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LINKS:
The Whole Foods Allergy Free Cookbook by Cybele Pascal
Divvies Allergy Free Goodies (Made to Share)
THIS POST HAS BEEN MARKED PRIVATE BY WORDPRESS.COM STAFF IN RESPONSE TO A COPYRIGHT VIOLATION COMPLAINT.
In the article below, Ms. Broussard alleges that the current perception of increased incidence in food allergies is all a big conspiracy propagated by the Food Allergy and Anaphylaxis Network and the pharmaceutical companies that benefit from the public’s “paranoia”. She dismisses the severity of fatal food related anaphylaxis and displays shallow understanding of the research and the issues in this field.
It is disappointing to say the least that Harper’s magazine and WNYC allowed this article to make it to press and on the air without doing the requisite research on such an important topic.
Ms. Broussard’s article is merely another manifestation of the “backlash” to the media attention to food allergies (see “Mean Grownups” post in this blog). These articles would be useful if they were well-researched and well- informed on the issues, instead of merely just cashing in on a hot topic by trying to be controversial and in the process, making the lives of many truly food allergic patients more difficult.
“Everyone’s Gone Nuts”
The Exaggerated Threat of Food Allergies
by Meredith Broussard
in Harpers Jan 2008
Of little concern to most parents or educators only a generation ago,food allergies are now seen as a childhood epidemic. The American Academy of Pediatrics recently began recommending that peanuts be withheld until a child turns three; hundreds of food-allergy non profitsand local parents groups have formed; and six states have passed laws requiring food-allergy safety measures in their schools, with similar legislation currently being considered in Congress. Children are even being recruited to help battle this supposed threat, as in this Food Allergy & Anaphylaxis Network (FAAN) brochure, which enjoins young students to “Be a PAL” and protect the lives of their classmates. But the rash of fatal food allergies is mostly myth, a cultural hysteria cooked up with a few key ingredients: fearful parents in an age of increased anxiety, sensationalist news coverage, and a coterie of wellplaced advocates whose dubious science has fed the frenzy.
One of the first and most influential of the food-allergy non profits, FAAN has successfully passed off as fact its message that food allergies have become more prevalent and dire. Since 2005, more than 400 news stories have used FAAN’s estimates that allergic reactions to food send 30,000 Americans to emergency rooms each year and that 150 to 200 ultimately die. The group derived these figures from a 1999 study of a rural Minnesota community,in which 133 people over a five-year period were determined to have suffered anaphylaxis-an allergic reaction that can mean everything from going into shock to developing an itchy mouth. Yet only nine people in the study ever required hospitalization for anaphylaxis from any cause. As for
the death estimate, just one person died of anaphylactic shock, prompted not by food allergies but by exercise. The Centers for Disease Control and Prevention, in its most up-to-dare figures, recorded only 12deaths from food allergies in all of 2004. When asked about these statistical discrepancies, FAAN founder and CEO Anne Munoz-Furlong said focusing on any number
misses the point: “One child dying from food allergies is too many.”
In 2005, every major American media outlet covered the story of a teenager who died after kissing a boy who earlier in the day had eaten a peanut-butter sandwich. This “kiss of death” confirmed for countless nervous parents their worst fears: food-allergic children were in constant danger-they could “even die!” as FAAN warns here-from any sort of secondhand exposure to certain foods. (In a press release soon after the girl’s death, FAAN instructed food-allergic teens to tell “thatspecial someone that you can die …. Don’t wait for the first kiss.”) But there is simply no evidence that a food allergen can do serious harm if not ingested. Nicholas Pawlowski, an allergist at Children’s Hospital of Philadelphia, says he occasionally has to spread peanut butter on a patient’s arm to demonstrate to parents that their child will not die from casual contact with a nut. In the case of the peanut-butter kiss, a coroner later ruled, to no fanfare, that the girl had smoked pot
In addition to offering certificates to “PAL Heroes,” FAAN presents individuals and businesses with a service award named after Mufioz-Furlong’s daughter, a former food-allergic child who, like most people, grew out of her allergies. Anne Munoz-Furlong says she founded FAAN when her community didn’t seem to believe the threat to her child was real. Her organization
and others have certainly helped to change the perception of food allergies. (A recent Newsweek cover showing a pigtailed girl in a gas mask with a carton of milk in one hand and a peanut-butter sandwich in the other is typical of much recent coverage.) But all we know for certain now is that more parents think their children suffer from food allergies. Indeed, even the best allergy tests produce high rates of false positives, and most studies of childhood
prevalence interview no one under the age of eighteen. Ken Kochanek, a CDC statistician, says there are far too few recorded incidents of anaphvlactic shock triggered by food allergies to draw any sound epidemiological conclusions:”We can’t find any hard data that supports the severity.”
