This isn't about the article in this thread, but interesting to see testing talked about on twitter ...

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Tweeted by @GoAllergy   (George du Toit - 1 of LEAP study docs)

QuoteI disagree with this indication I.e. react first, and only then undergo allergy testing, seems unnecessarily tough! twitter.com/aaaai_org/stat...

@AAAAI_org

QuoteIgE testing should be done for a food only if there is history consistent w/ reaction after eating that particular food.

Quote from: spacecanada on May 22, 2015, 07:08:46 PM
I'm fond of this topic too, Links.

Just a reminder to those reading ... if you have questions about the info in this thread or your FA and/or asthma action plans, talk to your allergist and/or pulmo.

Exactly what I'm thinking, Links!  The two may be integrated more than medical professionals currently perceive.  Whether the initial article is something to stand on or not isn't in question, it's that it shines light on the fact these two can, and often, coexist and one may be a diagnostic tool in figuring out the other.  Just like when the doctor asks about asthma triggers being exercise, illness, environmental allergies, etc. they may wish to consider adding food/eating to the list.  It's not a big step to take and it could save lives.  If they answer no, carry on like usual.  But if the patient suspects their asthma gets worse after eating, even just sometimes, then yellow flags should go up.

Action plans should have clearer asthma guidelines on them too and perhaps the big allergy organizations could talk to the pulmologists to come up with very basic guidelines.  It's not too difficult to say that if asthma symptoms do not improve with rescue medications within X minutes, give Epi.  (And by X, I mean a very small number, like 1, or the shortest time possible for the meds to work, to a limit.)  If symptoms worsen after giving rescue meds, give Epi.  Honestly, I might even Epi someone with known food allergies and asthma without trying asthma meds unless there was an obvious asthma trigger.  Better to Epi than not. Sorry, getting off topic there a bit.  I'm fond of this topic too, Links.

I think sometimes people like to divide asthma & FA with a big line ... but I think the reality might be more complicated ... a more integrated approach might work better ... & it will benefit patients if allergists & pulmos can work together & coordinate patient care.



^WORD.   

IMO-- this is no time for a turf war, guys.  There's enough trouble here for two groups of specialists.

Thanks,

~The patients and parents who live with this kind of reality.

Back to "links" ...


"Asthma-Peanut Sensitivity Study Questioned By Allergists"
http://www.allergyasthmanetwork.org/asthma-peanut-sensitivity-study-questioned-allergists/?utm_source=May+E-newsletter%3A+30th+Anniversary+Recap+%2F+Asthma-Peanut+Sensitivity+Study&utm_campaign=May+E-news&utm_medium=email

Quote"Many of the respiratory symptoms of peanut allergy can mirror those of an asthma attack, and vice versa," Dr. Cohn says. "The study aimed to evaluate the proportion of children with asthma who also demonstrated a sensitivity to peanuts."

This is a little off-topic for this thread, but related enough I think to the general asthma/FA topic ...

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For those with confirmed asthma & FA ....

there is a different risk/benefit calculus ... there are different questions at play than when dealing with only 1 of those conditions.

Ex -


Is this asthma or ana?  At what point (when unsure) should the decision be "better safe than sorry" and give epi?  Shouldn't the criteria used to interpret lung symptoms be written into the plans?

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I used to do some computer programming.  A patient with both FA & asthma going through the motions of following a typical asthma action plan reminds me of a program where there is the potential to get stuck in a loop ....

sometimes you need to direct things to go to another part of the program (in this case, point the patient to the food allergy action plan according to criteria that the allergists define) .

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Same sort of thing here ...

Re: Standard Protocol for "Asthma Action Plans"
"Lessons for management of anaphylaxis from a study of fatal reactions"
R. S. H. PUMPHREY

http://medicina.med.up.pt/im/trabalhos05_06/sites/Turma21/artigos%20-%20WEB/tiburcio%2017.pdf

Quote
Because all food-related reactions caused difficulty breathing, the paramedics commonly had difficulty deciding whether to use the protocol for anaphylaxis or for asthma. This led to delayed or inappropriate treatment that may have contributed to the fatality.

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I think sometimes people like to divide asthma & FA with a big line ... but I think the reality might be more complicated ... a more integrated approach might work better ... & it will benefit patients if allergists & pulmos can work together & coordinate patient care.

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... I got going on my favorite FA topic besides sesame ...  will.stop.now

Yes-- and Nathan Walters' fatal reaction presented as refractory asthma, too, if I'm recalling details correctly.

