Sniffing Out Leukemia?

3 doctorsOK Ladies – here’s a question for you.   If you suffer from seasonal allergic rhinitis who do you go and see?

(a)  An allergist

(b)  An oncologist

(c)  A hematologist

If you answered (a) you’re probably feeling pretty confident right now.  After all the more common term for seasonal allergic rhinitis is hayfever and that’s something best managed by an allergist.  Right?

Not so fast! Maybe (b) or (c) would have been better choices.  You see, a team of scientists looking into the interplay of the immune system and cancer have just found a link between a history of airborne allergies – in particular those to plants, grass and trees – with risk of blood cancers in women.

Notably, the study did not find the same association in men, which suggests a possible gender-specific role in chronic stimulation of the immune system that may lead to the development of hematologic cancers.

The findings were published online last week ahead of the December print issue of the American Journal of Hematology.

allergic rhinitisTo the best of our knowledge, ours is the first study to suggest important gender differences in the association between allergies and hematologic malignancies,” says Mazyar Shadman, MD, from the Fred Hutchinson Cancer Research Center.

According to Shadman, who led the research, the immune system’s potential role in the cause of cancer is a focus of intense scientific interest. “If your immune system is over-reactive, then you have problems; if it’s under-reactive, you’re going to have problems. Increasing evidence indicates that dysregulation of the immune system, such as you find in allergic and autoimmune disorders, can affect survival of cells in developing tumors.”

The study included a large sample of men and women aged 50-76 years old from western Washington from the VITamins And Lifestyle (VITAL) cohort study. Participants answered a 24-page questionnaire that focused on: (i) health history and cancer risk factors, (ii) medication and supplement use, and (iii) diet. Participants provided information on age, race/ethnicity, education, smoking, diet (fruit and vegetable intake), and other lifestyle characteristics, self-rated health, medical history, and family history of leukemia or lymphoma.

History of asthma and allergies was also taken, including allergies to plants, grasses or trees; mold or dust; cats, dogs or other animals; insect bites or stings; foods; and medications.  Of the 79,300 VITAL participants who filled out the questionnaires, more than 66,000 individuals were selected after eliminating those who had a prior history of malignancies other than non-melanoma skin cancers and missing information on baseline cancer history.

Participants were then followed for eight years until they either withdrew from the study, moved away, had a cancer diagnosis other than hematologic malignancy or non-melanoma skin cancer, or died.

seer_logoIncidence of hematologic malignancies and other cancers was identified via the Surveillance, Epidemiology and End Results (SEER) cancer registry of western Washington.

Of the participants, 681 developed a hematologic malignancy during the follow-up period. These participants were more likely to have two or more first-degree relatives with a family history of leukemia or lymphoma, to be less active and rank their health status as low.

A history of allergies to airborne antigens was associated with a higher risk of hematologic malignancies. The most statistically significant association was seen with allergies to plants, grass and trees.

cat allergyThere was also an increased risk of plasma-cell neoplasms for participants who reported a history of allergies to cats, dogs or other animals. Plasma-cell neoplasms are conditions, both cancerous and noncancerous, in which the body makes too many plasma cells.

When stratified by gender, the incidence of blood cancers in response to these allergens was increased in women but not in men. The reason for this is as yet unknown.

However, Shadman and colleagues warn, “Given the limited number of cases within each sub-type of hematologic cancer, the risk estimates need to be interpreted with caution … and the possibility of chance finding due to multiple testing should be recognized.”

Even so, if you’re a women with allergies, you may want to keep a close eye on your blood work.

SRxA-logo for web

Advertisements

Anaphylaxis Legislation gets Presidential Seal of Approval

HowtoUseYourEpiPen644x356-process-sc644x356-t1338817363SRxA is delighted to announce that earlier this week President Obama signed into law the School Access to Emergency Epinephrine Act.  During a week in which Obama and his new healthcare.gov website have made headlines for all the wrong reasons, we thought it only fair to commend him on this important anaphylaxis initiative.