These hugging forms evoke a better world in which we all look out for our food-allergic friends. Such chumminess already exists within the world of food-allergy advocacy. The FAAN children’s website was built using a donation from Dey, the distributor of the Epipen adrenaline in,
jector; Dey and Verus Pharmaceuticals, the maker of Epilpen’s chief competitor, sponsor FAAN’s major annual fundraising event. (As part of its safety guidelines, FAAN suggests carrying an adrenaline injector at all times and regularly renewing the prescription.) Just about all the
leading food allergists also have ties to FAAN or the Food Allergy Initiative (FAI), an organization prone to even more extreme rhetoric. This intimacy helps explain why suspect statistical findings get published. For instance, the coauthors of an oft-cited study on the dangers facing food-allergic children at restaurants were Anne Mufioz-Furlong’s husband, who serves as a top FAAN executive, and a FAAN medical,board member whose research is funded in part by FAl. The latter isalso an editor at the leading allergy journal where the study appeared;the journal’s editor-in-chief is head of FAl’s medical board.
There is no question that food allergies are real. Yet instead of creating the healthy, happy children shown here, exaggerating the threat may actually do as much harm as the allergies themselves. The peril is now perceived as so great that psychosomatic reactions to foods and their odors are not uncommon. Recent surveys have also shown that children thought to have food allergies feel more overwhelmed by anxiety, more limited in what they believe they can safely accomplish, than even children with diabetes and rheumatological disease. One study documented how food-allergic youths become terror-stricken when inside places like supermarkets and restaurants,since they know that allergens are nearby. Such psychological distress is exacerbated by parents, who report keeping their children away from birthday parties and sending them to school in “No Nuts” Tshirts. Having been fed a steady diet of fear for more than two decades, we have become, it appears, what we eat.
LINKS:
Interview with Meredith Broussard on WNYC
Ms. Broussard’s blog on Failed Relationships (and apparently, Food Allergies)
In response to the Harper’s article, I am posting an excerpt of an interview with Dr. Michael Pistiner, an Allergy- Immunology fellow at Harvard conducted by Sloane Miller originally posted on MyAllergy.com
DR. MICHAEL PISTINER: According to Broussard, the 150 to 200 deaths and 30,000 episodes of anaphylaxis in the United States each year were based on a 5-year study (1983 to 1987) by Yocum and colleagues in Olmsted County, Minnesota (a population that is similar in demographics to the white American population).
This study was published in the well respected Journal of Allergy and Clinical Immunology in 1999. (Yocum et al. JACI. 1999;104:452)
This was a groundbreaking study. Though it’s 20 years old, the information continues to be useful and, for some statistical facts, unmatched. Its uniqueness and usefulness is that all of the medical records (clinic, hospital, ER, etc.) from all of the residents of this county were collected and reviewed, giving the author of the study and his colleagues the rare opportunity to identify even cases of anaphylaxis that were misdiagnosed, mislabeled and would have otherwise not been reported (Weiler. JACI. 1999; 104:271-3).
It is common that researchers and clinicians use the results of studies such as this one to estimate how many people in the nation’s population as a whole suffer from a disease. Based on the 2007 population estimated numbers, one could predict that there would be 32,523 cases of food-induced anaphylaxis and 211 related deaths. FAAN and the many reputable investigators who derive numbers from this study are not misrepresenting or exaggerating the statistics, they are using the available data.
