Why is the incidence of food allergies rising in both adults and children?

 

Contributed by IFM Faculty Member Kara Fitzgerald, ND

IgE-mediated food allergies, the ones that can cause anaphylaxis, have historically been relatively rare. They primarily occurred in kids, who tended to outgrow them by adulthood. Recently, however, we have seen a rise in the incidence of these allergies in children, and the reactions increasingly are sustained into adulthood. Furthermore, we’re seeing new-onset food allergies and anaphylaxis in adults, something that was virtually unheard of a mere 20 or 30 years ago. So what factors are contributing to this onslaught of allergic disease?

One powerful shift that is promoting adult-onset food allergy is the relatively new, global use of acid blocking therapy such as PPIs and H2 blockers. A number of studies clearly demonstrate this association, including one completed in 2005 by Untersmayr, et al.1 In this trial, 152 adults were given either a PPI or H2 blocker for three months and IgE responses to 19 foods were measured at the end of the trial. Amazingly, there was a greater than 10-fold rise in the incidence of food allergy in the study group as measured by IgE response. Not surprisingly, a control group demonstrated no significant change in IgE food allergy incidence. The majority of these food allergies were de novo, or new onset reactions. Some patients with existing allergies experienced an increase in intensity of the reaction as a result of the drugs. In a significant subset of individuals, the reactions continued long after the acid blockers were stopped.

The mechanism of this reaction is straightforward: acid blockers inhibit digestion of protein in the stomach. When the stomach does not pre-digest protein for the intestine, the pancreatic and brush border enzymes found there don’t work as well, resulting in larger protein fragments that are sometimes absorbed. Larger protein fragments are more antigenic and therefore more likely to generate an allergic response.

Reference
1.    Untersmayr E, et al. Anti-ulcer drugs promote IgE formation toward dietary antigens in adult patients. FA SEB J. 2005 Apr;19(6):656-8. Epub 2005 Jan 25. (Link to free full text: http://www.fasebj.org/content/early/2005/03/25/fj.04-3170fje.long)

10 Things Your Nanny Won’t Tell You

nanny safetyI saw this article in the Wall Street Journal on October 13, 2013 and the title made me smile. What does my (your) nanny know that I (you) don’t? From a pediatrician’s perspective, this is a great opportunity to raise a few thought-proviking questions.

1. “Your kid loves me more than you.”

Wow – this means the parent is never around or the nanny is over stepping boundaries. TIme to change your lifestyle or nanny.

2. “You’re the worst part of my job.”

This is a natural yet unfortunate and avoidable situation. When you have two people caring for a child, they both want to be the ‘gatekeepers’ of health and wellness.  This creates a tension as the two people may have different value systems and thus caring styles. I see this all a lot with mothers and mother-in-laws. The solution is to make clear boundaries and know the child is yours. Always be open to advice and guidance but do not be afraid to hold your line and your family’s boundaries.

3. “I can’t save your kid’s life (or treat his injuries).”

Enroll all caregivers, is parents, grandparents, older children, nannies, etc, in a CPR course.

4. “I’m sleeping with your spouse.”

Umm, no comment.

5. “You’re not paying me enough.”

Salary is always a debate and fairness depends on the level of responsibility and availability of the nanny. $16 an hour is the median. I suggest thinking about the nanny’s  family needs as well. Your nanny is part of your community and if you do not take care of your community then points #1-4 are more likely to occur. Enough said.

6. “I’ll sue you.”

Be professional and respectful and this should not happen. If I were writing this for the nanny, I would make sure they created their own boundaries and would have them express these at the start of their employment to avoid unnecessary problems. Clear communication and respect are the key to to any healthy relationship. Karma, karma, karma.

7. “I’m smarter than you are.”

This may be true and often is true. However smarts do not determine who runs the house or how the children are cared for. Many times the employee is smarter than the boss but again let professionalism and respect rule the day.

8. “Your secret’s not safe with me.”

Having someone live in your house makes one vulnerable since they get to see you with your guard down. Again if you are respectful and professional then there should not be a problem but I suggest having the nanny sign a confidentiality and nondisclosure agreement.

9. “I know about that nanny cam.”

Technology allows 24 a day surveillance. Use it especially if your child is less then 6 years old. Every job should have markers of performance and when working with toddlers who cannot provide an adequate history then a camera (or several of them) are fine.  I would let the nanny know they are there too.

10. “You better do a thorough background check on me.”

This goes without saying. I have had parents run background checks on me as their pediatrician. This is not only smart to do but necessary. I work on the child protection team and never want to see your child in my office for a suspected abuse.

The bottom line is treat your nanny with respect, be clear about your boundaries, do not worry about disagreements as long as both sides are professional, and treat them like family. Working with a co-gatekeeper will force you to acknowledge your own strengths and weaknesses, will demonstra
te to your children how to work with others and give you time to contribute to your larger community. After all, our lives are about service.

