New Study: Children with atopic dermatitis (AD) might be at increased risk of of mental health disorders

A study into the associations between atopic dermatitis and mental health conditions revealed that the disease was linked to symptoms of depression and internalizing behaviors that carried on through childhood and adolescence.

Investigators led by Joy Wan, MD, MSCE, Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, believed the findings highlighted the importance of behavioral and mental health awareness in young populations.

Atopic dermatitis has been considered one of the most common inflammatory skin diseases, affecting up to 15%-20% of pediatric populations worldwide.

Associations between the disease and anxiety, suicidal ideation, and depression had been confirmed in earlier studies, though most studies had focused on adult populations.

According to investigators, pediatric depression often goes untreated and under-diagnosed, likely due to the subtle symptoms recorded.

A total of 11,181 children participated in the study. Each participating family had a child with at least 1 completed atopic dermatitis assessment and 1 completed mood questionnaire.

Wan and colleagues found that children with symptoms of depression were more likely to be female (2673 of 4710). [56.8%] usa 2767 of 6471 [42.8%]), from a higher social class (243 of 4710 [5.2%] usa 317 of 6471 [4.9%]).

In addition, the period prevalence of symptoms of depression, as measured by the SMFQ, increased from 6.0% at age 10 to 21.6% at age 18.

The study, “Association of Atopic Dermatitis and Mental Health Outcomes Across Childhood, A Longitudinal Cohort Study,” was published online in JAMA Dermatology.

This May, What Will You Do To Raise Food Allergy Awareness?

It is estimated that up to 250 million people may suffer from food allergies worldwide. To date, there is no cure for food allergies, and no definitive answer as to what causes them. What is agreed, however, is that raising awareness is crucial.

Don’t know where to start? Here are some options:

  • Learn to recognize the signs and symptoms of an allergic reaction. This small amount of knowledge could save lives!
  • Change Your Profile Picture to a teal ribbon, or any other food allergy awareness symbol. This starts a conversation, as well as encouraging others to do the same.
  • Light It Teal For Food Allergy Awareness. During May, many buildings and bridges around the world will ‘Light it Teal’ to raise awareness. To find out the landmarks near you, head to www.lightitteal.org
  • TRIGGER Food Allergy Awareness partnered with ‘Light It Teal’  to light up Australia. This year will see Brisbane, Melbourne, Canberra, Perth and Launceston take part. If you’re in the area, go take photos of this year’s teal buildings and share on your socials using the tags #foodallergyawarenessmonth #lightitteal #triggerawareness
  • Research the facts. Food allergies are on the rise worldwide, and knowing the facts helps you spread the word to your family, friends and community, as well as informing others how to help those living with the disease. Why not contact a media outlet and tell your own personal story?
  • Share awareness information on social media platforms. Take the issue of allergies to a greater audience. Spread the word, and encourage your followers to do the same. Use the awareness tags #foodallergyawarenessmonth #foodallergyawareness #triggerawareness
  • Start a petition for clearer labeling, more accessible medication, or any other thing that helps families struggling with this lifelong condition.

Any form of awareness helps the community, so get started today!  

Thank you!

Food allergies leave parents living in fear

Parents of children with food allergies face significant worry, severe anxiety and post-traumatic stress – according to new research from the University of East Anglia.

Between six and eight per cent of children suffer a food allergy – with eggs, milk, and peanuts being the most common causes. They can cause vomiting, cramps, hives, swelling, eczema, breathing problems and in severe cases anaphylactic shock, which can lead to hospitalisation or death.

A new study published finds that more than 80 per cent of parents face ‘significant worry’ about their child’s food allergy, while 42 per cent met the clinical cut-off for post-traumatic stress symptoms (PTSS) and 39 per cent reported moderate to extremely severe anxiety.

Parents whose children have had to have an adrenaline auto-injector (for example an Epipen) administered were seven times more likely to experience PTSS.

Judith Young, from UEA’s Norwich Medical School and Addenbrooke’s Hospital, noticed in her work as an Honorary Consultant Clinical Psychologist that parents were describing psychological distress related to their child’s allergy, but that there was little research into this.

Dr Kate Roberts carried out the study as part of her doctoral thesis at UEA, in collaboration with Judith Young,

Dr Alex Brightwell from Norfolk and Norwich University Hospitals NHS Foundation Trust and Prof Richard Meiser-Stedman, from UEA’s Norwich Medical School.

Dr Roberts said: “Caring for a child with a food allergy can be really challenging – not least because they can be exposed to the foods they are allergic to, even with very careful management.

“We wanted to see how the parents of children with food allergies were affected by anxiety, worry and PTSS. And we also evaluated whether the level of anxiety and stress experienced was linked to factors such as the severity of the child’s allergy.”

A total of 105 parents of children with medically diagnosed food allergies completed online questionnaires about their experiences.

Around half of the children had been rushed to hospital at least once because of an allergic reaction.

As well as considering the level of the child’s allergy, the team also looked at the parents’ intolerance of uncertainty – how they manage unforeseen events, like the fact that they cannot completely control their child’s exposure to food they’re allergic to.

They also assessed the parents’ ‘self efficacy’ – their confidence in allergy management.

