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
A coordinating committee representing 34 professional organizations, advocacy groups and federal agencies oversaw the development of the guidelines. The coordinating committee selected a 25-member expert panel, chaired by Joshua Boyce, M.D., co-director of the Inflammation and Allergic Disease Research Section at Boston's Brigham and Women's Hospital. The panel used an independent, systematic literature review of food allergy and their own expert clinical opinions to prepare draft guidelines. Public comments were invited and considered as well during the development of the guidelines.
“These guidelines are an important starting point toward a goal of a more cogent, evidence-based approach to the diagnosis and management of food allergy,” says Dr. Boyce. “We believe that they provide healthcare professionals with a clear-cut definition of what constitutes a food allergy and a logical framework for the appropriate use of diagnostic testing and accurate interpretation of the results.”
Additional topics covered by the guidelines include the prevalence of food allergy, natural history of food allergy and closely associated diseases, and management of acute allergic reactions to food, including anaphylaxis, a severe whole-body reaction. They also identify gaps about what is known about food allergy.
“The food allergy guidelines provide a rigorous assessment of the state of the science, and clearly identify the areas where evidence is lacking and where research needs to be pursued,” says Daniel Rotrosen, M.D., director of the Division of Allergy, Immunology and Transplantation at NIAID. “This information will help shape our research agenda for the near future.”
Food allergy has become a serious health concern in the United States. Recent studies estimate that food allergy affects nearly 5 percent of children younger than 5 years old and 4 percent of teens and adults. Its prevalence appears to be on the rise. Not only can food allergy be associated with immediate and sometimes life-threatening consequences, it also can affect an individual's health, nutrition, development and quality of life. While several potential treatments appear promising, currently no treatments for food allergy exist and avoidance of the food is the only way to prevent complications of the disease.
More information on the guidelines may be found at http://www.niaid.nih.gov/topics/foodAllergy/clinical/Pages/default.aspx
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On being asked about why she had decided to write a review, Dr Rayman replied: “There are three main reasons. First, to provide GPs and healthcare professionals with reliable information which could be used in treating patients and setting up healthcare programmes. Second, to raise concern that the levels of selenium are low in the UK and parts of Europe.
Third, to call for further research to clarify the optimal nutritional level with respect to selenium.” Dr Rayman explained that if, for example, there was further research to examine whether selenium as a nutrient could be helpful in slowing the progression of HIV to Aids, then it might provide a low cost solution in African countries particularly affected by HIV. The research so far had been carried out in the United States by Mariana Baum and colleagues of the University of Miami who found that HIV positive individuals have a twenty times greater chance of dying from Aids than those with adequate selenium levels. The Cancer Research Campaign is currently funding a £160,000 pilot study, which started in October 1999 led by Dr Rayman, and involves 500 people in the UK to see whether selenium can provide protection against cancer. This comes after an American study which showed encouraging health benefits for people who increased their daily intake of selenium. Dr Rayman said: “I am currently trying to raise £3.5m in funding to carry out a main UK study involving 10,000 people, when the pilot research finishes at the end of next year. It is essential to get sponsorship as scientific research is the only way to get positive proof of the health benefits of selenium. If a positive effect of selenium on cancer risk were to be established, the Government might then decide to act by adding selenium to the food supply. However, research is also needed to discover the optimal nutritional level with respect to selenium, because if people consume too much then it can become toxic”. Besides Britain, Sweden and Denmark are also taking part in the trial because of low dietary selenium. The US who are also participating in the study, have moderate selenium levels. The difference in countries' selenium levels depends on the amount of selenium present in the soil and which fertilisers are used. Finland has artificially added selenium to its fertilisers since 1984 to raise levels because of the reputed health benefit. In contrast, selenium levels in the UK have declined significantly over the last few decades – probably because we are no longer importing selenium-rich wheat from North America for use in our bread.
Previous studies have suggested that the fifty percent of the population who have a GSTM1 gene gain more benefit from eating broccoli than those who lack this gene. The study showed that the presence of the GSTM1 gene had a profound effect on the changes in gene expression caused by eating broccoli.
This study fills the gap between observational studies and studies with cell and animal models. While observational studies have shown that diets rich in cruciferous vegetables may reduce the risk of prostate cancer and other chronic disease, they do not provide an explanation of how this occurs. Evidence from animal and cell models has sought to provide an explanation, but these studies are usually based on high doses that would not normally be experienced as part of the diet.
The results of the study suggested that relatively low amounts of cruciferous vegetables in the diet – a few portions per week – can have large effects on gene expression by changing cell signalling pathways. These signalling pathways are the routes by which information is transmitted through a molecular cascade which amplifies the signal to the nucleus of the cell where gene expression occurs.
The Norwich team are currently planning a larger study with men with localised prostate cancer, and will compare the activity of standard broccoli with the special variety of high glucosinolate broccoli used in the current study.
Designer studies for health promotion
“Other fruits and vegetables have been shown to also reduce the risk of prostate cancer and are likely to act through other mechanisms,” says Professor Mithen.
“Once we understand these, we can provide much better dietary advice in which specific combinations of fruit and vegetable are likely to be particularly beneficial. Until then, eating two or three portions of cruciferous vegetable per week, and maybe a few more if you lack the GSTM1 gene, should be encouraged.”
