenix, Arizona.

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

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