𝐂𝐡𝐢𝐜𝐤𝐞𝐧 𝐌𝐞𝐚𝐭 𝐀𝐥𝐥𝐞𝐫𝐠𝐲 and 𝐁𝐢𝐫𝐝 𝐄𝐠𝐠 𝐒𝐲𝐧𝐝𝐫𝐨𝐦𝐞
❓How many times have I been asked if children should avoid chicken if they are allergic to eggs?
❗Not as often as parents telling me their child is allergic to chicken meat or start sneezing when there is either cooked eggs or cooked chicken around.
⁉️Can this really happen?
✔Actually, it can, but we need to understand that 𝘢𝘭𝘭 𝘢𝘳𝘦 𝘳𝘦𝘭𝘢𝘵𝘪𝘷𝘦𝘭𝘺 𝘳𝘢𝘳𝘦.
Chicken Allergy can be primary or secondary; this one often called Bird Egg Syndrome.
✳But let us take this into the several aspects that might cause any of the above symptoms.
➡️The main difference between the two types is that the primary kind is associated with a protein called 𝘎𝘢𝘭 𝘥 𝟽 and the second called 𝘎𝘢𝘭 𝘥 𝟻.
What does it mean?
✴𝐆𝐚𝐥 𝐝 𝟕 is 𝘩𝘦𝘢𝘵 𝘴𝘵𝘢𝘣𝘭𝘦 (long term allergy), and 𝐆𝐚𝐥 𝐝 𝟓 is 𝘩𝘦𝘢𝘵 𝘥𝘦𝘨𝘳𝘢𝘥𝘢𝘣𝘭𝘦 (very likely to outgrow the egg or chicken meat allergy).
🔻The symptoms vary, according to age group:
▶️In adults, the signs are usually respiratory associated (asthma or wheeze) or affect the eyes or nose (rhinoconjunctivitis).
▶️In children, it will mainly affect the gastrointestinal tract or leading to breathing problems.
👫Children with egg allergy and respiratory symptoms related to bird egg syndrome, tend to either acquire tolerance later or not outgrow it.
𝘜𝘴𝘶𝘢𝘭𝘭𝘺, 𝘴𝘺𝘮𝘱𝘵𝘰𝘮𝘴 𝘴𝘵𝘢𝘳𝘵 𝘭𝘢𝘵𝘦𝘳 𝘪𝘯 𝘵𝘩𝘦𝘪𝘳 𝘭𝘪𝘷𝘦𝘴.
⛔As with egg allergy, be aware of the cross-reactivity between chicken meat and turkey meat.
🚫But there can also be reactions to duck or goose meat, 𝘵𝘩𝘰𝘶𝘨𝘩 𝘵𝘩𝘦 𝘳𝘦𝘢𝘤𝘵𝘪𝘰𝘯𝘴 𝘵𝘦𝘯𝘥 𝘵𝘰 𝘣𝘦 𝘮𝘪𝘭𝘥𝘦𝘳.
So you will need to avoid all those meats until a proper diagnosis is made.
❓One of the most common questions I get from mothers is "𝐢𝐬 𝐦𝐲 𝐜𝐡𝐢𝐥𝐝 𝐚𝐥𝐥𝐞𝐫𝐠𝐢𝐜 𝐭𝐨 𝐬𝐨𝐦𝐞𝐭𝐡𝐢𝐧𝐠 𝐈 𝐚𝐦 𝐞𝐚𝐭𝐢𝐧𝐠?".
🤱Many have decided to go on a food exclusion, without any 𝘗𝘢𝘦𝘥𝘪𝘢𝘵𝘳𝘪𝘤 𝘈𝘭𝘭𝘦𝘳𝘨𝘺 𝘋𝘪𝘦𝘵𝘦𝘵𝘪𝘢𝘯'𝘴 or 𝘗𝘢𝘦𝘥𝘪𝘢𝘵𝘳𝘪𝘤 𝘈𝘭𝘭𝘦𝘳𝘨𝘪𝘴𝘵'𝘴 advice, meaning potential nutritional deficiencies and substantial confusion to what is the causative agent, if any.
⚠️Fortunately, when there is a relationship between maternal food ingestion and an allergic reaction in a baby, they tend to be non-IgE mediated.
