Can peanut allergy be prevented by introducing peanut early?

The question of when to introduce peanut is one that many of my patients and friends ask me. I asked myself the same question when I had my first baby girl.  At the time, I was completing a fellowship in allergy/immunology. There was no obvious answer based on the studies that had been done.  I would tell patients, “there is not strong evidence either way; do what makes you comfortable. I cannot, based on the studies that have been done, recommend a definitive plan”. This was frustrating as I felt I could not guide patients either way.

Peanut allergy is a big deal. In 2010, it was estimated that about 2% of the population has it.  Peanut allergy is the leading cause of anaphylaxis (a severe, systemic allergic reaction) and death related to food allergy in the United States.

What pediatric residents were taught to say about food introduction has varied throughout time. In 2000, the American Academy of Pediatrics (AAP) recommended that infants at risk for atopic disease refrain from feeding children until they were 3 years of age.  In 2008, in the middle of my pediatrics residency, the AAP retracted this recommendation, stating that there was insufficient evidence to make this recommendation.

On February 23, 2015, a landmark study called Learning Early about Peanut Allergy (LEAP), was published in the New England Journal of Medicine, and also presented by its authors at the American Academy of Allergy, Asthma and Immunology (AAAAI). This study was prospective and randomized (both good things in terms of scientific study design), and clearly showed that early introduction (11 months of age or younger) of peanut dramatically decreases the risk of development of peanut allergy (approximately 70 to 80%).  These results are impressive that they answer the question that many have wondered—when should peanut be introduced?

It is important to note that this study was only one study, and that it was done in a specific group of individuals—high risk patients, infants with severe eczema or egg allergy or both. It is unclear how the results would differ if this study was done in the general population. When the study participants were “introduced” to peanut, this was also a very specific and regimented schedule.  It is unclear if a less regimented schedule of eating peanut would produce the same results.  In addition, it is not clear if regular consumption of peanut were stopped, if the patient would continue to be tolerant of it.  Also, this study only looked at peanut, and the same question remains regarding other common allergenic foods such as egg, milk, and tree nuts.

Dr. Gruchalla and Dr. Sampson (who I did my allergy fellowship training with), wrote an editorial in the New England Journal of Medicine in response to this study. In it, they state “…we believe that because the results of this trial are so compelling, and the problem of increasing prevalence of peanut allergy so alarming, new guidelines should be forthcoming very soon”.

Times are exciting in the field of food allergy. As a physician and mother, I hope that we will be able to provide answers to parents that will allow us to prevent food allergy in our kids.  More studies more will need to be completed, but it is certainly helpful to have the LEAP so clearly demonstrate different outcomes based on if and when peanut is introduced.

If you are wondering about if and when your child should be introduced to peanut, please make an appointment!  In the LEAP study, all of the high risk children who were introduced to peanut had a skin prick test first to assess for risk of an allergic reaction, so it is important to discuss with your broad certified allergist the best plan of action. Please call (949) 364-2900 for an appointment.

-by Faith Huang, M.D.


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Household indoor pollution linked to lung problems!

By Faith Huang, M.D.

According to a study by Dr. Raj Kumar, titled “The Association of Household Air Pollution with Allergic Respiratory Diseases in Children” that was recently presented at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Atlanta, increased levels of asthma and hay fever (or allergic rhinitis) were found in children in India who were exposed to more indoor pollutants. This study looked at 70 households where no children had symptoms of asthma and/or hay fever, while the other 70 households had at least one child with one of those conditions. Researchers measured the levels of air pollutants – smoking, kerosene, biomass fuel combustion, and volatile organic compounds (VOCs) – in all the homes. They found that in the homes of children who suffered from asthma and allergies, there was twice as much household air pollution when compared to the homes of children with no asthma or allergies. This study is interesting as it shows a link between the environment that one lives in and specific disease processes. If you or your child is suffering from asthma or allergies, it is important to talk to your board certified allergist about your symptoms, and learn ways you can reduce exposure to harmful environmental pollutants that may cause or worsen the symptoms!

If you have any questions or concerns, call (949) 364-2900  and schedule an appointment today with one of our doctors. You can also use our online Request an Appointment form to schedule a future date and time.

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Do I have asthma or chronic obstructive airway disease? Doctors are telling me I have both!

By Faith Huang, adapted from an article here.

Some older adults with obstructive airway disease have overlapping characteristics of both asthma and chronic obstructive pulmonary disease (COPD).

Patients with asthma are used to symptoms of coughing, wheezing and shortness of breath. However, these are also symptoms of COPD. It can be difficult to tell the difference between the two conditions but it is important to do so as the optimal treatment regimen differs.

According to a presentation by Dr. William Busse at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting, as many as half of older adults with obstructive airway disease have overlapping characteristics of asthma and COPD, with this percentage increasing as people get older. “Based on symptoms alone, it can be difficult to diagnose COPD vs. asthma. The pathway to a diagnosis of COPD or asthma – smoking vs. a long-term persistence of asthma – can be quite different,” said allergist William Busse, MD, ACAAI fellow and presenter. “In every patient, but in older patients in particular, we need to take a thorough history and perform a physical examination, as well as measurements of lung functions…..Treatment will differ depending on diagnosis.”

Lung function changes in asthma are due to airway inflammation. For asthma, treatment is directed at reducing inflammation with mainly inhaled corticosteroids. The changes in lung function associated with COPD are caused by cigarette smoking and, exception with an exacerbation, are not particularly responsive to corticosteroids.

