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Thursday, September 27, 2012

Food Allergies and Asthma

Our last physician interview on kosherfoodallergies focused on atopic dermatitis (eczema).
Interestingly there is a connection between food allergies, atopic dermatitis, and asthma.

Kosher with Food Allergies Interview Series
Interview #5- Food Allergies and Asthma , Dr. Jon Stahlman
How many people have food allergies?  How many people have asthma?  How many people have both?
According to a 2011 study published in the Journal Pediatrics food allergy ranges from 6-9% of individuals in the U.S. in the first 18 years of life.  The World Allergy Organization reports that globally the incidence of food allergy anywhere from 220-520 million people.  The most common allergy appears to be peanut followed by milk then shellfish.  The Centers for Disease Control reports 1 in 10 children in the U.S. has asthma and 1 in 12 adults.  This represents over 25 million people in the United States.  The World Heath Organization (WHO) estimates over 235 million people world wide suffer from some form of asthma.
The picture of how many people truly have both food allergy and asthma depends somewhat on the severity of the food allergy and asthma.  The CDC has reported up to a third of patients with food allergies have asthma.  However those high numbers may represent the more severe patients.  That is the more severe both your food allergy and or your asthma the more likely you could have both conditions.

If you have food allergies does that mean you will develop asthma?
Researchers have worked very hard to try and predict which individuals will develop asthma after they are born.  Past studies have shown one of the greatest risk factors for asthma has been the presence of atopic dermatitis (eczema).  Asthma Predictive Indexes are now used to study which patients are more likely to develop chronic asthma.  In addition to eczema having a parent with asthma or being sensitized to environmental allergens put patients at risk.  Having an allergy to milk, egg or peanuts is a predictor for asthma too, but not quite as strong.  It seems other markers such as blood allergy cell levels (eosinophils) or wheezing without viruses may help us predict who will develop asthma.  Food allergy is just one piece of the puzzle.

Should people with asthma avoid certain foods?
The important point for patients with asthma is to eat a healthy well rounded diet.  Avoiding common food allergens is only important if a person is known to be allergic to that food.  This may be difficult in young patients who have severe eczema just broadening their diet to include certain foods or who already may be allergic to one or two foods.  In these cases a visit with their pediatrician or a board certified allergist may be helpful.  For a small group of patients sulfites (preservatives found in dried fruit, vinegar, alcohol and sometimes on salad bars) may trigger asthma and should be avoided.  Researchers are also looking at the importance of including enough vitamin D (along with a healthy amount of sunlight) in patients not only asthma but other allergic diseases because it may help prevent or lessen some symptoms.

What is the role of allergy immunotherapy (shots or drops) in food allergies and asthma?
Allergy immunotherapy (using shots) has been shown to improve both nasal allergies and asthma.  Patients can improve not only their asthma control but their quality of life a good deal.  This is a reasonable alternative for patients with allergic asthma who do not respond to standard therapy with medications.  Unfortunately allergy shots have not proven safe or effective for food allergies.  An alternative to shots are allergy drops (also known as sublingual immunontherapy).  Allergy drops are still being studied in the U.S. for nasal allergies but have been used in Europe for over 20 years.  Currently sublingual immunotherapy is being studied closely by several groups in the U.S. for allergies to peanuts, milk and egg and has shown some potential to help patients.  As there are still associated risks such as severe allergic reactions this treatment is only being performed at research centers where patients are monitored very carefully.r drops) in food allergies and asthma?

Dr. Jon E. Stahlman received his B.S. and M.D. degrees at Emory University. He subsequently completed his pediatric residency at Children's Hospital in Boston and his fellowship in Allergy and Clinical Immunology at Harvard University's Children's Hospital/Brigham and Woman's Hospital. After his training, Dr. Stahlman completed two years of clinical research at Boston Children's Hospital. His research interests included steroid dependent asthma as well as the use of computerized monitoring of lung function. 
Dr. Stahlman is Board Certified and recertified in Allergy and Clinical Immunology and Pediatrics. He also became a Certified Clinical Research Investigator in 2003.  He is currently the president of The Georgia Allergy Society and Section Chief of the Division of Allergy & Immunology at Children's Healthcare of Atlanta Scottish Rite Campus.  He is the Senior Partner at The Allergy & Asthma Center of Atlanta, Lawrenceville and Conyers Georgia.

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