➡️Excellent information on the management of those reactions can be seen in an 𝐄𝐀𝐀𝐂𝐈 𝐏𝐨𝐬𝐢𝐭𝐢𝐨𝐧 𝐏𝐚𝐩𝐞𝐫: "Diagnosis and management of Non‐IgE gastrointestinal allergies in breastfed infants — An EAACI Position Paper.
👨⚕️For all the others, referral to a 𝘗𝘢𝘦𝘥𝘪𝘢𝘵𝘳𝘪𝘤 𝘈𝘭𝘭𝘦𝘳𝘨𝘪𝘴𝘵 should be considered, so investigations (mainly skin prick tests - SPTs) can be done.
▶️After that, coordination with a 𝘗𝘢𝘦𝘥𝘪𝘢𝘵𝘳𝘪𝘤 𝘈𝘭𝘭𝘦𝘳𝘨𝘺 𝘋𝘪𝘦𝘵𝘪𝘵𝘪𝘢𝘯 will lead to re-introduction of foods into the maternal diet and, eventually, into the child's diet as well.
▶️The dietitian will also advise on the need for supplementation if the diet is not adequate.
✅Before that appointment happens, it is always a good idea for mothers to keep a food and symptoms diary.
‼That often, on its own, can be enough for us to make a diagnosis and management plan.
⚠️Please do bear in mind that though only four main allergens have been investigated so far, it is highly likely all or most others will also be expressed in breast milk.
🔀Unfortunately, there is significant variability of allergen presentation in breast milk, which is often related to the method used to detect the proteins associated with those allergens.
👨💻Further research into a unified and conclusive investigative tool is of great importance, so clarifying and establishing a causal relationship between allergen ingestion on a mother and allergic reaction on a baby can be achieved.
⚠️Bottom line if worried about a potential allergic reaction in your breastfed child:
1️⃣Start a food and symptoms diary.
2️⃣Speak to your GP.
3️⃣Potential referral to a Paediatric Allergy Dietitian and/or Paediatric Allergist.
4️⃣Do not start a food exclusion on your own, especially extensive food exclusions.
🎄So it is 🎅Christmas, and how many of you are 🍰 baking with 🥚eggs?
‼️This is probably one of the seasons where we should be cautious with this type of allergy!
In what comes to allergies in children, and due to the nature of baby´s weaning, egg sits almost at par with 🥛cow’s milk as the most prevalent form of allergy. This is closely followed by 🥜peanut allergy.
⚠️Up to now, it was believed roughly 50% of children would outgrow their egg allergy by 3 years of age, with that percentage increasing to roughly 66% at 5 years of age. But it seems those percentages are decreasing with time.
❓The reason for that is unknown still.
✅So the earlier a diagnosis and intervention is made, the higher will be the chances for children to outgrow their allergy.
➡️The initial step is to perform skin prick tests, eventually followed by an open food challenge to baked egg.
😊If the child passes this step, they will have roughly 95% chance of outgrowing their egg allergy.
😔As you might imagine, failing that challenge will give them less than 5% of outgrowing the allergy.
▶️If you suspect your child has an egg allergy, don’t give up or become demoralized.
▶️There is a pretty good chance he/she will outgrow it.
⛔Exclude egg and peanut from their diet, exception if already eating peanut.
⚕Ask for a Paediatric Allergy referral and see if their department will also involve a Paediatric Allergy Dietitian.
✳Very important to understand that when we speak about removing chicken eggs from the diet, we also talk about removing eggs from other birds due to cross-reactivity.
🚫The birds’ eggs you should also exclude are 🦃turkey, 🦆duck, 🦢goose, seagull and quail.
🥚Some children who are allergic to egg can eat small amounts of egg that is well baked (in cakes and biscuits, for example).
❗Often they will not tolerate raw egg, whole egg or lightly processed such as mayonnaise or meringue.
⚠️𝐂𝐡𝐢𝐥𝐝𝐫𝐞𝐧 𝐰𝐡𝐨 𝐜𝐚𝐧 𝐞𝐚𝐭 𝐛𝐚𝐤𝐞𝐝 𝐞𝐠𝐠𝐬 𝐚𝐫𝐞 𝐦𝐨𝐫𝐞 𝐥𝐢𝐤𝐞𝐥𝐲 𝐭𝐨 𝐨𝐮𝐭𝐠𝐫𝐨𝐰 𝐭𝐡𝐞𝐢𝐫 𝐚𝐥𝐥𝐞𝐫𝐠𝐲.