The School Access to Emergency Epinephrine Act is legislation that will help to protect schoolchildren who experience life-threatening anaphylaxis.

This legislation is a significant milestone for food, venom and latex allergy safety in our nation’s schools,” says Tonya Winders, chief operating officer of Allergy & Asthma Network Mothers of Asthmatics (AANMA). “It will help save lives of children who experience an anaphylactic reaction for the first time or don’t have epinephrine auto-injectors readily available when anaphylaxis occurs.”

Think Fast Allergy Symptoms PicThe measure provides a funding incentive to states that enact laws allowing school personnel to stock and administer emergency supplies of epinephrine auto-injectors. Epinephrine is the first line of treatment for anaphylaxis.

The School Access to Emergency Epinephrine Act was bipartisan legislation, first passing the U.S. House of Representatives on July 30, 2013, and then the U.S. Senate on Oct. 31, 2013, before heading to the President’s desk.

Allergic reactions to foods are the most common cause of anaphylaxis in community settings, according to the U.S. Centers for Disease Control and Prevention (CDC). Studies show that 16-18% of schoolchildren with food allergies have had a reaction from accidentally ingesting food allergens. In addition, 25% of anaphylaxis cases reported at schools happened in children with no prior history of food allergy.

USAnaphylaxis_10_14_13As of today, 28 states have passed emergency stock epinephrine legislation and six have bills pending.  Let’s hope this legislation will spur the remaining states to follow as soon as possible.

Green states that have passed stock epinephrine laws or regulations:

AlaskaArkansasArizonaCaliforniaColoradoFloridaGeorgiaIllinoisKansasKentuckyLouisiana,MarylandMassachusettsMinnesotaMissouriMontanaNebraskaNevadaNorth DakotaOklahoma,OregonSouth CarolinaTennesseeUtahVirginiaVermontWashington, and West Virginia

Yellow states have pending stock epinephrine bills:
MichiganNew JerseyNew YorkNorth CarolinaOhio and Pennsylvania

Red states that have no stock epinephrine bills: 
AlabamaConnecticutDelawareHawaiiIdahoIndianaIowaMaineMississippiNew HampshireNew MexicoRhode IslandSouth DakotaTexasWisconsin, and Wyoming

To find out more about anaphylaxis in schools please visit http://www.epipen4schools.com/ and https://www.anaphylaxis101.com/Resource-Library/Anaphylaxis-in-Schools.asp

SRxA-logo for web

Kudos to Canada

HamiltonOntarioSkylineCThis morning, SRxA’s Word on Health salutes the Canadian city of Hamilton, Ontario, for its pioneering lead in anaphylaxis safety. Hamilton is destined to become the first city in the world to require all food service outlets to have life-saving epinephrine auto-injectors on hand for people with severe food allergies.

The move is being led by Hamilton Councillor  – Lloyd Ferguson, in hopes of avoiding sudden and tragic deaths like one this past spring of a Stoney Creek girl.

MaiaTwelve-year-old Maia Santarelli-Gallo had what her doctor said was a mild allergy to eggs and milk that had only ever caused her a runny nose. But last March, while eating an ice cream cone at a Hamilton-area mall with her father and older sister, Maia experienced a sudden, severe allergic reaction.

Her sister found someone with an epinephrine injector, but by the time it was administered, it was too late. Emergency crews took Maia to hospital but she was pronounced dead.

epipen dispenserWhen Councillor Ferguson heard about Maia’s death, he decided to draft a ground-breaking motion to get epinephrine auto-injectors in every restaurant and mall in the city.

He says it’s high time that food providers have access to medicines that could help their customers who develop allergic reactions. He says if automated external defibrillator (AEDs) are now being installed in arenas and other community centers, it makes sense to have epinephrine injectors in areas where food allergy reactions are most likely to occur.

AEDs in schoolsIt took us about 40 years to get defibrillators into public facilities and they have been a great success. This is the next step,” he says.

