Food Allergies and the Pharmacy


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Head Lice, Star Wars, and Food Allergies?

School has started again. That means homework, packing lunches, after school sports, and the crud. In the retail pharmacy world, we see a flood of prescriptions about 3-5 weeks after school starts; children come down with everything from ear infections, strep throat, and bronchitis, to head lice.  That may be why September is “Head Lice Prevention Month”.

The scenario starts by receiving the dreaded letter from the school nurse. A kid in your child’s class has lice. Duh, duh, duuuh. I remember that note coming home when I was in elementary school. My mom sat my little second grade, Food Allergy Pharmacist self on a dining room chair and began to explore hair and scalp. Maybe I have been slightly traumatized (thanks Mom), but I clearly remember my mother, who had never seen a louse before, totally FREAK OUT. I had lice (insert the “Imperial March” music aka Darth Vader’s theme song).  My head is itching just typing this post.

Don’t panic and don’t death march up to the pharmacy. Its okay. Not the end of the world.

keep calm and strike back

Yes, you will spend hours examining every single hair on your child’s head with the precision of a surgeon and the intensity of…well…Darth Vader.  (Confession: E has been on a Star Wars kick for a while now, he and my husband will be happy to see that I have been fully integrated. At this moment, my brain can only conjure Dark Side metaphors.)

Numerous methods have been employed to do away with lice including heat (not a light saber), combing, smothering or suffocating, pediculicides (aka bug killer), and more. I want to be clear that I am not going to promote one type of lice treatment over another in this post. I simply want to discuss OTC lice treatment options as they relate to food allergies. I will provide links to a number of resources; I encourage everyone to read the good, the bad, and the ugly of each option and decide for themselves. Please use caution with anything (including food items and oils) placed on the head especially for those with atopic dermatitis, eczema, and any other skin conditions. Some of the forums I reviewed listed combinations of products, long treatment durations, large quantities, and use of plastic bags and sleeping caps especially in children that I felt were potentially dangerous. I did not include those links based on my opinion of safety issues.

I feel that two paths to reaction may be possible while treating and dealing with head lice. These paths are tentative, hypothetical connections. The medical community has not found definitive data directly correlating food allergy to the lice treatments I will discuss. What I am trying to highlight is a potential for allergic reaction. I am making a logical leap based on the clinical knowledge we do have.

1. food sensitization via damaged skin

A recent article in the Journal of Allergy and Clinical Immunology  detailed a sensitization route where a food allergen applied topically to eczematous skin lead to subsequent anaphylaxis upon ingestion of the food. The researchers suggest that skin care be bland, avoiding use of sensitizing agents especially food. This is hypothesized pathway one.

“Natural” treatments have historically included food products such as olive oil, almond oil, mayonnaise, coconut oil and essential oils such as tea tree (melalueca), lavendar, eucalyptus, clove, cinnamon, and peppermint. I have also seen lotions and creams listed as alternatives to mayonnaise; keep in mind that lotions and creams may also contain food allergens e.g. Cetaphil contains nut oils. Several of the sites/forums I reviewed suggested using these “natural” treatments frequently, in some cases every other day. It was also suggested that various essential oils be used on a daily basis (spritzed onto hair or several drops placed in shampoo) as a preventative measure. Lice can be surprisingly resilient.

Never underestimate power of dark side

The article findings coupled with the suggested preventative measures of spritzing or shampooing hair daily with various food items has made me wonder whether similar sensitizations will or have taken place.

2. cross-reactivity due to similar structural features of the allergens

The second pathway (cross-reactivity) might be achieved through use of over-the-counter, OTC, lice treatments.  Some OTC products contain Pyrethrins (Brand names include: RID, PRONTO, Triple-X) which are naturally occurring extracts from the chrysanthemum flower. Permethrin (Brand name: NIX) is a synthetic pyrethroid; a product similar to pyrethrins. Use of either pyrethrins or permethrin in ragweed allergic individuals may cause breathing difficulties and “asthmatic episodes” according to package warnings of both pyrethrins and permethrin.  Allergic reactions have been seen in a few people who have used pyrethrins according to the ASTDR and the potential for contact dermatitis exists as well. Ragweed and chrysanthemums are members of the Asteraceae/Compositae plant family. Other plants in this family include: sunflower, safflower, artichoke, marigolds, and dandelions.

I have been reviewing numerous resources but have yet to find a concrete yes or no answer to my question: Will pyrethrins and permethrin cross-react to food items that are known to cause oral allergy syndrome (or Type 2 hypersensitivity reactions) with ragweed?

the force is strong with this one

Oral allergy syndrome has become common knowledge in the allergy community. It has been noted by the Asthma and Allergy Foundation of America that “ragweed cross-reacts with bananas and melons, so people with ragweed allergies may also react to honeydew, cantaloupe, and watermelons, or tomatoes. Zucchini, sunflower seeds, dandelions, chamomile tea, and Echinacea may also affect some people.”

In other words, if a person has a severe allergy to cantaloupe or tomato (as an example), will that person also react to a topical lice treatment containing permethrin or pyrethrin?

I don’t know the answer to this question but, seemingly, neither does anyone else (yet). Given the data known to be true at this time, I would use caution when selecting permethrin or pyrethrin  for lice eradication if you or your child have a severe allergy to any of the ragweed cross-reactive foods (even more so with concurrent asthma diagnoses).