😔Unfortunately, those children who cannot tolerate baked egg are less likely to grow out of their egg allergy.
✅It is important to know that egg may be found in a wide range of foods, including:
➡️𝘉𝘢𝘵𝘵𝘦𝘳𝘦𝘥 𝘰𝘳 𝘣𝘳𝘦𝘢𝘥-𝘤𝘳𝘶𝘮𝘣𝘦𝘥 𝘧𝘰𝘰𝘥𝘴
➡️𝘚𝘰𝘮𝘦 𝘪𝘤𝘦 𝘤𝘳𝘦𝘢𝘮𝘴
✅Also, food labels with the below items may suggest the presence of egg so look out for:
➡ ️𝘈𝘭𝘣𝘶𝘮𝘪𝘯 , which suggests the presence of egg;
➡️𝘓𝘺𝘴𝘰𝘻𝘺𝘮𝘦, which is an enzyme derived from egg;
➡️𝘌𝘨𝘨 𝘓𝘦𝘵𝘤𝘪𝘵𝘩𝘪𝘯, (𝘌𝟹𝟸𝟸), which may, in rare cases, be made from egg; It works as emulsifiers and often is in trace amounts. Though trace amounts are not common to cause an egg allergy.
➡️𝘌𝘨𝘨 𝘸𝘩𝘪𝘵𝘦, in some bread it is used as a washing agent. In wine, alcohol-based drinks, coffee drinks and soup stocks (and sometimes along with eggshells) it might be used as a clarifying agent.
✴Resolution of egg allergy tends to occur in stages, starting with tolerance to baked egg.
▶️Further steps will involve cooking the egg so that the protein causing the allergy will be less degraded.
▶️It will end on the last step, which is raw egg.
(𝘧𝘰𝘳 𝘰𝘵𝘩𝘦𝘳 𝘰𝘱𝘵𝘪𝘰𝘯𝘴 𝘰𝘯 𝘦𝘢𝘤𝘩 𝘴𝘵𝘦𝘱 𝘰𝘧 𝘵𝘩𝘦 𝘭𝘢𝘥𝘥𝘦𝘳, 𝘢𝘴𝘬 𝘺𝘰𝘶𝘳 𝘋𝘪𝘦𝘵𝘪𝘵𝘪𝘢𝘯 𝘧𝘰𝘳 𝘢𝘥𝘷𝘪𝘤𝘦)
✔The suggestion is to have an initial dose of ¼ of the age-appropriate dose the child would have in one day.
✔From then double the dose every other day and aim to give it 2 to 3 times per week.
‼️Remember to always be guided by your Paediatric Allergy Team, which should include a Paediatric Allergy Dietitian.
𝐓𝐨𝐝𝐚𝐲'𝐬 𝐩𝐨𝐬𝐭 𝐢𝐬 𝐟𝐮𝐥𝐥 𝐨𝐟 𝐦𝐢𝐱𝐞𝐝 𝐟𝐞𝐞𝐥𝐢𝐧𝐠𝐬:
😊Happy as I have diagnosed a very rare disorder.
😊Happy as in a way, I have managed to provide closure to a mother that was looking for answers.
😊Happy because now there is a plan of treatment that should improve symptoms and quality of life.
😔Sad also because of having diagnosed a rare disorder that has so many complications associated and makes such a young child suffer so much and, with it, parents as well!
❗Many of you have never heard of 𝐌𝐚𝐬𝐭 𝐂𝐞𝐥𝐥 𝐀𝐜𝐭𝐢𝐯𝐚𝐭𝐢𝐨𝐧 𝐃𝐢𝐬𝐨𝐫𝐝𝐞𝐫 or, in fact, all other mast cell disorders that exist.
⚠️𝘔𝘢𝘴𝘵 𝘤𝘦𝘭𝘭𝘴 are an important part of our immune system, and we could not survive without them.
🐛It is thought the way this line of cells has evolved was mainly to fight against invasion and proliferation of 𝘱𝘢𝘳𝘢𝘴𝘪𝘵𝘦𝘴 in the human gut.
➡️It leads to significant histamine release, which originated from abdominal pain, cramps, and diarrhoea, intending to force the parasites out.
🔷️Now it works as the main mediator for allergic diseases but also to fight infections.
🔶️Only recently (around 𝟐𝟎𝟎𝟕) it has been named a known disorder and, due to that, its incidence and other epidemiological information are really not known.