Allergy specialist Dr. Mark Greenwald, Allergist, and Chief Medical Officer of EpiCenter Medical would like to go further and see public awareness campaigns that would train the public on how to use epinephrine injectors, just as there have been campaigns encouraging people to learn CPR.

Greenwald has developed an online course called EpiPenTraining.com, to offer training on how to recognize allergic reactions, and how to use the injectors. He says such training is vital because during anaphylaxis, seconds count.

And anaphylaxis isn’t rare.  Allergic disease is the 5th most prevalent chronic disease among all ages, and the 3rd most prevalent among children. Every 3 minutes in North America, a food allergic reaction sends someone to the Emergency Room. Every 6 minutes, that Emergency Room visit is for anaphylaxis, that’s 10 patients per hour!

In 25% of people requiring treatment, the reaction is their first episode, and they are completely unprepared.  And for 50% of the people who die from anaphylaxis, the victims had life-saving epinephrine, but it wasn’t used or it wasn’t used in time. The other 50% didn’t carry epinephrine despite their previous allergic episodes.

SAVE certificateParticipants in the online course become SAVE certified – Save Anaphylaxis Victims in an Emergency.

Debbie Bruce of the Canadian Anaphylaxis Initiative was part of a program this past spring to get epinephrine injectors on all fire trucks in Mississauga. She says that like Maia, up to one-third of people who have allergic reactions outside the home did not realize they had a severe allergy and didn’t carry an epinephrine injector. She is now petitioning politicians  to come up with a national allergy plan.

I think it is a new reality,” she says. “Reactions happen and we need to be prepared.”

Maia’s mother, Leah Santarelli, backs all efforts to make the public more aware of anaphylaxis and hopes the Hamilton city council passes Ferguson’s motion.

There’s no guarantee that an EpiPen will save your life 100 per cent of the time, just like a defibrillator won’t save you 100 per cent of the time, but it is there as a safety measure,” she says.

The motion is currently being reviewed by the city’s health team; if approved, it should go before Hamilton city council in October.

We certainly hope that it does and that this trend will rapidly spread across the borders.  As Greenwald says – every second counts!

SRxA-logo for web

Protecting Kids with temporary tattoos

food allergiesParents of the three million or so kids in the US who have been diagnosed with food allergies whose kids have severe food allergies know they can’t be too careful. One bite of the food they are allergic to could be deadly. Indeed, according to the CDS, more than 200 people with food allergies die every year as a result of anaphylaxis.

Now, Michele Walsh, a mother of three from Baltimore, has created SafetyTat  to help remind teachers, classmates and babysitters to be extra careful.

temp tattooThe safety tats are brightly colored temporary tattoos or long-lasting write-on stickers that can be placed prominently on a child’s arm, with information such as “ALERT: NUT ALLERGY” or other critical information.

When you leave a child in someone else’s care at school or camp, “no matter how many times you fill out the forms, you’re still taking a leap of faith,” Walsh says. “This is like my voice with my son when I’m not there. It’s almost like teaching them ‘stop, drop and roll…’ They know exactly what to do.”

Another company –  Allermates offers allergy education tools, stickers, alert bracelets and other products for kids. Allermates was created by Iris Shamus, inspired by her son’s multiple allergies and an incident at school. “When you have a child with a food allergy, you’re always worried. It’s just part of your life,” she says. “I wanted to have something a little more personalized for him to remind teachers and babysitters.”

allermatesIt began with a fun necklace, then a wristband and a large selection of products accompanied by cartoon characters such as Nutso, a charming peanut, to help her son understand, remember and confidently discuss his allergies.

It makes me feel so much more secure,” she says. “I know you can’t be there all the time when you’re a mom, and this gives you peace of mind.”