SM: Remember the now famous story of a peanut-allergic teen that supposedly died from kissing her boyfriend who had eaten peanuts? The coroner later proved that she died from an asthma attack.
Can asthma be part of an allergic or anaphylactic reaction?
MP: Yes. Anaphylaxis can trigger asthma attacks that are notoriously difficult to treat. Wheezing, cough, chest tightness, and shortness of breath commonly occur during an asthma attack but are also life threatening symptoms seen during anaphylaxis (Wang. Clinical and Experimental Allergy, 37, 651-660). In some cases, respiratory symptoms can be the only manifestation (Moneret-Vautrin et al. Allergy. 2005: 60: 443-451). Anaphylaxis presenting in this way must be quickly treated with epinephrine. Prior to the advent of albuterol, epinephrine was the drug of choice for asthma exacerbation. When in doubt, use your epinephrine and call 911.
SM: How real is the threat from so-called “second-hand exposure,” like a kiss, to an allergen?
MP: Allergens can be transferred through saliva, so the second-hand exposure threat is real but entirely avoidable. Rosemary Hallett and colleagues at the University of California Davis School of Medicine reviewed data collected on 379 subjects with self-reported immediate nut or seed allergy and found that 20 subjects (5.3%) reported that they experienced reactions from kissing. Most of these reactions were mild but 20% did experience respiratory symptoms (Hallett et al. N Engl J Med 2002; 346:1833-4). Studies in other countries showed that people with food allergies reported that they experienced allergic symptoms after having “close physical contact (for example, kissing) with someone who recently ate something they were hypersensitive to (Eriksson et al. Journal of Investigational Allergology and Clinical Immunology. 2003 13(3):149-154).
In 2006, Maloney and colleagues conducted a study measuring the amount of peanut protein in 1 ml of saliva at certain times after eating a peanut butter sandwich and following various interventions. The study showed that soon after eating peanut butter salivary levels of peanut protein were high enough in some to cause a reaction. Additionally, 13% of subjects had detectable peanut protein in the saliva after 1 hour. No subjects had detectable salivary peanut protein several hours later and after eating a peanut-free meal. This study supports the reports of patients experiencing symptoms after kissing and demonstrates that oral contact with saliva, such as from sharing utensils or cups, can contain significant amounts of allergen and should be avoided. Additionally this study gives some guidance as far as interventions that can reduce the risk of a reaction other than complete avoidance (Maloney et al. JACI. V 118, (3) 719-724).
SM: Broussard quotes a CDC statistician who says, “There are far too few recorded incidents of anaphylactic shock triggered by food allergies to draw any sound epidemiological conclusions: ‘We can’t find any hard data that supports the severity’.”
MP: Studies determining the rates anaphylaxis and death from anaphylaxis have been notoriously difficult to conduct. Until recently, there has been little consensus as to its definition or clinical criteria and it is widely thought that it is underreported and underdiagnosed (Lieberman et al. Annals of Allergy, Asthma & Immunology. 2007;98:519-523).
Statistical information on deaths caused by food anaphylaxis is reliant on appropriate coding, interpretation of death certificates, and the correct diagnosis of cause of death (Neugut et al. ARCH INTERN MED/VOL 161, JAN 8, 2001) .
Even with imperfect methods of data collection and reporting, it is clear from the existing studies that food-related anaphylaxis is a real and growing global issue.
The European Academy Of Allergology And Clinical Immunology recently published a position paper on the management of anaphylaxis in childhood. In this paper, they review several studies supporting an increase in cases of anaphylaxis in North America and Europe. They reference studies that support an increase in anaphylaxis and food allergies in the United Kingdom and Canada.
In looking at the literature, it is clear that food-induced anaphylaxis is very real.
These studies have additionally shown us what risk factors are associated with death:
delayed epinephrine administrationbeing an adolescence or young adultasthmapeanut allergytree nut allergyprior minor reactionsnot asking about ingredients when dining out (Bock at al. Journal of Allergy and Clinical immunology. V119 (4) 1016-1017)The studies have also shown us what we can do to prevent these tragedies.