🔸️As with other Mast Cell Disorders, it is believed it goes highly undiagnosed. The reason being, not many are aware of its symptoms or even how to investigate appropriately.
‼️As a rough idea Mastocytosis (another Mast Cell disorder) is thought to affect between 𝟓 𝐭𝐨 𝟏𝟎 cases per 1 million world population per year.
▶️In this case, it affects more children (around 𝟔𝟓%) than adults (around 𝟑𝟓%).
▶️It affects both genders more or less equally.
▶️Some say it affects more white people from northwestern Europe.
✳As 𝘔𝘢𝘴𝘵𝘰𝘤𝘺𝘵𝘰𝘴𝘪𝘴 is more common than 𝘔𝘊𝘈𝘚, we can only imagine how many cases are diagnosed worldwide per year. The rest of the data might be comparable, but it is not truly known.
💊Treatment is focused on a decrease of symptoms and trying to prevent as many 𝘈𝘯𝘢𝘱𝘩𝘺𝘭𝘢𝘤𝘵𝘪𝘤 episodes as possible.
❗Please do remember that MCAS's symptoms overlap with plenty of other conditions, mainly 𝐂𝐡𝐫𝐨𝐧𝐢𝐜 𝐒𝐩𝐨𝐧𝐭𝐚𝐧𝐞𝐨𝐮𝐬 𝐔𝐫𝐭𝐢𝐜𝐚𝐫𝐢𝐚(𝐂𝐒𝐔) and 𝐂𝐡𝐫𝐨𝐧𝐢𝐜 𝐒𝐩𝐨𝐧𝐭𝐚𝐧𝐞𝐨𝐮𝐬 𝐀𝐧𝐠𝐢𝐨𝐞𝐝𝐞𝐦𝐚 (𝐂𝐒𝐀).
🔜Soon I will also talk about this condition, which is fairly frequent.
🏨So, if you believe your child, or someone you know, fits into the signs and symptoms I speak about here, please do ask for a referral to either a 𝐏𝐚𝐞𝐝𝐢𝐚𝐭𝐫𝐢𝐜 𝐀𝐥𝐥𝐞𝐫𝐠𝐢𝐬𝐭 or an 𝐀𝐝𝐮𝐥𝐭 𝐀𝐥𝐥𝐞𝐫𝐠𝐢𝐬𝐭.
You might think the answer is obvious, but you would be surprised.
⁉️I still receive referrals to my allergy clinic asking patients to be tested as they might have a coeliac allergy!
🔷️𝐂𝐨𝐞𝐥𝐢𝐚𝐜 𝐝𝐢𝐬𝐞𝐚𝐬𝐞 is a serious pathology where the body's immune system attacks itself.
🔷️𝗪𝐡𝐞𝐚𝐭 𝐚𝐥𝐥𝐞𝐫𝐠𝐲 is a reaction to proteins found in wheat. It can be either IgE (immediate) or non-IgE (delayed).
🔷️𝐍𝐂𝐆𝐈/𝐍𝐂𝐆𝐒 has symptoms similar to coeliac disease. Still not well known if or how the immune system is involved. There doesn't seem to have damage to the lining of the gut.
🔶️Gluten is a protein found in cereals.
🔶️When it is ingested, it leads to damage of the internal wall of the bowel with malabsorption associated problems:
➡️Less absorption of nutrients, minerals, and the fat-soluble vitamins A, D, E, and K (this one potentially leading to bleeding problems).
➡️Anaemia due to iron deficiency, low Vit B12 and Folic Acid.
➡️Osteopenia and osteoporosis due to lack of Calcium and Vit D.
➡️Weight loss, growth failure and/or delay in puberty and lethargy as side effects of a lack of carbohydrates and fats.
➡️Potential copper, selenium and zinc deficiencies.
▶️It can develop at any age.
▶️Diagnosis sometimes is not easy as symptoms can be vague. You need to be eating gluten for a diagnosis to be done.
▶️Even a breadcrumb can be damaging. It is a lifelong exclusion of gluten.
▶️It can be inherited, though there are new mutations. The chance to get it if a close relative has it is 1:10.
▶️It is neither an allergy nor an intolerance.
▶️It was thought to be rare, but it is believed to be underdiagnosed.
▶️People can have normal weight or overweight at diagnosis.
▶️You cannot grow out of it!
