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Atopic dermatitis may be food allergy

In the past, positive blood and skin tests would often be mistaken for a food allergy because they would indicate the presence of immunoglobulin E antibodies, but it is important to remember that these are typically higher in patients with atopic dermatitis, according to a speaker at the 69th Annual American Academy of Dermatology Meeting conducted in New Orleans this week. “Those antibodies are not diagnostic, and the only way to diagnose food allergy is with a strong history of reactions or a challenge,” Jon M. Hanifin, MD, of Oregon Health & Science University, said in a press release. “This is done in a doctor’s office, using small increments of the food in question and increasing the amount until an allergic reaction occurs or does not occur. Usually a parent can pinpoint if a child has a true food allergy because the allergic reaction will appear so quickly with lip swelling or hives, quite distinct from simply food intolerance.”

Between 6% and 10% of children have atopic dermatitis, and about one-third of these children have food allergy. Recent research examining the genetic basis of atopic dermatitis has shown that this chronic skin condition is likely related to a defect in the epidermal barrier, which allows irritants, microbes and allergens (such as food) to penetrate the skin and cause adverse reactions. Because the skin barrier in patients with atopic dermatitis is compromised and open to absorb proteins, it allows sensitization to certain foods, leading to a positive skin or blood test.

New guidelines recently issued by the National Institute of Allergy and Infectious Diseases established a protocol for the proper evaluation and management of food allergy. The guidelines recommend that children who are younger than aged 5 years with moderate to severe atopic dermatitis be considered for food allergy evaluation if they have persistent atopic dermatitis despite optimized management or if the child has a reliable history of an immediate reaction after eating a specific food.

Hanifin said research is also ongoing into whether withholding foods is leading to more allergies than an unrestricted diet in young children. This may provide future insight in potential ways to prevent food allergies. He said children in Israel seldom get peanut allergy, which may potentially be attributed to the use of peanut proteins in pacifiers in that country. In the United States and Europe, where peanut allergies are more common, infants are not usually exposed to this food until they are toddlers – the time when most peanut allergies are noticed.

“There is some thinking that withholding foods might actually be causing more allergies, and that an unrestricted diet may help tolerize babies to foods that could potentially cause a problem later in life,” Hanifin said. “Ongoing studies in this country using oral immunotherapy appear promising, and physicians hope that we may discover how to prevent food allergies in the future while continuing to provide successful treatment for children with atopic dermatitis.”

Source: Hanifin J. Food allergy and dermatology. Presented at: The American Academy of Dermatology 69th Annual Meeting; Feb. 4-8, 2011; New Orleans

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Stroke deaths higher where fried fish aplenty

The steep rate of death from stroke in a swath of Southern states often referred to as America's “stroke belt” may be linked to a higher consumption of fried fish in that region, new research suggests. A study published in the journal Neurology shows people living in the stroke belt — which comprises North Carolina, South Carolina, Georgia, Alabama, Mississippi, Tennessee, Arkansas and Louisiana — eat more fried fish and less non-fried fish than people living in the rest of the country, and African-Americans eat more fried fish than Caucasians. “Differences in dietary fish consumption, specifically in cooking methods, may be contributing to higher rates of stroke in the stroke belt and also among African Americans,” says study author Fadi Nahab, medical director for the Stroke Program at Emory University Hospital in Atlanta.

The research, part of a large government-funded study, Reasons for Geographic and Racial Differences in Stroke (REGARDS), involved 21,675 participants from across the country; the average age was 65. Of the participants, 21% were from the “stroke buckle,” the coastal plain region of North Carolina, South Carolina and Georgia where stroke mortality rates are even higher than they are in the rest of the stroke belt. Another 34% were from the rest of the stroke belt and 44% were from the other states.

Participants were interviewed by phone and then given an in-home physical exam. The questionnaire asked how often they ate oysters, shellfish, tuna, fried fish and non-fried fish. The American Heart Association recommends people eat fish high in omega-3 fatty acids—essential fatty acids humans get through their diet—at least twice a week, baked or grilled but not fried. Fewer than one in four overall ate two or more servings of non-fried fish a week. Stroke belt residents were 32% more likely to eat two or more servings of fried fish each week than those in the rest of the country.

