Allergy, Asthma, Immunology of Delaware
Nasheds, PA          Maher Nashed MD


Interesting Allergy News
This information is not review of the topics. it is only to make the topics interesting and simple to understand.

Perceived stress predicts allergy flares

Contact with Farm Animals may explain Lower Asthma Risk in Amish?

Stein MM, Hrusch CL, Gozdz CL, et al: Innate immunity and asthma risk in Amish and Hutterite farm children.
N Engl J Med, 2016, 375:411-421

Cars exhaust effect on pregnancy.

Diesel exhaust particle exposure during pregnancy promotes development of asthma and allergy (atopy)
JACCI VOL 134,7/2014, P 73

Probiotics may decrease itch in adults with eczema

Probiotic LKM512 administration may exert antipruritic effects by increasing KYNA production. LKM512 could therefore be a potentially effective therapeutic candidate for the reduction of pruritus.

Cereal and Allergy

Early consumption of cereal (1st year) is associated with less allergy to pollen, Dust and Atopic sensitization in the first year of life, Depner et al, Jaci 2012,11,048. 

Acid-suppressive medications during pregnancy may increase the risk of asthma and allergy in children

Acid-suppressive medications, such as H2-receptor antagonists (H2RA) and proton pump inhibitors (PPI), are the main treatment options for dyspepsia and gastroesophageal reflux disease. These are common problems in pregnancy.1 Recently, concerns have been raised that prenatal exposure to these medications may increase the risk of allergic disease in the offspring.1 Dehlink et al1 were the first to report these associations, proposing that use of acid-suppressive medications in pregnancy may increase the risk of allergic disease in the offspring through interference with maternal digestion of labile antigens, thereby increasing the amount of allergen to which the fetus is exposed.
Acid-suppressive medications during pregnancy and risk of asthma and allergy in children: A systematic review and meta-analysis. Rebecca E. Devine, MPH.
Nicola McCleary, PhD. Aziz Sheikh, MD. Bright I. Nwaru, PhD Email the author PhD Bright I. Nwaru. [Article has an altmetric score of 570]

Stomach infection (H. Pylori) and Eczema

Early life exposure to H. pylori may play a protective role in the development of allergy.
Original Article-Epidemiology of Allergic Disease
Exposure to Helicobacter pylori infection in early childhood and the risk of allergic disease and atopic sensitization: a longitudinal birth cohort study

Breast milk IgA protects against atopic dermatitis (Eczema)

There is an inverse association between soluble IgA in breast milk (n=610) collected 2 months postpartum and the development of atopic dermatitis (Eczema)
 Clinical & Experimental Allergy

Farm milk and Asthma

 Drinking farm milk can decrease your chance of having asthma and Allergy.
Jaci, vol133,2/2014.

Peanut allergy and tree nut allergy

Allergy to peanut does not mean you are allergic to tree nuts. You can be allergic to peanuts but still can eat other nuts with no problem.

Boiled Milk and allergy

Allergy to  Milk is less common if you drink unboiled milk rather Than boiled Milk.

Allergic diseases and Cancer (Hodgkin Lymphoma)

The results of a study done may indicate true increased risk for Hodgkin Lymphoma with family history of autoimmune and allergic conditions that varies by tumor EBV status.
The study,
 Infectious, autoimmune, and allergic diseases and risk of Hodgkin lymphoma in children and adolescents: A Children-s Oncology Group (COG) study.
International Journal of CancerAccepted Articles, Accepted manuscript online: 13 FEB 2014

Vitamin D and infections

People with low vitamin D have more frequent infections than those with normal levels.
The presence of upper respiratory tract  infections (URI) in NHANES III was higher with lower [25(OH)D] levels, regardless of season of year. This association was even stronger in subjects with asthma. [Ginde, AA et al. Arch Intern Med. 2009;169:384-390].

Pet Allergy

Allergy Prevention

Do you know an increased diversity of food within the first year of life might have a protective effect on asthma, food allergy, and food sensitization.
Current Allergy and Asthma Reports, 01/10/2014  Review Article.

Soy milk and Skin

Do you know that when using Soy moisturing agent on the skin, improvement in the skin tone, texture, and radiance, as well as a significant increase in skin luminosity was demonstrated.
cutis vol 82, no 6S, 2008

Cat Allergy

  Cat allergen; it is found primarily on skin and fur and is produced in sebaceous, anal, and salivary glands.
Highly concentrated areas of cat allergen include upholstery, bedding, and carpet.
After removal of cats from the home, the decrease of Fel d 1 (cat allergen) levels can be slow over time. Therefore, although removal of cat from the environment is important, other methods of allergen elimination are necessary.

Allergy and Molds exposure

The risk of having nose allergy is high if you get exposed to dampness and molds at home. The relationship is higher if there is molds odor in the house. JACI v132. Nov 2013

Allergy and Migraine Headache

If you have nasal allergy (stuffy nose, runny nose or sneezing) for a long time, you might get more frequent and more severe Migraine headache than other people.
Chronic rhinitis and its association with headache frequency and disability in persons with migraine: Results of the American  Migraine Prevalence and Prevention (AMPP) Study               

Dog Allergy

Sebaceous glands secrete dog allergen which is found in canine saliva, fur, and dander.
Reservoirs for dog allergen include bedding, furniture, and carpeting.

