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House CallDec/Jan 2012 Issue

Research Roundup: Milk Allergy, Food Allergens, Celiac Disease and More!

The latest medical news for people with allergies and food sensitivities

© Emely/Cultura/Maxximages.com

© Emely/Cultura/Maxximages.com

Help for Milk Allergy

Introducing foods containing baked milk into the diets of some children with milk allergy may help them outgrow their allergy faster, according to a study out of Mount Sinai School of Medicine. Earlier work by the Mount Sinai team showed that approximately 75 percent of milk-allergic children can tolerate baked milk. High temperatures alter milk proteins in a way that makes them less allergenic for some children.

In the new study, published in the Journal of Allergy and Clinical Immunology, 65 children who had no reaction to consuming milk baked in a muffin were then gradually exposed to progressively less-heated forms of milk, such as cheese pizza. By the end of the five-year study, 47 percent of children who ate baked milk products were able to tolerate unheated milk (cold skim milk, yogurt and ice cream) versus just 22 percent of children in the comparison group. The team plans to continue its research to determine how best to apply results in a clinical setting. Researchers are also curious if a more rapid introduction of less-heated forms of baked milk would result in even faster tolerance of unheated milk and if findings could be extrapolated to egg allergy.

Note: Baked milk should be given only under close medical supervision.

 

New Food Allergens

Researchers from the Norwegian Institute of Public Health have discovered two “new” food allergens of importance in Norway—lupine and fenugreek. Members of the legume family, which includes peanuts and soybeans, lupine and fenugreek were relatively rare in Norway until recently. In the last decade, however, bakeries have been adding fiber-rich lupine flour to breads and pastries. At the same time, growing interest in international cuisine has led to the introduction of fenugreek, found in curry and mixed spices, to the Norwegian diet. As exposure increased, the Norwegian Food Allergy Register began receiving a number of reports of peanut-allergic patients experiencing serious reactions traced to lupine and fenugreek.

A high rate of cross-reactivity between peanut and lupine and peanut and fenugreek has been previously reported. One study showed that peanut-allergic individuals have positive skin tests to lupine about 27 percent of the time and that they react with symptoms, which can include anaphylaxis, about 8 percent of the time.  

Currently, lupine is not commonly used in the United States and fenugreek is found more often in supplements than in food. (Fenugreek supplements are sometimes taken by breastfeeding mothers to help increase milk production.) However, allergist Neal Jain, MD, says that with the globalization of foods, lupine and fenugreek are legumes people with peanut allergy need to be aware of, particularly if they’re trying new grains and foods. There have been reports of lupine flour in gluten-free bread imported from Europe.

The bottom line? Always read labels. If you’re unsure of an ingredient, don’t eat it until you’ve determined from your allergist that it’s safe for you.

Food-Allergic Families

In a small study published in Appetite, researchers from the UK found that although severe food allergy negatively influenced the quality of life for some children, their parent’s quality of life was affected more. Compared to those with children without food allergy, these parents had significantly lower overall quality of life.

Researchers say their findings support the idea that caring for a child with food allergy has a great impact on families, with the day-to-day management and emotional strain of the allergy falling on the parent, particularly when children are young. Specifically, researchers found that added anxiety about the health of their child, fear of eating out and frustration with grocery shopping (difficulty finding foods that don’t contain allergen warnings, such as “May Contain Nuts”) all contributed to lowered quality of life.

Larger studies are needed but results suggest clinicians should assess family quality-of-life issues and, when indicated, offer caregivers additional support to manage their children’s food allergy.

Diagnosing Celiac Disease

Celiac disease can be tricky to diagnose, in part because it doesn’t always cause uniform injury to the small intestine. Professional guidelines recommend doctors take at least four biopsy samples of the small intestine, helping to ensure celiac isn’t missed—but new research suggests that’s not always happening.

A team at the Celiac Disease Center at Columbia University Medical Center reviewed a national database of 132,352 individuals who underwent biopsy (for reasons such as anemia, abdominal pain and suspected celiac disease) since the guideline was proposed in 2006. They found just 35 percent had at least four samples taken; the most common number of samples was two. When at least four samples were taken, the diagnosis rate of celiac disease more than doubled, underscoring the importance of increasing physician adherence to the guideline.

The work was published in Gastrointestinal Endoscopy.

Epi Training

A study from Emory University has found just 59 percent of children prescribed an epinephrine auto-injector had one readily available during a routine visit to their allergist.

In the study, the parents of 63 children with food allergy were asked to complete a questionnaire and to show researchers their child’s epinephrine auto-injector. Having the auto-injector at the doctor’s office was used as a proxy for having it available all the time. The investigators found that parents and children who reported receiving training on the use of epinephrine auto-injectors were nearly nine times more likely to carry one, strengthening the case for providing ongoing training and education on these devices. Timely epinephrine administration reduces the risk of death due to anaphylaxis. The work was published in Allergy and Asthma Proceedings.

Celiac Screening

The majority of adults (over 80 percent) at a community health fair in Wyoming were willing to be screened for celiac disease, according to a study led by a team from the Mayo Clinic. Researchers offered screening tests (and an intestinal biopsy, when results were positive) to 5,000 fair attendees who were taking part in unrelated laboratory testing, such as cholesterol screening.

They found 1 in 126 adults had undiagnosed celiac disease, a figure on par with the widely cited estimate, 1 in 133. They also found that the presence of gastrointestinal symptoms didn’t predict those who had undiagnosed celiac disease, suggesting that screening the general population may be needed to find individuals with celiac disease.

The study authors say long-term follow-up of patients identified by screening is needed to further clarify the usefulness and benefit of population-based screening. The study was published in the American Journal of Gastroenterology.

Medical writer Christine Boyd lives in Baltimore.

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