African-Americans were more than 3.5 times more likely to eat two or more servings of fried fish each week than Caucasians, with an overall average of about one serving per week of fried fish compared with about half a serving for Caucasians. When it came to eating non-fried fish meals, stroke belt residents ate an average of 1.45 servings per week, compared with 1.63 servings eaten by people elsewhere.

“This is good stuff. It's a well-done study, but I think one thing to bear in mind is that it's not specifically a study of stroke risk. You're looking at a community and seeing how it's behaving on the whole,” says Daniel Labovitz, a stroke neurologist at Montefiore Medical Center in the Bronx. “This study can't tell you causation. It can't tell you there's a direct link between one thing and another, it just tells you they're associated,” says stroke neurologist Victor Urrutia, an assistant professor at Johns Hopkins University School of Medicine.

How might eating fried fish impact stroke?

It could be that frying the fish leaches out the omega-3s, says Jeremy Lanford, stroke director at Scott & White Healthcare in Roundrock, Texas. Or the increased fat calorie content from the frying oil may contribute to stroke, says author Nahab. He also notes that fish used for frying, such as cod and haddock, tend to be the types lower in healthy fats. More research is needed to tease out whether cooking methods affect stroke risk, Labovitz says. “In other words, is fried fish a problem, or is it another red herring?” he says.

The study was supported by the National Institute of Neurological Disorders and Stroke, the National Institutes of Health, and the Department of Health and Human Services. Funding was provided by General Mills for coding of the food frequency questionnaire.

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Mediterranean diet set for World Heritage List

The Unesco world heritage list is normally associated with towering religious monuments and ancient Greek temples, crumbling castles and areas of outstanding natural beauty. It recognises the cultural value of the Hindu complex at Angkor Wat and the Acropolis in Athens, alongside the Great Pyramid of Giza and the Banaue rice terraces in the Philippines.

Now Italian officials are certain the UN will add a salad of tomato and mozzarella, topped off by a splash of olive oil to its list of global patrimony worth protecting.

The Mediterranean diet, with its mix of fresh fruit and vegetables, grilled fish and olive oil faces a final vote in November for ranking on Unesco's list of “intangible” cultural heritage, launched in 2003 to complement the collection of monuments and natural wonders, and covers oral traditions, performing arts, social practices, rituals and festivals.

A plate of pasta washed down with a glass of wine could join the list of 178 cultural experiences including the tango, the polyphonic singing of the Aka Pygmies of central Africa and Croatian lacemaking.

“This is a big success for our country, our dietary traditions and our culture,” said the Italian agriculture minister, Giancarlo Galan.

Rolando Manfredini of the Italian farmers' lobby group, Coldiretti, said: “It is a bit strange putting a diet on the list, and the first time they would do it, but it makes perfect sense. Not only is this culture, but it also makes you live longer and better.”

While trying not to dampen Italy's enthusiasm, a spokeswoman for Unesco warned that no decision would be made before a meeting in November. “The committee is free to make up its mind and there is no indication on what it will approve,” said Sue Williams.

Galan said the proposal was first made by Italy, Greece, Spain and Morocco four years ago, and was turned down. The countries resubmitted it, stressing the cultural content of the diet, and this time he was convinced it would get the nod.

“A positive recommendation made by Unesco will now be ratified,” he said. The diet would join Sicilian puppet theatres and Sardinian pastoral songs, which already represent Italy on the list.

The diet took off in the rest of the world in the late 20th century, with postwar cookery writer Elizabeth David helping to promote it among English speakers. Today, said Williams, protecting a plate of tortellini was no different to stopping people scratching their initials in the Great Wall of China: “Being on the intangible list means the host country must promote and protect it exactly as it would a monument like Stonehenge,” she said.

Recent activities sponsored by Unesco include the revival of the intergenerational transmission of Georgian traditional polyphony and the “safeguarding” of Somali board games.

While the Mediterranean diet has found favour with chefs around the world, Coldiretti said it was in desperate need of protection in its native countries.
“In Italy today parents are still in good shape, but their children are increasingly suffering from obesity,” said Manfredini. “There has been a complete break in eating habits from one generation to another.”

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