DD has had a few reactions like that-- the most recent was the one in Paris.  It was super-freaky to not KNOW whether you were dealing with asthma-- and if so, why meds weren't doing anything for it-- or something else. 

DS's first ana reaction at school presented as asthma that would not resolve with meds.  Luckily that spaciness symptom kicked in, and DH told the nurse to give DS the epi.

It was one of those brilliant Anaphylaxix Grading Chart Moments.

Then eight hours later, he had a biphasic reaction with stomach symptoms, chest pains if I remember right and hives if I remember right.  But first--asthma.

You know, I get what the allergists are saying about testing and I agree.

On the other hand, I know there are many patients falling through the gap of "pure asthma" & "asthma-like symptoms that are really a food allergy reaction".  Docs get confused by this, paramedics get confused by this ... of course, patients are confused about this.

I think it's good for pulmos to be on the lookout for "asthma" that is accompanied by other possible FA symptoms or "asthma" that seems to occur with ingestion of certain foods & refer those patients to allergist, possibly prescribe epi/educate until patient can be seen by allergist.  Raising awareness of this among pulmos is a good thing.

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For those diagnosed with both FA & asthma ... my non-expert opinion from a patient perspective is that coordinated asthma/FA action plans would help patients greatly.  Not all deaths can be prevented, but too many patients & other carers like schools are not being educated enough about how "anaphylaxis can look like asthma".

Will be happy to post info that goes against this opinion of mine if I learn of diff info/perspective.   





Wondering if I can bring one of these  to dd's next allergy appt.

http://www.deadlinenews.co.uk/2015/05/20/tv-doctor-set-to-visit-edinburgh-to-raise-awareness-about-asthma-and-allergies/


'best to test' campaign run by mother who lost her child to peanut allergy. had asthma but was never tested for peanut allergy.

Will be following this topic to see how it plays out ...


hopefully the article won't be behind a paywall when published.

I'm not so sure that "misguided" is a good way to describe this study--

elevating awareness amongst allergy and pulmonology specialists of the clear possible LINK between the two conditions seems, at least to me, to be a very good thing.

Can peanut allergy manifest solely as "asthma"?  Well, I think it's probably possible, yes.    Is that group of patients at risk if they aren't being seen/evaluated by an allergist (in addition to a pulmonologist evaluating the asthma)?  Yes, again.

If this awareness (remember-- aimed at pulmonologists) gets that level of awareness going, then I don't see the problem here.

What this study certainly DOES suggest is that one in ten asthmatic patients probably is peanut-sensitive.

I'm really dismayed that AAAAI seems to be so dismissive about that.  Those people are in the group at highest risk of fatality, after all-- and those who don't KNOW that they're in that group, because they have reactivity that manifests primarily as asthma?  Highest risk of all, I'd say.  They ought to be carrying epinephrine-- more than any other group, in fact, they ought to be carrying epinephrine and educated about how deadly those reactions can be. 


I have to conclude that AAAAI is objecting primarily because this didn't come from them, but from clinical researchers on the thoracic side of things.  But-- baby, bathwater.  That's all.

Media Alert: AAAAI Adverse Reactions to Foods Committee Responds to Calls for Asthmatic Patients to be Indiscriminately Tested for Peanut Allergies

Misconceptions Over Asthma and Peanut Allergy Study Released at 2015 ATS Meeting Need Clarification

http://www.aaaai.org/about-the-aaaai/newsroom/news-releases/asthma-peanut-allergy.aspx

QuoteThe study unfortunately has a misguided premise and conclusion.

Either way, it's an interesting study.  I can relate to it because, for many years, my parents thought my asthma was worsened by allergies, but was never diagnosed as such because many of my allergy test came back negative (and still do).  I think this study is one to be used with a great deal of caution, with an allergist who can really monitor peanut exposure vs. asthma symptoms in a safe manner and truly diagnose an allergy if it exists - that takes a great deal of dedication, patience, and education from both parties.  The same can be said for any 'macro' allergen, though, and would require the patient to see great benefit from time-consuming testing and (possible) resulting diet modifications. 

Then there's the whole consequence of people with this type of asthma allergy with high thresholds who may confuse people on the standards we need for low thresholds. 

Ah, yes, the allergy dynamics continue to unfold.

http://acaai.org/news/acaai-says-children-asthma-do-not-need-be-routinely-tested-peanut-allergy

ACAAI disagrees with this recommendation.

I think the recommendation is probably going to lead to a lot of people getting diagnosed who don't actually have it.