 

Parents Magazine features Dr. J Brian Thornburg as a doctor “Making A Difference”

Parents Magazine selected Dr. J Brian Thornburg as one of the top 7 pediatricians in the country “Making A Difference.” The magazine highlights the 7 of us in their November 2013 issue, and the American Academy of Pediatrics is honoring us at their 2013 National Convention and Exhibition Welcome Reception.

At the opening reception of the AAP’s national conference, Parents Magazine and Desitin will provide each of us a $1,000 check for a charity of our choice.  My check will go to the Children’s Advocacy Center of Collier County for abused children.

Thank you to everyone from my family and friends to my patients for giving me the courage to pursue a vision and to care for so many wonderful children. I am grateful to Parents Magazine, Desitin and the AAP for this recognition.

NBC-2 Interview of Dr. J. Brian Thornburg on the Appropriateness of BMI Screenings at School

BMI ChartWatch the NBC news video by clicking here.

By NBC-2

An 11-year-old’s weight is now the talk of the country after her story aired on the “Today” show and “Good Morning America.”

Lily Grasso is a star volleyball player, and by looking at her picture you can tell she’s far from obese.

But when school started last month, Lily brought home a letter from the Collier County Health Department that included results from her health screening.

Those results labeled her body weight “at risk.”

“I was crying when my parents told me the news was going to come, and I just didn’t know what people were going to say at school,” said Lily.

Her parents labeled it a “fat letter” that destroys a child’s self-esteem.

“I don’t think anyone will look at a letter and feel better about themselves,” said Lily’s mom, Kristen Grasso.

Doctor James Thornburg is a local Naples pediatrician. He says the body mass index can easily be off for athletes like Lily, adding that parents should follow up with their primary physician.

“It’s like any other static mark, you have to go find out what it really means because just a number on a piece of paper doesn’t really explain you as a person,” said Dr. Thornburg.

The Collier County Health Department says it has conducted the screenings for years, and has never received any complaints other than this incident.

“I was surprised because we don’t really get any complaints about this program” said Dr. Joan Colfer, with the Florida Department of Health and Collier County.

The department says whether the letters are sent home with children or mailed home is up to the school itself.

Department officials add the tests do more good than bad.

“These are important things that you need to find out about children early in life so you can make those corrections if needed,” said Colfer.

When asked if the department was considering a change in light of the incident, officials firmly said no.

“Absolutely not! This is a mandated by state law,” said Colfer.

Massachusetts is one state where representatives are trying to ban those screenings. Grasso’s mother wants the same push here in Florida.

“If we can change the law and get the tests out of schools even better,” said Lily’s mom.

Holistic Medicine & Supplements Are Magic

Alter of medicineDr. Paul Offit, an outspoken vaccine advocate, developer of the rotavirus vaccine & chairman of the infectious disease department at CHoPs, just published a book that holistic medicine and the use of supplements are magic and therefore nonsense. Dr. Topol, the physician-editor of Medscape, interviewed him and posted the discussion online. Physician comments were both for and against the book with most being against the premise of the book. Here is my comment:

I love the reference to the National Academy of Science’s finding that FDA-approved drugs cause well over a 100,000 deaths a year, the fact that medicine is only supported by science 15% of the time, the failure of Offit to acknowledge the proven benefits of fish oil, vitamin E and acupuncture, the fact that the US medical system spends more per capita on healthcare but ranks 34th in the world and fails to address health and nutrition, as well as the reference to the strawman argument proposed by Offit.

It is good to see that physicians can still think for themselves and understand allopathic medicine only addresses disease and fails miserably when it comes to health and wellness.

Healing is the result of an alignment with nature or God – depending on your value set. I recall a poem I learned at my white coat ceremony, “A surgeon must be careful, when he takes his knife, for underneath his fine incision, stirs the culprit, LIFE.”

Topol (the editor of Medscape) provided the Wizard of Oz backdrop for Offit’s politically-biased ramblings that are truly no better or worse than listening to the CAM proponents who state that allopathic medicine is evil. A wise man once said, “Follow those who seek truth and run from those who know the truth.”

Offit’s next book will likely tell us how his religion is the only true religion… wait a minute, science can’t prove religion so therefore religion is magic and nonsense.

Let’s look to a true thought-leader – C. Everett Koop, MD, the former US Surgeon General – he stated “During the 19th century, American medicine was an eclectic pursuit where a number of competing ideas and approaches thrived. Doctors were able to draw on elements from different traditions in attempting to make people well. Perhaps there is more to this older model of American medicine than we in the 20th century had been willing to examine.”

The human experience is a combination of mind-body-soul – to separate these into artificial silos of reality and preach from these false ivory towers reminds me of the story of the Tower of Babel. I will stay true to a functional medicine approach that understands the whole person. Those who are afraid to seek the truth will follow their false gods, ignore the science that illuminates other possibilities and always be amazed at the shadows on the cave wall. Sad – there is so much more to life.