Study: Spike in new nut anaphylaxis in children at Halloween and Easter

A new study looking at the link between peanut and tree-nut anaphylaxis in children and holidays found spikes at Halloween and Easter. The study, published in CMAJ (Canadian Medical Association Journal) found that most were previously unknown allergies, calling for increased awareness http://www.cmaj.ca/lookup/doi/10.1503/cmaj.200034.

“Identifying certain times associated with an increased risk of anaphylaxis could help to raise community awareness, support and vigilance,” write Dr. Melanie Leung, 4th-year medical student at McGill University and Dr. Moshe Ben-Shoshan, McGill University Health Centre, Montreal, Quebec, with coauthors. “This information would identify the best timing for public awareness campaigns to prevent allergic reactions.”

Researchers compared anaphylaxis at Halloween, Easter, Christmas, Diwali, Chinese New Year and Eid al-Adha.

The study included 1390 patients visiting participating pediatric emergency departments between 2011 and 2020 in 4 Canadian provinces: Quebec, Ontario, Newfoundland and Labrador, and British Columbia. The median age of patients was 5.4 years and 62% were boys.

For peanut-triggered anaphylaxis, there was an 85% increase in daily average cases during Halloween and a 60% increase during Easter compared with the rest of the year. For anaphylaxis triggered by unknown nuts, there was a 70% increase during Halloween and Easter compared with the rest of the year. However, the researchers did not find an increase at Christmas, Diwali, Chinese New Year or Eid al-Adha.

“The difference in the anaphylaxis incidence among holidays may have been due to the social setting in which each holiday takes place,” write the authors. “At Halloween and Easter, children often receive candies and other treats from people who may be unaware of their allergies. The absence of such an association at Christmas may be because Christmas is a more intimate celebration among family members and close friends, who are more vigilant regarding allergen exposure.”

Canadian labelling may also be a factor, as individual packages of candies and snacks, which are exempt from labelling requirements listing ingredients, are popular at Halloween and Easter.

The authors suggest education and awareness may help reduce the risk of anaphylaxis.

“Our findings suggest that educational tools to increase vigilance regarding the presence of potential allergens is required among children with food allergies, their families and lay people interacting with children who have food allergies. Newer strategies targeting intervals associated with high anaphylaxis risk are required.”

Therapy Helps Children with Food Allergies Manage Severe Anxiety

Imagine a young girl with a peanut allergy, so stricken by fear of anaphylaxis that she no longer takes part in everyday activities many children take for granted. She’s stopped playing with her siblings, worried that residue from their peanut butter crackers may trigger an allergic reaction. She obsessively washes her hands to make sure there is no trace of peanut on them. She worries that every stomachache could mean she accidently ate something she was allergic to.

This story is becoming more familiar to families across the country. While most children with food allergies maintain a healthy level of caution, there is a small percentage whose anxiety is excessive and impairing. The hallmark of excessive anxiety is going to extreme, medically unnecessary lengths to avoid the allergen, such as no longer visiting extended family or refusing to eat any allergen-free food that isn’t familiar. While these coping mechanisms may relieve anxiety in the short term, they may ultimately cause more harm by negatively reinforcing the idea that the world is a dangerous place and that children are helpless to keep themselves safe.

Now, Children’s Hospital of Philadelphia (CHOP) has launched the Food Allergy Bravery (FAB) Clinic to help children with a phobia of anaphylaxis. This revolutionary clinic, housed within the Food Allergy Center, is the first in the world to bring together psychologists and food allergy experts to treat food allergic children with severe phobia of anaphylaxis.

The three Founders of the FAB Clinic published a set of best practices in the Journal of Allergy and Clinical Immunology, providing guidance to allergists and pediatricians on how to address allergy-related phobias through Cognitive Behavioral Therapy (CBT).

“CBT works by gradually encouraging anxious children to take part in ‘brave practices,’ like eating with the rest of their family, playing with siblings, and trying new foods that don’t contain allergens,” said Katherine Dahlsgaard, PhD, ABPP, Director of the FAB Clinic at CHOP. “As a child’s confidence grows, we gradually introduce them to more challenging brave practices. This could include sitting in the same room with the food they’re allergic to, or even touching the food and then washing their hands thoroughly. The aim is to help children realize, through safe, structured practices in the FAB Clinic, that the world is much safer than they think and that they are capable of keeping themselves safe within it.”