People with lactose intolerance do not produce enough of the enzyme lactase to break down lactose (the form of sugar naturally found in milk). Instead, when people with lactose intolerance ingest large amounts of dairy products, or foods or medicines containing lactose, lactose stays in the intestinal tract until it reaches the colon where it can cause gas, bloating, stomach cramps or diarrhea.
Last February, the National Institutes of Health (NIH) released a statement on lactose intolerance and health to provide health care providers, patients and the general public with the latest information on the topic.
“What many people fail to understand is that lactose intolerance is not an all-or-nothing situation,” says Susan Nitzke, professor of Nutritional Sciences at the University of Wisconsin-Madison and nutrition specialist with the University of Wisconsin-Extension.
Nitzke points out that many people with lactose intolerance can consume small amounts of lactose–for example, a half cup of milk or yogurt–without experiencing any symptoms. “This is especially true if the milk or other lactose-containing food is consumed with a meal,” she says.
Nitzke urges people to consult their doctor or a dietitian (like Nastaran) before making drastic dietary changes for suspected lactose intolerance. Your doctor may do a blood, breath or stool test to find out if lactose intolerance is the true cause of your digestive problems.
Milk and dairy foods provide many important nutrients. Milk is a well-known source of calcium and vitamin D. “Dairy products are also excellent sources of protein, potassium and many other vitamins and minerals,” says Mallory Koenings, a graduate student in the Department of Nutritional Sciences at UW-Madison.
Because dairy products contain so many important nutrients, even people who are lactose-intolerant are urged to consider alternatives within the milk food group, such as yogurt or lactose-free milk.
Eating a diet of plenty of oily fish daily can protect women against infertility, says a new study. Researchers have carried out the study of 70,000 nurses and found those who ate the most tuna, salmon, mackerel and other fish high in omega-3 fatty acids were nearly 22 per cent less likely to develop endometriosis which is known to causes infertility.
However, the study found that those whose diets were heavily laden with harmful transfats – chemically altered vegetable oils – found in thousands of products from cakes and biscuits to pies and chips were 48 per cent more at risk of developing endometriosis. The condition arises when cells normally found in the womb lining attach themselves to other parts of the pelvic area, causing inflammation and often leading to infertility.
The study, the largest to have investigated the link between diet and endometriosis, followed the nurses for 12 years from 1989. It found while the total amount of fat consumed did not matter, the type did.
Gynaecologist Dr Stacey Missmer, of Harvard Medical School, Boston, said her findings, not only suggest that diet may be important in the development of endometriosis but also provide more evidence for eliminating trans fats, which are used to bulk up foods and increase their shelf life.
“Millions of women worldwide suffer from endometriosis. Many have been searching for something they can do for themselves, or their daughters, to reduce the risk of developing the disease. These findings suggest dietary changes may be something they can do. The results need to be confirmed by further research, but this study gives us a strong indication that we are on the right track in identifying food rich in omega-3 oils as protective for endometriosis and trans fats as detrimental,” she said.
The study is published in the 'Human Reproduction' journal.
While most private health funds provide rebates for visits to APDs, some patients may be eligible for a Medicare rebate instead.
The Medicare Allied Health Initiative allows chronically ill people being managed by their GP under the Enhanced Primary Care (EPC) Program access to Medicare rebates for ADP services. Eligible patients are those with a chronic condition, defined as one that is likely to be present for at least 6 months. This includes, but is not limited to, asthma, cancer, cardiovascular disease and diabetes. General practitioners must be managing the patient through the GP Management Plan (GPMP) and the need must be identified as part of a Team Care Arrangement (TCA). (Please note these are not the only criteria for Medicare eligibility for a GPMP, TCA and referral.) The dietitian must provide a service that is directly related to the management of the patient’s chronic condition. General practitioners must then fill out the EPC Program Referral Form for Allied Health Services under Medicare for the rebate to be possible. The Medicare rebate is currently $48.95 per service with out-of-pocket expenses counting toward the extended Medicare safety net. Patients are given a maximum of five allied health visits per calendar year.
Medicare rebates are now also payable for group services for patients with type 2 diabetes, on referral from a GP. Contact Medicare for further information about eligibility, requirements, rebates and referral forms.
A referral to Nastaran Habibi should be made when your patient needs more intensive dietary, nutritional and lifestyle behavior education than you can provide in your office environment. Nastaran can help particularly when the patient is in the preparation, action or relapse stages of change.
A consultation generally includes a diet and lifestyle assessment, and nutrition education and counselling. Nastaran will review your patient’s medical and social status, including biochemistry and othe relevant test results, dietary and family history and home environment. In addition she will take anthropometric measurements and collect information on the patient’s individual food preferences and cultural, socio-economic and lifestyle needs. Taking into account the patient’s own goals, knowledge, skills and access to resources, Nastaran will custom design a program for your patient based on the principles of Medical Nutrition Therapy. She integrates self-management training regarding information on nutrient content, food choices, and meal preparation based on each patient’s particular and unique circumstances. Initial appointments are more than 1 hour.
What happens next:
- You will receive a formal report assessing your patient’s nutritional, physical activity and lifestyle status including Nastaran’s recommendations for improvement, possible barriers to success and guidelines for evaluating progress.
- During the 45-90 minute follow-up visits, Nastaran will review your patient’s progress, provide further education, encourage continued adherence to the plan and identify any obstacles to success.
In order for your patient to qualify for a Medicare rebate, referral must be through an Enhanced Care Plan. Referrals outside Medicare will still qualify for a Health Fund rebate.