SM: Ms. Broussard implied that FAAN’s medical board and advising doctors are in some way colluding to disseminate exaggerated evidence. Do you know anything about FAAN’s studies’ objectivity?
MP: FAAN’s medical board and advising doctors are many of the leaders in food allergy and academic allergy and have been responsible for many of the studies leading to information that has dispelled fear and has increased patient safety. The studies published by these authors have been in well respected, peer reviewed journals which are scrutinized by other allergists and experts in the field prior to their publication. This identical process goes for studies that have received funding by FAAN. This process leaves little room for the dissemination of confabulated or manipulated data for self gain.
SM: Ms. Broussard wrote, “…exaggerating the threat may actually do as much harm as the allergies themselves. The peril is now perceived as so great that psychosomatic reactions to foods and their odors are not un-common”. Are you seeing this in your practice?
MP: I have experienced fear first hand while watching my own child have a severe, life threatening allergic reaction and not having the appropriate medication that could save his life. After my son recovered and my family had time to process what had happened we put into place well thought-out strategies, based on existing literature, to attempt to prevent this from happening again (avoidance strategies) and in the event that it did, a treatment plan to save his life (allergy action plan and epinephrine). Although we have a healthy respect for his allergy and are vigilant we are no longer afraid.
**
Dr. Michael Pistiner:
Dr. Michael Pistiner is currently a fellow in Allergy and Immunology at Children’s Hospital Boston, Harvard Medical School and is in his final year of the Scholars in Clinical Science Program of Harvard Medical School (masters program in patient based research). Over the last 2 years he has developed a special interest in pediatric food allergy and in the management of food allergy in schools. Within the last 4 months he has seen first hand the critical importance of community wide education as his pre-school aged son experienced anaphylaxis (life-threatening allergic reaction) after eating a small amount of walnut. He is committed to the use of practical food allergy education to replace fear and divisiveness with empowerment, confidence, and unity. Upon completion of his fellowship in July 2008, he will return to New York State and join Allergy & Asthma Consultants of Rockland & Bergen.
For references to the articles mentioned by Dr. Pistiner, please go to the original article on MyAllergyNetwork.com
Posted by: Scott Sicherer, MD January 03, 2008
(on the WNYC response forum)
Dr. Sicherer is Asst. Professor of Allergy and Immunology at Mt. Sinai Hospital
New York
My name is Scott Sicherer. I am a pediatric allergist and researcher (government and private funded) specializing in food allergy. I am co-author on most of the studies that Ms. Broussard “quotes” in her Harpers article where she implies conspiracy and trivializes this significant medical problem. I am also a volunteer medical advisor to FAAN, an organization that she mocks but is, in my view, a non-profit that has clearly increased safety for those who suffer from this medical illness. I mention these points because by Ms. Broussard’s reasoning these personal involvements would probably disqualify me from discussing food allergy (e.g., conspiracy to exagerate). Apparently, NPR also sees some odd virtue in having a non-medical expert journalist be a spokesperson for health issues. I have never “posted” to sites like this and I am a bit reluctant to draw any additional attention to Ms. Broussard’s hurtful, confused and potentially dangerous comments, but I was obviously compelled to do so…It is easy to play “debate team” with any topic but here it has become irresponsible and, indeed, potentially dangerous. I am glad to see so many listeners have spoken up on their disappointment and made important points that I will not reiterate. I would be pleased to provide actual evidence-based educational information about food allergy on this “show”–but maybe that is too uninteresting for the media? I hope that is not the case.
Esophagitis is a general term for any inflammation, irritation, or swelling of the esophagus, the tube that leads from the back of the mouth to the stomach. Eosinophilic esophagitis patients present with gastric reflux symptoms (heartburn, chest pain, vomiting, regurgitation, abdominal pain) in addition to difficulty swallowing and/ or food impaction and are found on biopsy of the esophagus to have high number of eosinophils (greater than 15-20 per high power field) without infiltration of the rest of the gastrointestinal tract.
Eosinophils are a type of white blood cell which play an important role in immune function, mainly as a defense against against parasites, but are also involved in diseases like allergies and asthma.