Anything that can help educate the patient about their problem and continue to make them aware about it is helpful whether it’s a temporary tattoo or a warning bracelet,” says Stan Fineman MD, immediate past president of the American College of Allergy, Asthma and Immunology.  “The important thing is for people to accurately find out what they’re allergic to and then make sure to take the appropriate precautions,” Fineman says. He says parents of kids with severe allergies should keep EpiPens on hand, check school policies, talk to school officials and bring in treats their kids can eat for special events.

allermates 2Betsy Shea of Chicago says both of her boys, 4-year-old Colin and 2-year-old Emmet, have nut allergies, and Colin wears Allermates’ green snap-on wristband featuring Nutso. She’s thinking about trying temporary tattoos for Emmet.

Having allergies herself, she remembers having to wear the traditional metal medical alert band, which made her feel different and self-conscious. But Colin “loves that band. He wears it with pride and thinks it’s just so cool. We couldn’t get him to take it off for a while,” she says.

We thinks it’s pretty cool too!

SRxA-logo for web

COPD & asthma linked to poor anaphylaxis outcomes

patient with maskResearchers have found that patients with chronic lung diseases, including asthma and chronic obstructive pulmonary disease (COPD), are significantly more likely to have poor outcomes when hospitalized for anaphylaxis and other allergic conditions compared with other patients.

Zuber Mulla, MSPH, PhD, Associate Professor and Director of Epidemiologic Research at the University of Texas School of Public Health and Estelle Simons, MD, FRCP from the University of Manitoba, Winnipeg, Canada identified 30,390 patients who were hospitalized in Texas for allergic conditions between 2004 and 2007. Of these, 2,410 had a primary or secondary diagnosis of anaphylaxis at discharge.

The 2,772 (9.1%) patients in the overall cohort who had asthma were 67% more likely to receive mechanical ventilation than patients without asthma, while the 1,818 (6.0%) patients with COPD were 35% more likely to be admitted to the intensive care unit (ICU), 41% more likely to experience a prolonged stay in hospital (over 3 days), and 98% more likely to receive mechanical ventilation than those without the condition.

Patient on ventilatorIn the sub-cohort of patients with anaphylaxis, patients with asthma (n=334; 13.9%) did not have an increased risk for mortality compared with other patients, but they were over two-times more likely to be mechanically ventilated than patients without asthma).

Meanwhile, COPD patients with anaphylaxis (n=149; 6.2%) were 86% more likely to experience a prolonged hospital stay and 61% more likely to receive mechanical ventilation than patients without COPD.

Other lung conditions associated with poor outcomes included pulmonary eosinophilia, which increased the odds for ICU admission in patients with allergic conditions, while chronic bronchitis, emphysema, and interstitial lung diseases were linked to an increased risk for hospital mortality.

In particular, in the sub-cohort of patients with anaphylaxis, interstitial lung disease was linked to an 8.71-fold increased odds for mortality and a 5.16-fold increased odds for mechanical ventilation.

Writing in BMJ Open, Mulla and Simons say that their “unique exploratory analysis of a large database offers new insight into the effects of chronic pulmonary disease on anaphylaxis, an area for which there has previously been a dearth of information.”

SRxA-logo for web

Planting an Ugly Face on Allergies

allergic rhinitisAs allergy season continues for much of the nation, a largely unknown adage rings true: the uglier a flower or weed, the more allergy-inducing its pollen tends to be.

Ragweed, mugwort and pigweed have more than just their unattractive names and unappealing appearance in common, they’re also some of the worst offenders to allergy sufferers.

Of those allergic to pollen-producing plants, 75 percent are allergic to ragweed which can produce up to 1 billion pollen grains per plant throughout a pollen season.

mugwort0003_midThe relationship between allergy-causing pollens and their flowers is something like a beauty pageant,” says Robert Valet, M.D., an allergist at Vanderbilt University Medical Center’s Asthma, Sinus and Allergy Program. “A general rule of thumb is that flowers that smell or look pretty attract insect pollenators, so they are not generally important allergens, because their pollen is not airborne. However, those that are very ugly or plain are meant to disperse pollen in the wind, which is the route most important for allergy.”

