Think it's "just asthma?" THINK AGAIN-- could be peanuts.

[CMdeux]

http://www.gponline.com/gps-urged-test-children-asthma-peanut-allergy/respiratory-system/asthma/article/1347520


http://time.com/3860542/the-connection-between-peanut-allergies-and-asthma/



REALLY scary, the articles based on this (admittedly preliminary) study.  I really look forward to seeing this once it has been published.  If the methodology is solid (and it seems very much so, on the surface)-- then about 10% of asthmatics may be "peanut sensitive asthmatics."

In other words-- they may actually be peanut allergic people whose reactions MANIFEST as asthma.  I know that we (at FAS) have talked a LOT about this kind of reaction over the years-- it's frighteningly difficult to convince even first responders and physicians that it's "really allergy" and not garden-variety asthma without overt cutaneous symptoms. 

REALLY important to spread this info-- because of what it indicates even about people who KNOW that they have a peanut allergy. 

[CMdeux]

Also going to note, here, however-- 22% of those asthmatics in this study had positive RAST tests for peanuts, which is not at all to say that they are actually clinically ALLERGIC to peanuts... and that "half of them" didn't know that they were allergic (well, sensitized, more accurately)-- that kind of adds up, when you think about the 10% figure that knew that they had a peanut allergy--

however--

22% is far higher than a random sampling of people, which is estimated to be more like 10% or a bit less.  In other words, the stage is certainly set for those people to become clinically allergic if the conditions shift slightly.

Just the fact that in this sample of asthmatics, the rate of peanut allergy was a whopping 10% ought to be enough to give one pause, honestly. 

[spacecanada]

Wow, just wow.  Lightbulb moment, for sure. 

[becca]

I saw this last night.  Great news that it was delivered very seriously, and from a "medical expert" on my channel.  It was not a human interest story of a single reaction, or advocate, but a stern caution to get it checked out if you or your child has asthma. 

What it said to me was that there is a significantly higher incidence of PA, maybe many food allergies, than documented.  Many are thinking they only have asthma and never get food tested.  Better food avoidance would better control the asthma too. 

[spacecanada]

Many are thinking they only have asthma and never get food tested.  Better food avoidance would better control the asthma too.

This was me for many years until a major reaction happened.  I can see this being the case in many people because asthma is so prevalent where I live.  Some experts have speculated that asthma is merely a symptom of other illnesses we haven't connected yet, much like fever was not long ago.  This is starting to build those links. 

[LinksEtc]

Tweeted by @AllergyKidsDoc


"America's Allergy Experts Don't Agree with Recent Study Suggesting Children with Asthma Need to Be Tested for Peanut Allergy"

http://newswise.com/articles/america-s-allergy-experts-don-t-agree-with-recent-study-suggesting-children-with-asthma-need-to-be-tested-for-peanut-allergy

According to allergist Matthew Greenhawt, MD, FACAAI, "Such testing could potentially lead to misdiagnosis, and represents an unnecessary and unjustified use of resources.

There is no evidence that diagnosing peanut sensitization better controls chronic asthma.

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




I see lots of allergists on twitter agreeing with this ACAAI statement.

[CMdeux]

Yes-- BUT-- personally, I'd love to know how many of those "non-allergic" asthmatic kids have an aversion to peanuts, wouldn't you?

I mean, not every person with a peanut allergy has a reaction threshold like my DD's or like Dr. Wood's-- at least not most of the time, YK?

I'm guessing, based on the distrubution in desensitization trials, that a lot of people have reaction thresholds that are more or less "macro" or for overt exposures-- mostly.

Which would totally make sense of asthma exacerbations that primarily occur when a child's allergy cup is otherwise a little on the full side.

KWIM?

So with all respect to Dr. Greenhawt, there, this sounds like a turf dispute as much a a caution about sensitization =/= allergy.  To be clear, I do agree with that.  We should NOT be labeling kids who have IgE and a history of regular, non-eventful consumption "allergic" in any sense of the term, nor should anyone be rushing to do RAST evaluation for peanuts on every person on the planet.

But it is a curious connection-- 10% peanut allergy is almost 10X the rate in the general population, after all.  There's SOMETHING there-- and who knows, maybe "peanut-sensitive asthma" is a thing.

[LinksEtc]

I don't know, but the allergists are not happy ...


Ex:


Tweeted by @WayneShreffler

No, No, No!!! This is fatally flawed: Nut allergy tests urged for children with asthma - Toledo Blade po.st/SbVVPe via @Po_st

[lanamilo]

I am allergic to peanuts, but my asthma didn't get better until I eliminated corn from my diet.  Was just working an elimination diet with my allergist (still am) but when I had corn week, my asthma was out of control.  No corn now for 9 days and I can breathe easy now.

[lakeswimr]

It could be a corn allergy but this time of year it could also be asthma caused by pollen and that type of pollen that caused it suddenly was over for the season.  I would want to do a food challenge before declaring a corn allergy because corn is super hard to avoid.  It can be in foods and not on labels.  It is in so many things including being used to dust paper plates. 

[lakeswimr]

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. 

[spacecanada]

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.

[LinksEtc]

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

The study unfortunately has a misguided premise and conclusion.

[CMdeux]

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.

[LinksEtc]

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


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