How to investigate and diagnose:
✅𝐂𝐨𝐞𝐥𝐢𝐚𝐜 𝐝𝐢𝐬𝐞𝐚𝐬𝐞 - Blood tests (TTg IgA and Endomysial Antibodies. Sometimes HLA DQ2 and HLA DQ8).
✅𝗪𝐡𝐞𝐚𝐭 𝐚𝐥𝐥𝐞𝐫𝐠𝐲 - Skin prick tests. Eventually, specific IgE and/or component diagnostics. Sometimes there is also the need for a food challenge. 🔜I will address this issue in another post.
✅𝐍𝐂𝐆𝐈/𝐍𝐂𝐆𝐒 - No validated test. Food exclusion, followed by food inclusion with symptoms coming back again, is the diagnostic took. Before this, Coeliac disease must be excluded.
It is an Allergy or an Intolerance?
🥛In a milk allergy, the body reacts to milk proteins, not milk sugar.
❗In lactose intolerance, there is little to no lactase (an enzyme produced by our body), so the milk sugar (lactose) cannot be digested.
⚠️Cow's milk protein allergy (CMPA) affects from 2 to 6% of children, with the highest prevalence during the first year of age.
➡️About 50% of children have been shown to resolve CMPA within the first year of age, 80-90% within their fifth year.
➡️Symptoms usually develop within a week of cow's milk introduction, although it may be delayed for many weeks, reported up to 24 and 36 weeks.
🔶️Lactose intolerance has 4 types:
1️⃣Primary (the most common form in which our bodies decrease the production of lactase from 5 years of age)
2️⃣Secondary (after a gut injury, illness or surgery our bodies produce less lactase)
3️⃣Developmental (mostly affecting preterms and resolving soon after birth)
4️⃣Congenital (rare and genetic in origin, where there is little to no lactase production - higher incidence in Finland)
💉The tests for both are different.
➡️skin prick tests or blood tests (specific IgE) for IgE mediated for milk allergy
➡️hydrogen breath test or stool sample for lactose intolerance
➡️no tests available for non-IgE mediated (normally food exclusion is the only option)
⚠️Obviously, the symptoms are also different.
➡️IgE mediated (immediate kind) affects the skin most commonly, then the gastrointestinal tract, and least frequently the respiratory system. Cardiovascular symptoms are rarely reported. Symptoms can range in severity from mild to life-threatening. Their onset is typically within minutes of exposure.
➡️Non-IgE-mediated (delayed kind) have typically an onset several hours and in some instances several days after ingestion. They tend to cause skin changes (eczema) and gastrointestinal disturbances (reflux with or without vomiting; constipation or diarrhoea).
➡️Lactose intolerance presents mainly with gastrointestinal problems (abdominal pain, flatulence and diarrhoea).
If you or your child have an immediate reaction to a food, avoid it and ask for a referral to either a Paediatric Allergist or an Adult Allergist.
In case the reactions are delayed (2 hours to several days), your best option is to be seen by either a Paediatric Dietitian or an Adult Dietitian.
‼️A common source of debate, misconception and confusion is "𝘤𝘢𝘯 𝘮𝘺 𝘤𝘩𝘪𝘭𝘥 𝘣𝘦 𝘷𝘢𝘤𝘤𝘪𝘯𝘢𝘵𝘦𝘥 𝘪𝘧 𝘩𝘦/𝘴𝘩𝘦 𝘩𝘢𝘴 𝘢𝘯 𝘦𝘨𝘨 𝘢𝘭𝘭𝘦𝘳𝘨𝘺?".
Especially now with the circulating Pfizer and AstraZeneca (Oxford) COVID19 vaccines, many have asked me about their safety.
But let's start with the basics.
❓𝐒𝐨 𝐰𝐡𝐲 𝐢𝐬 𝐢𝐭 𝐭𝐡𝐚𝐭 𝐦𝐨𝐬𝐭 𝐨𝐟 𝐭𝐡𝐞𝐦 𝐮𝐬𝐞 𝐡𝐞𝐧𝐬' 𝐞𝐠𝐠𝐬?
🦠The process of growing a virus in an egg leads to that virus becoming less infectious to the human being, but still leading to a protective effect against potential infections in the future.
After a virus is injected, the egg will be sealed with gelatine. This is normally made from pork protein.