“The primary treatment in COPD is bronchodilators, including long-acting beta agonists. They help relax muscles around the airways in the lungs, allowing air to flow more freely,” said allergist Michael Foggs, MD, ACAAI president. “They should not be given alone to people with asthma. In COPD, but not asthma, inhaled corticosteroids have been associated with an increased risk for pneumonia, and in some cases, features of both asthma and COPD exist. For these patients a combination of inhaled corticosteroids and long-acting beta agonists is usually best.”

Some treatments for COPD and asthma are similar. Bronchodilators are used for both conditions, while other treatments tend to be more condition-specific. People with asthma are encouraged to avoid their specific triggers, like keeping pets out of the home or avoiding the outdoors when allergen concentrations are high. While people with COPD are also encouraged to avoid triggers, the emphasis in this condition is to stop smoking. Similarly, if a patient has asthma, smoking makes the underlying disease worse and reduces the response to inhaled corticosteroids.

Allergists who treat these conditions recognize that each patient, and their symptoms, must be treated according to their unique set of circumstances. Patient need to tell their allergists all their symptoms and complete medical history in order to receive the correct diagnosis and appropriately tailored therapy. Your board certified allergist can help by asking the right questions, and sometimes working together with your other doctors to specifically come up with a plan that will optimize your health.

If you have any questions or concerns, call (949) 364-2900  and schedule an appointment today with one of our doctors. You can also use our online Request an Appointment form to schedule a future date and time.

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‘Tis the season for Postnasal Drip!

Written by Faith Huang, M.D.
Adapted from article by Dr. Harold Katz

Postnasal drip tends to crop up during the holiday season—for many reasons!  Postnasal drip is when mucus runs down the back of your nose to your throat.

Normally, mucus mixes with saliva and drips in small amounts that is unnoticeable down the back of your throat. The glands in the lining of your nose, throat, airways and intestinal tract produce about 1 to 2 quarts of mucus a day to moisten these areas and trap foreign invaders such as bacteria and viruses before they can cause infection. However, when there is too much mucus made or it is not cleared effectively, this can cause the bothersome symptom of post nasal drip. Post nasal drips causes a feeling that makes you want to incessantly clear your throat.

What are some causes of postnasal drip?

  • Allergies (allergic postnasal drip)
  • Cold temperatures, changing weather or low humidity
  • Fumes from cleaning products, chemicals, perfumes and smoke
  • Sinus infections and upper respiratory infections
  • Pregnancy
  • Certain medications (such as birth control pills and blood pressure medications)
  • Spicy foods

How can you get rid of postnasal drip?

  • It’s important to identify the cause of the postnasal drip. You want to target the cause of the symptom!
  • Your board certified allergist can help you identify why you may be having postnasal drip by listening to your medical history and your symptoms, doing a physical exam to look for findings that may direct he or she to a specific cause of the drip, and sometimes doing allergy skin testing and imaging studies.
  • Depending on what the cause of your postnasal drip is, your allergist can prescribe an appropriate treatment regimen so you can enjoy the holidays, instead of being worried or bothered by this annoying symptom!

If you have any questions about postnasal drip give us a call at (949) 364-2900 to schedule your appointment today. You can also use our online Request an Appointment form to schedule a future appointment.

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‘Tis the season: beware of nuts in alcoholic beverages!

By Faith Huang

This holiday season, it is important to be aware of food allergens that can pop up in unexpected places if you have food allergy to peanuts or tree nuts! I recently came across a nice article written by kevvyg at the following link, , and have adapted it for your information!

Peanuts and tree nuts are often found in holiday food, such as desserts and stuffing, but have you thought about nut proteins that may be in alcoholic beverages? While most food and beverages are under the regulation of the Food and Drug Administration (FDA), alcohol falls under the Alcohol and Tobacco Tax and Trade Bureau.

Some alcoholic beverages may contain nut flavorings. These beverages are not currently regulated by the labeling laws therefore it may be necessary to call the manufacturer to determine the safety of ingredients such as natural flavoring. As of right now, major food allergens can voluntarily be listed for wines, distilled spirits, and malt beverages, but again, this is only voluntary.
So while your yummy bottled coffee drink will likely have a label listing nutritional value as well as the ingredients, including common allergens, your alcoholic beverage will not likely have this labelling. Some producers list ingredients of their alcoholic beverages on their website, but this is not a requirement.
Another tip to keep you safe is to be aware of cross contamination of mixed drinks served at bars. A good general tip is to skip the garnish. One garnish in particular that can be troublesome for those with nut allergies is maraschino cherries. These are often processed or flavored with almond extract.
For reference purposes, here’s a quick list of some common alcoholic beverages that contain nuts or nut extracts. This list is by no means comprehensive. Keep in mind, things can and do change, so contacting the producer is still your best bet.

  • Amaretto
  • Creme de noyaux
  • Creme de noix
  • Frangelico
  • Galliano
  • Kahana Royale
  • Nocello
  • Beefeater
  • Bombay Sapphire
  • Harp Lager
  • Phillips Dirty Squirrel
  • Southern Comfort
  • Eblana
  • Nocino

It is a good idea to check producers’ websites whenever possible, and if you don’t see the information you need listed, call or email them. Most producers would much prefer you contact them and err on the side of safety when consuming their products. Lastly, make sure you keep your auto injectable epinephrine handy at all times.

Be safe and enjoy the holidays responsibly!

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