Children with low Vitamin D

Children with a history of asthma who took vit D experienced a 6-fold reduction in asthma attacks [Urashima, M et al. Am J Clin Nutr. 2010;91(5):1255-1260].  Compared with normal vit D levels, those with vit D insufficiency/deficiency had:
– Poorer lung function (FEV₁ & FEV₁/FVC),  Higher levels of IgE, 
– More likely need for ICS & OCS
– More likely need for LABA
• Children taking ICS or OCS had lower vit D levels in a doserelated manner (p = 0.001)

Hypoallergenic dogs

  Many patients allergic to dog report better tolerance of certain breeds over others, leading to various breeds being referred to as hypoallergenic.
In a study that examined dust samples taken from homes with various breeds of dogs, those in homes with hypoallergenic breeds had no difference in Can f 1 (dog allergen) levels compared with other breeds.
Another study found that Can f 1 levels were actually higher in hair and coat samples in breeds that were touted as hypoallergenic. Currently, evidence does not support breed-specific differences in allergenicity.

Rodents Allergy

  The primary source of allergen from pests such as mice and rats is urine,
Mouse allergen is prevalent in inner-city and suburban home and schools,
Whereas rat allergen is less prevalent than mouse but still common in the inner-city setting.
Individuals sensitized and exposed to rodents in turn can have higher asthma morbidity, highlighting the importance of abatement tactics in homes and schools.

Roaches Allergy

  A major allergen in cockroach is found in cockroach fecal material.
Asthma morbidity in inner-city children is associated with cockroach allergy.
Further, cockroach exposure in inner-city children has been indicated as a risk factor in the development of asthma.

Dust Allergy

Dust mites require adequate moisture and a feeding source for survival, so abatement tactics should focus on these factors.
Dust mites feed off dead skin cells and microorganisms, so minimizing the food source as a facilitating factor can decrease dust mites in the environment.
Dust mites thrive in humid environments, so maintaining humidity below 50% limits dust mite growth.
The common household dust mites in the United States are Dermatophagoides farinae and Dermatophagoides pteronyssinus, and the major allergenic proteins are Der p 1 and Der f 1.

Mold Allergy

   Approximately 5% to 20% of individuals with atopy/allergy are sensitized to mold.
Mold depends on moisture for growth, and individual molds thrive on different levels of moisture to support growth.
Common indoor molds include Fusarium, Penicillium, and Aspergillus species; some molds require higher moisture including Penicillium, Aspergillus, Stachybotrys, and Chaetomium species, so these molds can be found indoors in the setting of sustained water intrusion.
Common outdoor molds include Cladosporium, Alternaria, and Epicoccum species. , Alternaria and Cladosporium species grow outdoors in a damp or humid environment.
Many outdoor molds contaminate indoor areas by way of open windows, clothing, or pet fur.

  Skin care starts with cleansing.
Avoid drying soaps or harsh detergents. The average pH level (acidity or alkaline) of soap is 9 to 10. The skin’s normal pH level is 4 to 5. Because of this difference, soap increases the skin’s pH to an undesirable level and can worsen eczema symptoms.
It is best to use a non-soap cleanser because they are usually free of sodium lauryl sulfate.
When bathing or showering, avoid using anything that will scrape the skin, such as a washcloth, sponge, or loofah.
Do not use bubble bath.
Pat skin dry rather than rub.
Moisturize immediately after bathing/showering to seal in moisture.

Skin care for Eczema/dry skin

Wheat Allergy  

Wheat flour allergy is one of the top eight food allergens.

Symptoms : A child or adult with wheat allergy is likely to develop symptoms within minutes to hours after eating something containing wheat. Wheat allergy symptoms include:
Swelling, itching or irritation of the mouth or throat
Hives, itchy rash or swelling of the skin
Nasal congestion,
Itchy, watery eyes
Difficulty breathing
Cramps, nausea or vomiting
(Mayo clinic website)

Lab tests:  IgE for wheat

Treatment: Wheat avoidance.

Non-Celiac Gluten Sensitivity


 Non-coeliac gluten/wheat sensitivity (NCG/WS) is a syndrome characterized by intestinal and extra-intestinal symptoms occurring a few hours or days after the ingestion of gluten and wheat proteins in patients testing negative for coeliac disease and wheat allergy.
Symptoms: abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, “foggy mind”, depression, ADHD-like behavior, and chronic fatigue (They are similar to those with celiac disease)

Lab: IgG antigliadin antibodies (in only a part of the patients)

Treatment: Gluten Avoidance.