🥚On the process of collecting the grown virus from the egg, a small amount of protein will come along as well. This can potentially lead to an allergic reaction.
▶️Studies have shown that this vaccine may contain from no amount to 1ng per 0.5ml of egg protein.
▶️Food challenges done on egg-allergic patients showed most people would react to amounts of 50-100mg, with some as low as 2mg of egg protein.
▶️This means the amount on the vaccine is too small to cause an allergic reaction.
⚠️Saying this, other components might lead to allergic reactions.
The ones I am referring to are 𝐆𝐞𝐥𝐚𝐭𝐢𝐧𝐞 (𝐩𝐨𝐫𝐤 𝐨𝐫𝐢𝐠𝐢𝐧) and 𝐍𝐞𝐨𝐦𝐲𝐜𝐢𝐧.
Both have higher concentrations than Ovalbumin.
➡️𝘛𝘩𝘦 𝘚NIFFLE 𝘴𝘵𝘶𝘥𝘪𝘦𝘴 have shown the safety of the Nasal Flu vaccine.
Several studies have shown that the LAIV (Live Attenuated Influenza Vaccine) that contain less than 0.12μg/mL (so 0.06 μg for a 0.5 mL dose) is safe for patients with an egg allergy.
To produce this vaccine, the virus is grown on chick embryonic fibroblast cells.
In case a patient with an egg allergy needs this vaccine, there two other options that can be used, as they do not contain egg:
1️⃣Human Diploid Cell Vaccine (HDCV)
2️⃣Purified Vero Cell Rabies Vaccine (PVRV)
✅𝐘𝐞𝐥𝐥𝐨𝐰 𝐟𝐞𝐯𝐞𝐫 𝐯𝐚𝐜𝐜𝐢𝐧𝐞
The virus for this vaccine is also grown on chick embryos.
If a patient needs this vaccine, there is only one potential option.
What I am referring to is a graded vaccination programme done in a hospital.
As with the MMR vaccine, the Yellow Fever and the Rabies vaccines one also contain Gelatine.
So extra caution needs to be had in this case.
✅Finally, the COVID19 vaccines:
1️⃣"There is no egg or egg-related component of the Pfizer RNA vaccines.
2️⃣ The Oxford AstraZeneca vaccine is produced in genetically modified human embryonic kidney (HEK) 293 cells.
This means both vaccines are safe to be used in egg-allergic children.
The only children who need to be vaccinated in a hospital are those with an allergy to eggs, with previous anaphylaxis to egg or who had a cardiorespiratory reaction needing admission to Intensive Care or those with coexisting active, chronic asthma.
⛔How many times have you had nasal symptoms, and you have gone to an allergist, but no allergy has been found?
Have you ever felt a sore throat, runny nose or nasal congestion, occasionally itchy eyes, and sometimes problems with your ears?
The summer season is over, and the pollen count is now too low even to count!
So it can no longer be associated with hay or hayfever, so what is it?
If this has happened to you, then it is likely we are talking of a different diagnosis.
𝐍𝐨𝐧-𝐚𝐥𝐥𝐞𝐫𝐠𝐢𝐜 𝐫𝐡𝐢𝐧𝐢𝐭𝐢𝐬 is often also known as noninfectious, perennial eosinophilic rhinitis and non-allergic rhinitis with eosinophilic syndrome.
Many conditions can cause it.
❄As we have reached the cold season, it will be common to see children (not as often in adults) with nasal congestion when exposed to cold air.
❎Some medication can also lead to nasal symptoms.
▶️Among others, Aspirin can lead to rhinitis and be associated with non-atopic Asthma and the development of nasal polyps. Though it is more often seen in adults than in children.
▶️Adults who often use nasal decongestants should also be careful as one of the common side effects is a rebound nasal congestion, called rhinitis medicamentosa. As with Aspirin, this is more common in adults and rarely seen in children.
❗Treatment wise, and apart from antihistamines, it should be the same as with Allergic Rhinitis.
👃The best and first-line treatment are nasal steroids.
❓And which ones to use?
➡️Age 3 years and above - Mometasone furoate (Nasonex) - my choice
➡️Age 6 years and above - Fluticasone furoate (Avamys)
➡️Age 12 years and above - Fluticasone and Azelastine (a combination of steroid and antihistamine - Dymista)
👁For your eyes, there are a couple of choices:
➡️Any age - Sodium cromoglicate (a mast cell stabilizer)- my choice
➡️Age 3 years and above - Olopatadine (a combination of mast cell stabilizer and antihistamines)
➡️Some patients like to use artificial tears as the main choice - though better for allergic rhinitis.