Allergy season is divided into spring, summer and fall and for most of the country runs from March to October.

Early spring is typically tree season, with common tree allergens including oak, maple, walnut, pecan and hickory. While many people are concerned about fragrant and flowering trees like the Bradford pear and crabapple they rely on insects instead of the wind to carry their pollen and do not typically trigger allergies.

Amaranthus_retroflexus_020207_1In late spring and early summer, grasses start to pick up their pollen production.  And in late summer and fall, weeds such as ragweed, lamb’s quarter, pigweed, English plantain and mugwort make their presence known.

The pollen count may change from day to day, due to an event like rain – which decreases the pollen in the air temporarily – but once allergy season is underway, anything between a moderate and very high pollen count will aggravate allergy sufferers,” Valet said.

For people with known pollen allergies, simple solutions can include taking an antihistamine before going outside and showering once back inside, and choosing the air conditioner over an open window for cooling homes. If these measures do not relieve the symptoms, Valent suggests going to see an allergist for testing and treatment.

In the meantime, it wouldn’t hurt to stay away from ugly plants.

SRxA-logo for web

Welcome to World Allergy Week

WAWlogo_clearToday marks the start of the World Allergy Organization’s (WAO) annual World Allergy Week.

During the 2013 event, WAO together with its 93 national Member Societies, will be addressing the topic of “Food Allergy – A Rising Global Health Problem,” and its growing burden on children.

Globally, it’s estimated that as many as 220-250 million people suffer from food allergy.  And the incidence is on the rise in both developed and developing countries, especially in children.

During World Allergy Week WAO plans to highlight the need for greater awareness and understanding of food allergy as well as the exchange of ideas and collaboration in order to address a variety of safety and quality-of-life issues related to the care of patients with food sensitivity.

According to Professor Ruby Pawankar, President of the World Allergy Organization, “There are problems that need to be addressed in many countries throughout the world such as the lack of awareness of food allergies, lack of standardized national anaphylaxis action plans for food allergy, limited or no access to epinephrine auto-injectors, and the lack of food labeling laws. Moreover, some countries have standardized action plans but no ready access to auto-injectors; while others have auto-injectors but no standardized action plans.”

An important part of the initiative of World Allergy Week 2013 is to advocate for the safety and quality of life of patients who suffer from food hypersensitivity. WAO has also produced a list of online food allergy resources for healthcare professionals and patients / caregivers, which we have reproduced below.

HEALTHCARE RESOURCES

Kids Teased about Food Allergies No Laughing Matter

Access the article

WAO White Book on Allergy

Access the book

Food Allergy: Pathogenesis and Prevention
World Allergy Forum, December 2012, Orlando, Florida, USA
Access the presentations

Food Allergy
Cassim Motala, Joaquín Sastre, Dolores Ibáñez
WAO Global Resources in Allergy (GLORIA™), 2009, updated 2011
Access slide deck

Cow’s Milk Allergy in Children
Access the summary

Anaphylaxis
Richard F. Lockey, September 2012, updated Disease Summary

Access the summary

WAO Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines
Access the article

ICON: Food Allergy
The Journal of Allergy and Clinical Immunology, 2012; 129(4): 906-920
Access the article

World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis
World Allergy Organization Journal, 4:13-37, February 2011
Access the article

PATIENT / CAREGIVER RESOURCES

PrintFood Allergy Research & Education (FARE)

The FARE website has an abundant source of valuable resources specifically for patients suffering from food allergies and the people who care for them, including:


anaphylaxis-campaignAnaphylaxis Campaign

The Anaphylaxis Campaign is a UK charity catering exclusively to the needs of people at risk from anaphylaxis by providing information and support relating to foods and other triggers such as latex, drugs and insect stings.
The AllergyWise online programs provide training for families, carers and individuals as well as health professionals. General information on Anaphylaxis and Severe Allergy

SRxA-logo for web