The FAB clinic enthusiastically employs the help of family members, coaching parents or caregivers to repeat brave practices at home.

“We want these children and their families to know they’re safe and capable,” said Dr. Dahlsgaard. “Our ultimate goal is to equip families with practical skills and confidence via focused treatment sessions, so that their child can safely navigate a world that can’t always be allergen-free.”

Two-thirds of pediatricians not following full guidelines on peanut allergy prevention, report finds

As many as two-thirds of pediatricians in America do not follow the newest guidelines about how to introduce peanuts to children for allergy prevention, according to a new report.

The report, published in the Journal of the American Medical Association (JAMA) found that 93% of pediatricians are aware of the new guidelines, which were released in 2017 by the National Institute of Allergy and Infectious Diseases.

But less than 30% of pediatricians are following the guidelines in full, according to the report.

The guidelines issued in 2017 call for assessment of peanut-allergy risk and introduction of peanut- containing foods in the diet of infants at 4-6 months of age, in efforts to prevent peanut allergy. This is a reversal from 20 years ago, when the American Academy of Pediatrics recommended that peanut should be avoided until the child is 3 years old.

The survey data included responses from 1,781 pediatricians found that common barriers to guideline implementation included lack of clinic time, conducting in-office supervised feeding of peanut-containing food, performing peanut allergy testing, concerns about newness of the guidelines, and parental fear of allergic reactions. 

Researchers discover critical new allergy pathway

Mouse study discovery points to potential new drug targets for treating asthma, hay fever, and other inflammatory disorders

JOHNS HOPKINS UNIVERSITY BLOOMBERG SCHOOL OF PUBLIC HEALTH

Researchers at Johns Hopkins Bloomberg School of Public Health have identified the sequence of molecular events by which tiny, tick-like creatures called house dust mites trigger asthma and allergic rhinitis.

The researchers, whose study was published online June 22 in Nature Immunology, found that allergy-triggering molecules from dust mites can interact with an immune protein called SAA1, which is better known as a sentinel against bacteria and other infectious agents. The researchers showed step-by-step how this interaction between mite-molecules and SAA1 triggers an allergic-type immune response in mice.

The findings reveal what may be a significant new pathway by which allergic and inflammatory disorders arise. They also suggest that blocking the pathway could potentially work as a preventive or treatment strategy against asthma and other allergic reactions.

“We think that the signaling interactions that occur immediately downstream of the mite-proteins’ activation of SAA1 may be good targets for future drugs,” says study senior author Marsha Wills-Karp, PhD, the Anna M. Baetjer Professor of Environmental Health and Chair of the Department of Environmental Health and Engineering at the Bloomberg School.

Asthma affects between 8 to 15 percent of people in the U.S., and is typically triggered by dust mites, tree and grass pollens, and other allergens. Researchers suspect that this inappropriate immune triggering happens when the immune system mistakes allergens–which are otherwise harmless–for pieces of bacteria or other infectious agents. However, the molecular mechanisms underlying this misidentification haven’t been well understood.

In their study, Wills-Karp and her colleagues zeroed in on SAA1, an immune protein that is found, among other places, in the fluid that lines the airways and other mucosal surfaces. A member of the evolutionarily ancient “innate immune system” of mammals, SAA1 is thought to have evolved as a sentinel or early-responder molecule that, for example, recognizes and helps clear away certain types of bacteria and other infectious agents.

The researchers found that exposure to dust-mite proteins causes an asthma-like sensitization of the airways of the control group mice. In contrast, exposure to dust-mite proteins hardly had any effect in mice in which SAA1 was neutralized by antibodies, or in mice whose genes for SAA1 were knocked out. Further experiments confirmed that SAA1, when it is present, directly binds certain dust-mite allergens called fatty-acid binding proteins, which have structural similarities with proteins found in some bacteria and parasites. This allergen-SAA1 interaction releases SAA1 into its active form, wherein it activates a receptor called FPR2 on airway-lining cells. The airway cells then produce and secrete large quantities of interleukin-33, a protein known for its ability to stimulate allergic-type immune responses.

Confirming the likely relevance to humans, the researchers found evidence of increased production of SAA1 and FPR2 in nasal airway-lining cells from patients with chronic sinusitis–which is often linked to dust-mite allergens–compared to healthy controls.

“We think that different allergens take different routes to the activation of interleukin-33 and related allergic responses, and this SAA1-FPR2 route seems to be one that is taken by some dust-mite allergens,” Wills-Karp says.