For more information on diagnosing and treating head lice at home visit headlice.org and the American Academy of Dermatology. It should also be noted that permethrin can be found in prescription scabies treatments, insect repellent directed to be used on gear and equipment, livestock insect repellent in the form of dust and spray, canine flea collars (permethrin is toxic to cats), and is listed on the World Health Organization’s Model List of Essential Medications Oct. 2013.

And remember , with lice “Do or do not.  There is no try.”

 

Images used are pieces of art for sale:

https://www.etsy.com/listing/106430722/keep-calm-and-strike-back-poster?ref=market

http://ludovitnastisin.deviantart.com/art/Darth-Vader-Quote-360922238

https://www.etsy.com/listing/179051508/the-force-is-strong-with-this?

 

Sources:

CDC: http://www.cdc.gov/parasites/lice/head/treatment.html

Asthma and Allergy Foundation of America: http://www.aafa.org/display.cfm?id=9&sub=20&cont=728

http://www.atsdr.cdc.gov/phs/phs.asp?id=785&tid=153

http://www.aafa.org/display.cfm?id=9&sub=20&cont=728

http://www.healthline.com/health-slideshow/home-remedies-for-head-lice#1

http://healthfinder.gov/FindServices/Organizations/Organization.aspx?code=HR2088

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362728/

http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=3cdec6f3-4da6-467f-96c3-c8941ff46b56

http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=9b44bf94-62c9-49d8-97ec-cf475824eb35

http://www.epa.gov/oppsrrd1/REDs/factsheets/permethrin_fs.htm

http://www.epa.gov/oppsrrd1/reevaluation/pyrethrins-pyrethroids-asthma-allergy-9-18-09.pdf

http://www.rxlist.com/pyrethrum-page2/supplements.htm

http://www.britannica.com/EBchecked/topic/39698/Asteraceae

http://www.skintherapyletter.com/treat/lice/permethrin_pyrethrin_piperonyl_butoxide.html

 


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Are you pregnant with an allergic child?

Normally, I try to give advice that combines the benefits of my education, work experience, and living with food allergies, but today I want to talk about a frustration I have with a gap in medical knowledge and what appears to be a gap in medical research.

I recently read about a study conducted at the Murdoch Children’s Research Institute in Victoria, Australia. The study’s preliminary findings indicate that children may develop allergies in utero.

As I have written in other posts and the “about me” section of this blog, my son, E, is severely allergic to eggs, soy, peanuts, and four kinds of tree nuts. During my pregnancy with him, I was sick. Very sick. One month I lost between 15 and 20 lbs due to vomiting. TMI, I know, but this severity coupled with 1. my mother’s account of becoming extremely sick every time she drank milk while pregnant with my milk-allergic sister 2. similar social media anecdotes and 3. E’s subsequent food allergy diagnoses lead me to a question: Was the reason I was so sick while pregnant with E because I was eating food to which he was already allergic?

Several years ago, while pregnant with A, my second child, I tried to convince the OB/GYN to write a script for allergy testing–just a simple blood sample, nothing that would jeopardize the pregnancy or cause an allergic reaction on or in my body. I wondered if my sample would test positive while pregnant with an allergic child whereas normally I am not allergic. Of course I wouldn’t know if this child would be allergic until later and I would need another blood test to compare; I would also need a food-reaction journal among other things. Regardless, I wanted to test my theory. I don’t think the doctor understood what I was trying to do exactly (or maybe he thought I was crazy). He repeatedly told me that I needed to wait to test for “my” allergies until after the pregnancy. In the end, I did not have the allergy testing and, so far, A is not allergic although she does have some skin issues. I was still very sick while pregnant with A but nothing like the extremes of E’s pregnancy. So my questions remain. The article reignited my thoughts on the subject.

The study is investigating whether the allergy development is due to maternal influence (weight, diet, smoking, etc) on predisposed genes. Certainly, this aspect bears much investigation.

But, what if the genetics of the child (i.e the allergy within the baby) influence the eating habits, activity, weight (obviously not smoking) of the mother during pregnancy? In these cases, could maternal eating habits and diets be the result of the “allergic” pregnancy as opposed to the allergy being the result of the maternal diet? Perhaps it’s both; a predisposed genetic mechanism catalyzed by a diet that then becomes unsustainable due to the developed allergy of the unborn child.

To be clear, I am not talking about the typical cravings, food aversions, and nausea/vomiting of pregnancy; I am talking about extreme and/or specific cases.

To further extrapolate: Could my theory, if proven correct, lead to earlier childhood diagnosis and anaphylaxis prevention by utilizing a simple prenatal maternal allergy screening process?

This very question is the crux of my theory. If a simple blood test could prescreen for significant allergic reaction then the children could be saved the months and years of itchy rashes, breathing problems, misdiagnoses, and unnecessary medications. The mothers could avoid offending foods while pregnant and breastfeeding, thus potentially eliminating signs and symptoms in both themselves and their child. Avoidance and prevention of anaphylaxis in this population would be amazing.

Of course all this is just a theory (not even a scientifically based theory) of mine established on anecdotes of pregnancy illness vs food allergies discovered early in a child’s life, including my own. This theory also does not address those that develop allergies later in life. I would love to test my theory informally via a large-scale questionnaire or poll. Maybe I will one day, but for now: What have been your experiences while pregnant with your allergic child? Were there any noticeable differences between allergic and non-allergic sibling pregnancies?

 

Update 6/12/2015:

Could passive transfer of allergies such as with the Canadian transfusion patient account for the maternal reactions I discussed in the blog?  The case was published in the Canadian Medical Association Journal on April 7, 2015.