People with eosinophilic esophagitis usually have a personal or family history of allergic disease such as hayfever, asthma, or eczema. They present with difficult to treat reflux symptoms, and often food impaction in teens or young adults. Upper endoscopy can show linear furrows, mucosal rings, strictures, or appear normal.
The diagnosis is established by obtaining multiple (at least 5) biopsy specimens of the esophagus which show increased eosinophils (15-20/hpf) in the mucosa only, with none in the stomach or duodenum.
The exact etiology of eosinophilic esophagitis is not yet known, but food and environmental allergies are possible contributors. Short-term studies of the natural history of the disease show no concomitant eosinophilic infiltration of stomach or duodenum, no progression to hypereosinophilic syndrome or development of malignancy.
Food Allergy testing via prick and atopy patch skin test have been used to identify relevant food allergens to guide elimination diets.
Treatment consists of elimination diets, topical corticosteroids, and systemic corticosteroids.
LINKS:
Center for Pediatric Eosinophil Disorders
Resources for Families
More Resources for Families dealing with Eosinophilic Disorders
American Partnership for Eosinophilic Disorders (APFED)
Allergy and Asthma Consultants of Rockland and Bergen
Neocate
MERRY CHRISTMAS and
REMEMBER TO ALWAYS CHECK INGREDIENTS!
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Greg Ruffing / Redux for Newsweek
by By Claudia Kalb | NEWSWEEK Nov 5, 2007 Issue
It’s 1 p.m. at Mercer Elementary School in Shaker Heights, Ohio, and Lena Paskewitz’s kindergarten class is filled with the happy hum of kids getting ready for their favorite part of the day: lunch. Caleigh Leiken, 6, is toting a pink Hello Kitty bag her mom has packed with goodies: strawberry yogurt, string cheese, some veggies and a cookie. But there’s one childhood staple missing—a PB&J. Caleigh was diagnosed with a peanut and tree-nut allergy when she was just 7 months old. Nuts are a no-no at her table in the Mercer lunchroom. Her allergy-free friends can sit there, but only if their lunches have been stored in a special bin and carefully inspected by the teacher. Home, too, is a nut-free zone for Caleigh. When she goes trick-or-treating this week, her candy will be scarier than any costume; she won’t be able to eat any of it for fear it’s tainted with peanut residue. For Caleigh’s mom, Erika Friedman—whose other two kids also have allergies—food can seem like an enemy. “We plan everything,” says Friedman. “It’s our job—actually, everyone’s job—to keep them safe.”
There was a time when food allergies were of little concern to the medical community. Today about 11 million Americans suffer from them, and many scientists agree the numbers are climbing. Most significantly, peanut allergies—among the most dire—doubled between 1997 and 2002 in children under 5. “Clearly, the number has increased in the younger population,” says Dr. Hugh Sampson, a food-allergy pioneer at Mount Sinai School of Medicine in N.Y. “We suspect that [in the future], the numbers in general are going to increase.” Allergists say they’re now seeing more children with multiple allergies than ever before, not just to 1950s staples such as milk and wheat—but to global foods we have adopted since, like sesame and kiwi. And allergies many kids outgrow—like those to eggs—seem to be lingering longer than they did in the past.
Parents of very young children now worry over the introduction of each new food, on alert for the first signs of trouble, such as rashes, diarrhea and vomiting. Deaths are rare, but the most-sensitive kids’ throats may swell and completely close up if they’re exposed to the wrong foods. Even if your school-age child is allergy-free, you still have to be concerned about inadvertently triggering an allergic reaction in one of your kid’s friends or classmates. Dairy-free birthday cakes are de rigueur these days, as are no-peanut Halloween parties.
But why do allergies appear to be on the rise? One of the most intriguing theories, dubbed the “hygiene hypothesis,” is that we’ve all become too clean. The immune system is designed to battle dangerous foreign invaders like parasites and viruses and infections. But clean water, antibiotics and vaccines have eliminated some of our most toxic challenges. Intriguing research even posits that kids born by Caesarean section, which have risen 40 percent in the last decade, could be at higher risk for allergies, perhaps because they were never exposed to healthy bacteria in their mothers’ birth canals. Without hard-core adversaries, the theory goes, the immune system starts battling the innocuous—egg or wheat—instead.
