House CallJun/Jul 2012 Issue

Pediactric Allergies Q & A - Bee Stings, Allergy Diagnosis, Epinephrine, and More!

Buzz on Bee Stings

I had a bad reaction the last time I was stung by a bee. Should I be carrying around an EpiPen with me?

Dr. Jain It depends on the reaction. In general, we classify reactions as being either systemic or local. Many people will have a large, local reaction after a sting—there’s swelling where they were stung. The swelling can sometimes seem severe but that doesn’t necessarily mean that the reaction is widespread or systemic. These types of local reactions generally don’t require a person to carry an EpiPen. In some instances, an allergist may prescribe epinephrine if a patient is in a high-risk profession (beekeeper, forester, farmer) and such swelling seems to be worsening.

If you’ve had a systemic reaction manifested by hives all over your body, difficulty breathing, light headedness, swelling that’s not at the site of your sting or similar symptoms, you definitely need to have an EpiPen. You should be evaluated by an allergist who can test you and offer other options for treatment to prevent future sting reactions.

It’s important to note that if you have a history of systemic reactions to bee sting, you’re very likely (a 60 percent chance) to have another one with your next sting.

Allergy Diagnosis

What's the best way to diagnose a food allergy? How do I know for certain that I'm really allergic?

Dr. Jain Diagnosing a food allergy can actually be a complicated task. Generally speaking, there is no perfect diagnostic test. Blood testing for food allergies, typically IgE testing, can be used to confirm a suspected allergy but it’s not great as a screening test for diagnosing food allergies when someone is unsure they’re having a problem. The reason for this is that many people who aren’t necessarily allergic to a food can still test positive with this kind of testing. The same can be true for skin testing. In general, skin testing and blood testing are better at confirming a suspected allergy and ruling out an allergy.

The gold standard test (meaning the best way of diagnosing something) for food allergies is a double-blind, placebo-controlled food challenge (DBPCFC), conducted under the supervision of a board certified allergist. In this type of test, the person with a suspected food allergy is given either the food (usually in a capsule) or a placebo (also in a capsule). Then he or she is monitored for a reaction by a healthcare professional who doesn’t know whether the patient received the food or the placebo. The patient may be given increasing doses of the food or placebo and is closely monitored throughout this process.

This type of test is useful in pinpointing immediate-type allergic reactions. It is not as helpful for food reactions that may be delayed, like those that can occur due to eosinophilic GI disease or other conditions, like celiac disease.

Some people rely on a food diary, where they record every item eaten and any corresponding reactions. This process is helpful in revealing a troublesome ingredient but it’s not perfect, as such diaries don’t distinguish between intolerances (food reactions not caused by an immune system reaction) and true food allergies.

If you suspect you have a food allergy, consult a board certified allergist.

Getting Worse?

I get a rash whenever I eat peanut butter. It never gets too bad. But now I've heard the reaction could get worse if I keep eating peanuts. Is this true?

Dr. Jain The answer is maybe. There are many factors that influence the severity of a food allergy reaction. The amount of food ingested, as well as the degree of a patient’s sensitivity to the food are both important factors. Other factors can include whether a patient has asthma or not, as having asthma, especially asthma that is not well controlled, can lead to more severe reactions. Having a cold or bad allergy symptoms, such as hayfever, at the time of ingestion can also cause more severe reactions.

I tell patients that one reaction is not predictive of what might happen with future reactions. They could be worse or less severe, depending upon the circumstances.

Expired Epinephrine

My EpiPen is out of date. Does it matter in terms of effectiveness? These things are so expensive that I hate to throw them away!

Dr. Jain Yes, that expiration date matters. All medications tend to lose some of their potency and effectiveness over time. If you need epinephrine due to risk of anyphylaxis, make certain your medicine is up to date.

Other factors that can influence the effectiveness of an EpiPen include extreme heat and cold—so don’t leave your EpiPens in the car.

Acetaminophen and Asthma

I’ve heard that acetominophen and medicines for fevers may contribute to childhood asthma and allergies. Is there really a connection?

Dr. Leo In several large-scale studies of over 200,000 children, epidemiologists have noted that increased incidence of childhood asthma seems to correlate with the widespread use of acetaminophen, the key ingredient in products like Tylenol and other fever reducers. About 30 years ago, pediatricians began recommending acetaminophen rather than aspirin-containing medications for childhood fever to ward off risk of Reye’s syndrome. The most recent study reported a dose-dependent relationship between acetaminophen use and the development and severity of asthma in children at both ages 6 to 7 and in adolescence.

Acetaminophen can affect glutathione metabolism (an important biochemical process) which may impact the immune system and promote the development of inflammation and allergic tendencies. This may be particularly true when acetaminophen is administered during an intense immune response (i.e., when a child has a cold or fever).

More research is needed. At this time, most pediatricians, family practitioners and internists, as well as their academic and professional organizations, do not discourage the use of acetaminophen in young children or pregnant women. Consult with your health care provider about what is best for your child.

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