She and her colleagues now plan to investigate why some people develop allergic disorders in which this pathway is hyperactive, while most don’t. They also plan to explore the possibility of blocking this pathway, perhaps at the SAA1-FPR2 interaction, as a way of treating asthma and other allergic disorders.

The researchers suspect that the newly described SAA1-FPR2 allergic pathway may be relevant not only in asthma and hay fever-type disorders but also in atopic dermatitis (eczema) and food allergies–possibly even in chronic inflammatory disorders such as rheumatoid arthritis and atherosclerosis.

Perth Picturesque in Teal

For the third consecutive year, Perth’s stunning Trafalgar Bridge triggered teal for Food Allergy Awareness Month from Friday the 15th to Saturday the 16th of May, 2020.

A very special thanks to all those at Perth City Council for their commitment to making this happen once again, as well as to our good friend Dr. Anthony Chaffee (pictured), who last year took time to visit Trafalgar Bridge. This year, he and all health care workers all around the world are working tirelessly to help keep us all safe during the COVID-19 Pandemic. We thank you and salute you all for your efforts!

TURN IT TEAL was created by Cleveland, Ohio native Stephanie Lowe, who founded ‘Turn it Teal’ in 2014. The aim of which was to light as many prominent monuments and buildings as possible to highlight Food Allergy Awareness Month.
At TRIGGER Food Allergy Awareness we are proud to have helped to make the initiative global with the lighting of the Sydney Town Hall in 2017,
being the first building outside of North America to turn teal in support of Food Allergy Awareness and have since lit Brisbane, Melbourne, Perth and Tasmania.

For more information about this initiative please visit turnitteal.org or email us at info@triggerawareness.org – Thank you.

Teal Time in Brisbane!

As Food Allergy Awareness Month rolled on, Brisbane lit up its beautiful Story and Victoria Bridges in teal to support those with food allergies, and help raise awareness.

Despite COVID-19, the two bridges dazzled and lit a teal beacon for those with food allergies. A special thank you once again to the team at the Brisbane City Council, who made this effort possible!

Another thank you to GlobalAAI.org for your continued support!

TURN IT TEAL was created by Cleveland, Ohio native Stephanie Lowe, who founded ‘Turn it Teal’ in 2014. The aim of which was to light as many prominent monuments and buildings as possible to highlight Food Allergy Awareness Month.
At TRIGGER Food Allergy Awareness we are proud to have helped to make the initiative global with the lighting of the Sydney Town Hall in 2017,
being the first building outside of North America to turn teal in support of Food Allergy Awareness and have since lit Brisbane, Melbourne, Perth and Tasmania.

For more information about this initiative please visit turnitteal.org or email us at info@triggerawareness.org – Thank you.

Tasmania Triggers Teal in 2020

Australia is all set to raise Food Allergy Awareness throughout May and will ‘Turn It Teal’ to shine a light on food allergies, which affect millions around the world.

This year, despite the COVID-19 Pandemic, we welcomed aboard Launceston, Tasmania, who was the first city to switch on the teal lights for 2020 and illuminated the stunning Launceston Town Hall from May 1st to May 4th, 2020.

This was the inaugural year for Tasmania to join the initiative and we thank all at Launceston City Council who helped to make this happen.

TURN IT TEAL was created by Cleveland, Ohio native Stephanie Lowe, who founded ‘Turn it Teal’ in 2014. The aim of which was to light as many prominent monuments and buildings as possible to highlight Food Allergy Awareness Month.
At TRIGGER Food Allergy Awareness we are proud to have helped to make the initiative global with the lighting of the Sydney Town Hall in 2017,
being the first building outside of North America to turn teal in support of Food Allergy Awareness, and have since lit Brisbane, Melbourne, Perth and now Tasmania.

For more information about this initiative please visit turnitteal.org or email us at info@triggerawareness.org – Thank you.

Turn It Teal This May

This year, despite the unprecedented disruption of COVID-19, TRIGGER AWARENESS will once again join with TURN IT TEAL to raise food allergy awareness.

May is Food Allergy Awareness Month, a dedicated time to help increase awareness of food allergies and help to protect those at risk. TRIGGER AWARENESS will once again join with TURN IT TEAL to raise food allergy awareness by continuing to light prominent structures around the world in teal, the hue of food allergies.