Almost everyone, it seems, has had to adapt to the rise in food allergies. Affected kids are carrying EpiPens, syringelike devices loaded with epinephrine, in case of severe reactions. Many schools, like Mercer Elementary, maintain “peanut-free zones,” where allergic students can eat in safety. A growing number of states are establishing allergy guidelines. Manufacturers, thanks to a federal law implemented last year, now list the eight most common allergens (from milk to fish) on their food labels. And many airlines offer their passengers pretzels instead of peanuts.
While scientists have a basic understanding of how allergies work, they can still be stumped by the immune system, which is too complex to submit easily to their control. There are no cures for food allergies—only treatments for some of the symptoms—and the best parents and children can do now is avoid the culprits. Still, in recent years, researchers have begun to make exciting progress. They’re studying a radical approach: introducing the offending ingredients early to see if they can treat, cure or even prevent food allergies from developing. In one study, children allergic to peanuts are being given tiny amounts of peanut flour to see if they can build up tolerance. In another, funded by the Consortium of Food Allergy Research (coFAR), a five-year $17 million initiative launched in 2005 by the National Institute of Allergy and Infectious Diseases, researchers will give peanut-allergic adults small doses of an engineered peanut protein to ward off reactions and possibly eliminate the problem. The idea is ultimately to have a peanut-allergy vaccine. For Sampson, who is working on it, the quest for a solution is more urgent than ever. “We’re desperate,” he says.
Story continued at Newsweek.com
LINKS:
Food Allergy Tips to Remember
Mean Grown-Ups and Psychological Support of Patients with Food Allergy
Food Allergy and Anaphylaxis Network
Kids with Food Allergies
Video: Kids Talk About Their Food Allergies
Having food allergy is a stressful thing, as is having any potentially life threatening disease. What can make it even more stressful is when your peer group and community don’t take you seriously. Shinga from BreathSpa for Kids and Allergic Girl from Please Don’t Pass the Nuts brought my attention to a recent article by Jean Warner in the April 19, 2007 New York Times titled “Mean Grown Ups” (full text on Please Don’t Pass the Nuts) about conflict between the parents of the food allergic kids and non-allergic kids, here’s an excerpt:
“There’s an absolutely horrifying article in the current issue of Child Magazine about the food fight now raging between parents of children with life-threatening food allergies and parents of the allergy-free. The latter, apparently, have started to push back against “peanut-free” school regulations to assert their children’s natural right to eat whatever they darn well please.
The stories are downright chilling: One parent joked on a message board about having his daughter dress as “the Death Peanut” on Halloween. A North Carolina father at a parent-teacher organization meeting said he’d continue to send his child to school with peanut butter sandwiches and “tell his child to ’smear’ the peanut butter along the hallway walls.” Another father sent his child to school with a “disguised” sandwich that had peanut butter hidden in the middle of the bread.”
All I can recommend is “Education, Education, Education”. As far as I know, there is no amendment in the constitution that states that any child has a right to a PB&J sandwich in school, particularly if it might cause the death of his or her classmate. This was the same issue that came up when they stopped serving the little peanut packets on airplanes. The airlines realized that it was cheaper and easier to switch to pretzels instead of having to make emergency landings whenever a patient anaphylaxed. Of course, the “mean grown ups” in the article might have said that peanut allergic people shouldn’t fly on planes because it restricts their right to eat peanuts while flying.
I have posted an excerpt from my chapter in the upcoming 4th edition of Food Allergy (Blackwell Science) which I hope will shed some more light on the matter, and I refer you to the excellent Food Allergy and Anaphylaxis Network which has a School Food Allergy Program to increase food allergy awareness in schools, pre-schools, camps, and daycare centers and a Kids site to help children deal with their situation.