Dr Roberts, who now works at Cambridgeshire Community Services NHS Trust and the Queen Elizabeth Hospital King’s Lynn, said: “We found that a large proportion of the parents – 81 per cent – reported clinically significant worry and 42 per cent reported significant trauma symptoms related to their child’s food allergy.

“Parents who reported their child to have had an adrenaline auto-injector (AAI) administered, were around seven times more likely to report clinically significant PTSS.

“Greater intolerance of uncertainty and lower food allergy self-efficacy were associated with poorer psychological outcomes. But we found mixed results for the relationship between allergy severity and parent mental health, with PTSS observed in parents of children with both life-threatening and milder allergies.

“This really highlights the need for greater awareness about the mental health problems that parents of children with food allergies may be experiencing.

“Knowing which factors could predict different psychological outcomes is important because it could help identify those parents who may be struggling with their mental health and help them overcome some of the problems they may be experiencing,” she added.

Dr Alex Brightwell, Consultant Paediatrician, said: “I am delighted to have had the opportunity to work with UEA in this important area to contribute to an emerging body of evidence and ongoing research about the impact of food allergies on families. Anxiety and worry about having a child with food allergies is something we are seeing on a day to day basis. We are looking forward to working with UEA on further research to develop tools to support families affected by food allergy.”

UCLA study: using nanoparticle technology shows promising results for treating severe allergies

UCLA scientists may have developed a long-term treatment for severe food allergies.
The technology uses a nanoparticle — a particle to deliver proteins to specific cells in the liver. Those proteins may trigger an allergic response in other organs in the body, but in the liver, they cause the targeted cells to activate a tolerant immune response that switches the allergic response off.
“The researchers’ therapy takes advantage of the liver’s ability to stop the immune system from entering an allergic reaction”, said Tian Xia, an associate professor of medicine and co-author of the study. “The liver frequently interacts with foreign proteins that people eat, so it has a natural immune tolerance,” he added.

The treatment uses injections into the bloodstream to deliver allergen particles to the liver so that it can perform the process it undergoes commonly when encountering foreign proteins.
Further experimentation must be done to determine how long the therapy’s effect could last it is hoped that the therapy could provide resistance against allergies for a lifetime. If not, the treatment could be administered on an interval basis, around weeks or months apart.
Currently, the treatment is in the preclinical phase. The team is testing its therapy on animals and will submit documentation to the Food and Drug Administration to move on to human clinical trials.

Study: Nearly one in five parents of food-allergic children are bullied

New research shows that food allergy bullying is not just a problem for food-allergic kids but also their parents too.

“We know children are often bullied about their food allergies,” says Dannielle Brown, MHS, lead author of the study. “What we weren’t aware of was how many parents are bullied by multiple sources. Of the 252 parents or guardians we surveyed, more than 17% said they had been bullied.”

Parents of children 4-17 years (school-age children) in the survey found it was helpful to take action to stop the bullying. 13% of parents/guardians spoke with their child, 7% spoke with the offender or the offender’s parent, 17% spoke with a teacher and 15% spoke with a principal or administrator. Almost 50% of those who did something to stop food allergy bullying said it was helpful.

Another important finding in the survey was that while there were no significant differences in the percentages of Black and white children who were bullied around food allergies.

“No child or their parent should be bullied because of their food allergies,” says food allergy researcher Ruchi Gupta, MD, MPH, ACAAI member and one of the lead researchers on the study. “Having a food allergy puts tremendous stress on the entire family and any form of bullying makes life that much harder.”

Study finds antibiotics before age 2 associated with childhood health issues

In a retrospective case study, Mayo Clinic researchers have found that antibiotics administered to children younger than 2 are associated with several ongoing illnesses or conditions, ranging from allergies to obesity. The findings appear in Mayo Clinic Proceedings.

Using health record data from the Rochester Epidemiology Project, a population-based research collaboration in Minnesota and Wisconsin, researchers analyzed data from over 14,500 children. About 70% of the children had received at least one treatment with antibiotics for illness before age 2. Children receiving multiple antibiotic treatments were more likely to have multiple illnesses or conditions later in childhood.

Types and frequency of illness varied depending on age, type of medication, dose and number of doses. There also were some differences between boys and girls. Conditions associated with early use of antibiotics included asthma, allergic rhinitis, weight issues and obesity, food allergies, attention deficit hyperactivity disorder, celiac disease, and atopic dermatitis. The authors speculate that even though antibiotics may only transiently affect the microbiome, the collection of microbes in the body, this may have long-term health consequences.

“We want to emphasize that this study shows association ,not causation of these conditions,” says Nathan LeBrasseur, Ph.D., a researcher at Mayo Clinic’s Robert and Arlene Kogod Center on Aging and the study’s senior author. “These findings offer the opportunity to target future research to determine more reliable and safer approaches to timing, dosing and types of antibiotics for children in this age group.”

While recent data show an increase in some of the childhood conditions involved in the study, experts are not sure why. Other than the issue of multidrug resistance, antibiotics have been presumed safe by most pediatricians.

Researchers also say the ultimate goal is to provide practical guidelines for physicians on the safest way to use antibiotics early in life.

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.

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

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