This year Australia will continue to shine the teal spotlight in:

We welcome Launceston, Tasmania, which joins the initiative this year and will light up the beautiful Launceston Town Hall from May 1 – May 4, 2020.
Brisbane joined us in 2018 and this year will illuminate both its Story Bridge and Victoria Bridge on Monday, May 11.
Perth will put a teal spotlight on food allergy awareness for the third consecutive year by lighting its Trafalgar Bridge in teal on Friday, 15th and Saturday, 16th May.

TURN IT TEAL was created by Cleveland, Ohio native Stephanie Lowe, who founded ‘Turn it Teal’ in 2014. The aim of which was to light as many prominent monuments and buildings as possible to highlight Food Allergy Awareness Month.
At TRIGGER Food Allergy Awareness we are proud to have helped to make the initiative global with the lighting of the Sydney Town Hall in 2017,
being the first building outside of North America to turn teal in support of Food Allergy Awareness.

For more information about this initiative please visit turnitteal.org or email us at info@triggerawareness.org – Thank you.

First peanut allergy drug for children approved by FDA

The U.S. Food and Drug Administration approved Palforzia [Peanut (Arachis hypogaea) Allergen Powder-dnfp] to mitigate allergic reactions, including anaphylaxis, that may occur with accidental exposure to peanuts. Treatment with Palforzia may be initiated in individuals ages 4 through 17 years with a confirmed diagnosis of peanut allergy and may be continued in individuals 4 years of age and older. Those who take Palforzia must continue to avoid peanuts in their diets.

“Peanut allergy affects approximately 1 million children in the U.S. and only 1 out of 5 of these children will outgrow their allergy. Because there is no cure, allergic individuals must strictly avoid exposure to prevent severe and potentially life-threatening reactions,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. “Even with strict avoidance, inadvertent exposures can and do occur. When used in conjunction with peanut avoidance, Palforzia provides an FDA-approved treatment option to help reduce the risk of these allergic reactions in children with peanut allergy.”

Palforzia is a powder that is manufactured from peanuts and packaged in pull-apart color-coded capsules for Dose Escalation and Up-Dosing, and in a sachet for maintenance treatment. The powder is emptied from the capsules or sachet and mixed with a small amount of semisolid food – such as applesauce, yogurt, or pudding – that the patient then consumes.

More information about this is available in FDA Press Release

Research – New clues in understanding how to prevent food allergies by breastfeeding

Breastfeeding mothers may be encouraged to eat eggs to help prevent babies from developing an egg allergy, according to new studies by researchers at The University of Western Australia.

Study leader Professor Valerie Verhasselt, from UWA’s School of Molecular Sciences, said the findings were important because in western countries up to 10% of children already have a food allergy at one year of age.

“Among high-risk population, one third are already sensitised to egg at 4 months of age and may experience severe allergic reaction if egg is introduced into their diet,” Professor Verhasselt said.

“Our study shows that protection could be induced through breastfeeding and before the introduction of any solid food to the child’s diet.”

The researchers were able to discover that some breastmilk components were more successful than others in preventing allergy.

“Ten years ago, we demonstrated in an animal model that you could educate the immune system of a baby to accept egg protein as well as protect the baby from egg allergy later on,” Professor Verhasselt said.

“Our new study shows for the first time that this may also happen in humans. We’ve found that cases of egg allergy in children are four times less likely when they have been exposed to breastmilk containing egg protein, compared to those exposed to breastmilk without detectable egg protein.”

Targeting house dust mites allergens in breastmilk may be an additional key to ensure food allergy prevention in breastfed children.

The team at UWA was also able to uncover that some mothers shed house dust mite allergens in breastmilk. House dust mite allergens are known to be responsible for respiratory allergies such as rhinitis and asthma.

“By conducting pre-clinical experiments, we demonstrated the very new concept that respiratory allergens in a baby’s gut may represent a risk factor for food allergies,” Professor Verhasselt said.

“Targeting respiratory allergens may be essential for prevention of egg allergy in breastfed children.”

Professor Verhasselt, who is also the Larssen-Rosenquist Chair in Human Lactology at UWA, said the studies, published in the journals Allergy and Journal of Allergy and Clinical Immunology, showed researchers were on the path to preventing egg allergy through breastfeeding.

“Our data still needs to be confirmed in large randomised control trials to bring formal proof of this promising new approach of exposing babies to egg protein through breastmilk,” she said.

“Our research is aiming to find ways to prevent allergy and stop this modern world epidemic,” Professor Verhasselt said.

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