Psychological Support of Patients and Families with Food Allergy
The first and most important step in the management of food allergic patients is obtaining an accurate diagnosis. Once the diagnosis is established, education of the patient and their family regarding avoidance of the allergic food and treatment of anaphylactic reactions can be conducted [1]. However, avoidance measures and vigilance required have been shown to diminish quality of life and increase stress levels, particularly for families of children with food allergy [2,3]. This may also be a factor in decreased compliance with proscribed measures and precautions and result in increased risk-taking behaviour, particularly in teens and young adults [4]. Recognition of these issues are often overlooked in the evaluation and management of these patients. Use of disease specific quality of life measures, such as the Food Allergy Quality of Life –Parental Burden [5], increases understanding of these factors and may aid in the development of improved treatment strategies.
Use of self-management support and education, similar to the model used in the management of chronic illnesses such as diabetes, may offer insight into how we can improve quality of life and compliance in food allergic patients. Patient education provides knowledge-based instructions in the hope that this will lead to behavioural changes and improved clinical outcomes. Self-management support is directed towards improving the patient’s ability to deal with their medical condition, including physical and social consequences and lifestyle changes. It goes beyond patient education to include processes that develop patient problem-solving skills, improve self-efficacy, and support implementation of knowledge in real-life situations [6].
References:
1. Munoz- Furlong A. Daily coping strategies for patients and their families. Pediatrics. 2003 Jun;111 (6 pt 3):1654-61.
2. Primeau MN, Kagan R, Joseph L, Lim H, Dufresne C, Duffy C, Prhcal D, Clarke A. The psychological burden of peanut allergy as perceived by adults with peanut allergy and parents of peanut allergic children. Clin Exp Allergy. 2000 Aug; 30(8):1135-43.
3. Bollinger ME, Dahlquist LM, Mudd K, Sonntag C, Dillinger L, McKenna K. The impact of food allergy on the daily activities of children and their families. Ann Allergy Asthma Immunol. 2006 Mar; 96(3):415-21.
4. Sampson MA, Munoz-Furlong A, Sicherer SH. Risk-taking and coping strategies of adolescents and young adults with food allergy. J Allergy Clin Immunol. 2006 Jun;117 (6):1440-5.
5. Cohen BL, Noone S, Munoz-Furlong A, Sicherer SH. Development of a questionnaire to measure quality of life in families with a child with food allergy. J Allergy Clin Immunol. 2004 Nov;114(5):1159-63.
6. Coleman MT, Newton KS. Supporting self-management in patients with chronic illness. Am Fam Physician 2005;72: 1503-10.
From: de Asis L, Simon R. Psychological Considerations of Food Allergy chapter, Food Allergy and Adverse Reactions 4th ed. Blackwell Science (in press)
Link: Autism Speaks, Expert Interview
from the Centers for Disease Control: Mercury, Thimerosal, Vaccines and Autism
Excerpt from “Psychological Considerations in Food Allergy” Chapter in Food Allergy (4th ed), Blackwell Science, in press:
Childhood autism is characterized by significant abnormal or impaired development in social interaction and communication, and restricted repertoire of activity and interests [1]. Immunologic abnormalities, gluten sensitivity, and food allergy have been proposed to play a role in the pathogenesis and management of autism [2-4]. However, evidence supporting the beneficial effects of dietary manipulation on behavior and cognition in children with autism spectrum disorder have consisted mainly of anecdotal reports and small trials.
Bidet and colleagues [5] reported increased basophil degranulation to food allergens in 10 autistic children and Lucarelli [6] reported improvement in behavioral disturbance in 36 autistic children placed on a cow’s milk elimination diet More recently, two small trials examined the benefit of gluten and casein free diets in autistic children. One trial [7] reported reduction in autistic traits but equivocal results on cognitive skills, and on linguistic and motor ability. The trial by Knivsberg [8] studied 10 autistic children over one year and reported improvement in the children on the gluten and casein free diets.
Other studies by Sponheim [9], Renzoni, [10] and Pavone [11] were unable to demonstrate improvement in behavior with a gluten free diet, or any association between autism and food allergy or celiac disease. Studies by Walker-Smith [12] and McCarthy [13] failed to demonstrate an increased prevalence of celiac disease in autistic patients using antigliadin assays and jejunal biopsies.