⚠️It is crucial first to achieve a diagnosis, so appropriate treatment can be done, as other therapies might be needed, including treatment of the primary cause.
✅For this condition, it is essential good cooperation between an Allergy Doctor and an ENT specialist.
What is also extremely important is to use the right technique for any nasal spray.
Also, remember to cross your hands.
Right hand to the left nostril.
Left hand to your right nostril.
⚠️Many people think that pet allergies are caused by a 🐕dog's or 🐈cat's fur (or any other pet, for what it matters), but the real source of pet allergies is often a protein that's in the saliva and urine of dogs and cats, also some produced in sebaceous glands. This protein sticks to the dead, dried flakes (dander) from your pet's skin.
❗Some cats or dogs may shed less dander than others, which potentially can lead to fewer symptoms.
👨💻The most interesting piece of research done so far came to the following conclusion:
▶️"There was no evidence for differential shedding of allergen by dogs grouped as hypoallergenic. Clinicians should advise patients that they cannot rely on breeds deemed to be "hypoallergenic" to, in fact, disperse less allergen in their environment."
(Dog allergen levels in homes with hypoallergenic compared with non-hypoallergenic dogs. Am J Rhinol Allergy. 2011 Jul-Aug;25(4):252-6. doi: 10.2500/ajra.2011.25.3606.)◀️.
🐰There is also extensive research done by Prof A. Custovic, related to the development of allergies to pets (can provide references if asked).
🔶️The most common symptoms seen in pet allergy are very similar to most other airborne allergens.
But they will vary depending on the person's own sensitivity to the pet in question.
❗The greater the skin prick test and/or specific IgE, the higher the chance to develop more severe symptoms.
➡️Sneezing or a runny or stuffy nose.
➡️Facial pain (from nasal congestion).
➡️Coughing, chest tightness, shortness of breath, and wheezing.
➡️Watery, red or itchy eyes.
➡️Skin rash or hives.
➡️Anaphylaxis - can happen, though it is extremely rare. There are one or two cases published, by the famous American Mayo Clinic, of dog anaphylaxis. More reports are to cat and 🐎horse.
The worse respiratory symptoms tend to be associated with someone who already has an underlying breathing pathology, like asthma, poorly controlled allergic rhinitis or recurrent wheeze of varied aetiology.
This potentially can lead to significant deterioration, often leading to hospital admission for treatment, often including moderate to intensive admissions and treatment.
Prof John Warner, one of the best known worldwide experts in Allergy, has once said that "If you remove a cat from home, you clean all the walls down, do the laundry, do the draperies, it still takes six months for the level of cat protein to get down to normal."
More of less the same will apply to dogs.
Research done by Allergist Dana Wallace, MD, has shown cat dander to be the smallest among pets. This means it will remain airborne for at least 30mins after being disturbed, leading to constant exposure to it.
What to do?
Depending on the severity of symptoms, you might need to avoid the pet (leading to allergic symptoms) completely.
If mild, then you can try mild avoidance and cleaning methods, like:
➡️Keep the dog out of your bedroom and restrict it to only a few rooms. Be advised that keeping the dog in only one room will not limit the allergens to that room.
➡️Don't pet, hug or kiss the dog; if you do, wash your hands with soap and water.
➡️High-efficiency particulate air (HEPA) cleaners run continuously in a bedroom or living room can reduce allergen levels over time.
➡️Regular use of a high-efficiency vacuum cleaner or a central vacuum can reduce allergen levels.
➡️Wash soft furnishings like duvet covers, curtains, cushions, soft toys on a hot wash cycle.
➡️Bathing your dog at least once a week can reduce airborne dog allergen.
➡️For horse allergy, remove all clothing, bag it, take a shower, before getting in contact with the person allergic to horses.
➡️Nasal symptoms are often treated with steroid nasal sprays, oral antihistamines or other oral medications.
➡️Eye symptoms are often treated with antihistamine eye drops.
➡️Respiratory or asthma symptoms can be treated with inhaled corticosteroids or bronchodilators to prevent or relieve respiratory symptoms.
Dr Costa is a Consultant Paediatrician and fellow of the Royal College of Paediatrics and Child Health.