Lymphocytic infiltration in the upper and lower GI tract [14], immune activation [15], and abnormal lymphocytic responses to dietary antigens [16] have also been recently reported in children with autism, but the relevance of these findings to cognitive function or to development of autism is still unclear.
These studies demonstrate the need for large scale quality controlled trials in this area. Given the lack of hard evidence supporting the benefits of dietary manipulation in preventing or treating autistic patients, implementation of rigorous elimination diets should be undertaken with great caution. Such unproven measures may divert the autistic patient’s family from more useful treatments and contribute to poor nutrition and further social isolation in families already facing great difficulties.
References:
1. DSM-IV Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington DC: American Psychiatric Association; 1994.
2. Coleman M. Autism: Non-drug biologic treatments. In: Gilbert C, ed. Diagnosis and Treatment of Autism. New York:Plenum Press; 1989:219-35.
3. Goodwin MS, Cowen MA, Goodwin TC. Malabsorption and cerebral dysfunction: A multicariate and comparative study of autistic children. J Autism Child Schiz 1971;1:48-62.
4. Tsaltas MO, Jefferson T. A pilot study on allergic responses. J Autism Dev Disorders 1986;16:91-2.
5. Bidet B, Leboyer M, Descours B, Bouvard MP, Benveniste J. Allergic sensitization in infantile autism. J Autism Dev Disorders 1993;23:419-20.
6. Lucarelli S, Frediani t, Zingoni AM, et al. Food allergy and infantile autism. Panminerva Med 1995;37:137-41.
7. Millward C, Ferriter M, Calver S, Connel-Jones G. Gluten-and casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev. 2004; (2): CD003498.
8. Knivsberg AM, Reichelt KL, Hoien T, Nodland M. A randomised, controlled study of dietary intervention in autistic syndromes. Nutr Neurosci. 2002 Sep;5(4):251-61.
9. Sponheim E. (Gluten-free diet in infantile autism. A therapeutic trial). Tidsskr Nor Laegeforen 1991;111(6):704-7.
10. Renzoni E, Beltrami V, Sestani P, Pompella A, Menchetti G, Zappella M. Brief report: Allergological evaluation of children with autism. J Autism Dev Disorders 1995;25(3):327-33.
11. Pavone L, Fiumara A, Bottaro G, Mazzone D, Coleman M. Autism and coeliac disease: failure to validate the hypothesis that a link might exist. Biol Psyhciatry 1997;42:72
12. Walker-Smith J. Gastrointestinal disease and autism-the result of a survey. Symposium on Autism. Sidney, Australia: Abbott Laboratories; 1973.
13. McCarthy DM, Coleman M. Response of intestinal mucosa to gluten challenge in autistic subjects. Lancet. 1979;2:877-8.
14. Ashwood P, Anthony A, Pellicer AA, Torrente F, Walker-Smith JA, Wakefield AJ. Intestinal lymphocyte populations in children with regressive autism: evidence for extensive mucosal immunopathology. J Clin Immunol 2003 Nov, 23(6): 504-17.
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I found this shocking video on YouTube. It is a tragic example of what happens when a child is misdiagnosed and the family is given a diagnosis of “Multiple Chemical Sensitivity”.
From the video, I seriously doubt that this child is being treated by a board certified Allergist- Immunologist. Her treatment (sub-lingual drops for food allergy???) is definitely not a scientifically proven therapy. The insurance company is absolutely right. ($2500 a month? Who are they kidding?)
It also does not speak well of Fox News’ fact checking department. A phone call to any trained allergist would have revealed to them that this child’s treatment is bogus.
Also see Multiple Chemical Sensitivity and Food Allergy pages
June 2007 UPDATE: Thanks to Orac and “Respectful Insolence”, we have an insight into Dr. Patel’s finances and the income she has acquired through her practice($30M, dang! there’s gold in them thar neutralizing enzymes!)
LINKS:
Multiple Chemical Sensitivity Syndrome Has Strong Psychological Component