Gluten free diet problems (GFD)

Celiac disease

   Approximately 5% to 20% of individuals with atopy/allergy are sensitized to mold.
Mold depends on moisture for growth, and individual molds thrive on different levels of moisture to support growth.
Common indoor molds include Fusarium, Penicillium, and Aspergillus species; some molds require higher moisture including Penicillium, Aspergillus, Stachybotrys, and Chaetomium species, so these molds can be found indoors in the setting of sustained water intrusion.
Common outdoor molds include Cladosporium, Alternaria, and Epicoccum species. , Alternaria and Cladosporium species grow outdoors in a damp or humid environment.
Many outdoor molds contaminate indoor areas by way of open windows, clothing, or pet fur.

 There is little information in the literature on minimal disease-eliciting doses of gluten, which would be safe for CD patients. Apparently, it should lie between 10 and 50–100 mg daily intake.

GFD, which has low fiber, may lead to possible nutrient deficiencies in fiber resulting in consequent diseases.

GFD also leads to deficiency in Vitamins C, B12, D and folic acid, which is associated not only with malabsorption caused by villi atrophy but also with low quality of GFD.

GFD appears to be unbalanced in terms of calcium, magnesium, zinc in male and iron in women.

Non-Celiac Gluten Sensitivity and
Nickle Allergy.

People with Non celiac wheat sensitivity have a higher chance of having Nickel allergy.
People have Non celiac wheat allergy and nickel allergy, will have more skin symptoms after eating wheat than those without nickel allergy. 
People with Non celiac wheat allergy and get frequent skin symptoms after wheat ingestion, should be screened for nickel allergy.

Management of Gluten free diet problems.

Consuming fruits and vegetables rich in vitamins and antioxidant substances up to five times a day is recommended.

There is a need for additional folate supplementation as well as Calcium, Magnesium, Zinc and Iron.

It is recommended that gluten-free products are substituted with other cereals such as quinoa, sorghum and amaranth, which are safe and rich in folic acid, vitamins (riboflavin, Vitamin C and Vitamin E) and minerals.

Annual screening for nutrient status of a patient is required.

    Acid reflux

    Acid reflux Complications

1. Narrowing and scarring of the esophagus with possible oesophageal stricture.

2. An open sore in the esophagus (esophageal ulcer)

3. Precancerous changes to the esophagus (Barrett's esophagus)
4. Oesophageal cancer.
  When the acid from the stomach backs up to the esophagus, It may causes persistent heartburn, acid regurgitation, nausea, hoarseness in the morning, or trouble swallowing. it is called (Gastroesophageal reflux disease) ​​

When the acid goes all the way up in the esophagus, it may causes bitter taste, a sensation of burning, or something stuck, hoarseness, difficulty swallowing, throat clearing, postnasal drip, difficulty breathing, dry cough, hoarseness of voice, bad breath and chest pain. All these can happen without heartburn. This is called (laryngopharyngeal reflux)

When the acid goes beyond the esophagus, It can cause recurrent ear and sinus infections.

Some patients might experience the symptoms of only one location and not the others. Some patients’ feel nothing at all when the acid goes up in the esophagus and that is called (silent acid reflux)

    Acid reflux causes​​

  Weakness of the ring of the muscles at the bottom of the    esophagus
Risk factors
1. Overweight
2. Diet including smoking, alcohol, coffee and chocolate.
3. Stress
4. Others like
     A. Hiatal hernia (Bulging of top of stomach up into the  diaphragm)
     B. Pregnancy
     C. Delayed stomach emptying
     D. Medications
     E. Diabetes, dry mouth, Asthma, and connective tissue diseases.

    Acid reflux Treatment 
       a.​​ Changing life style

1. Diet: Eat smaller and more frequent meals.
2. Avoid anything you think triggers your symptoms. 
3. Avoid eating 2-3 hours before sleep.
4. Don't wear tight clothing .
5. Raise the head of your bed by up to 20cm (8 inches) 
6. Try to relax – stress can make heartburn and GORD worse.
7. Maintain a healthy weight.
8. Stop smoking.

    Acid reflux Treatment 
       b.​​ Medications

   There are 4 types of stomach medications
1. Antacids that neutralize stomach acid. They provide quick relief.
a. Examples of antacids: Maalox, Mylanta, Gelusil, Gaviscon, Rolaids and Tums.
b. Side effects: They won't heal an inflamed esophagus. Overuse can cause side effects, such as diarrhea or constipation. It might interfere with other medications absorption.

2. Medications to reduce acid production. Called H-2-receptor blockers. They provide longer relief and may decrease acid production from the stomach for up to 12 hours.
a. Examples: Cimetidine (Tagamet HB), Famotidine (Pepcid AC), Nizatidine (Axid AR) or Ranitidine (Zantac).
b. Side effects: They are uncommon, but can include diarrhea, headaches, dizziness, a rash and tiredness.
3. Medications that block acid production and heal the esophagus. Proton pump inhibitors are stronger blockers of acid production than are H-2-receptor blockers and allow time for damaged esophageal tissue to heal.
a. Examples: Lansoprazole (Prevacid 24 HR), Esomeprazole (Nexium), Omeprazole (Prilosec, Zegerid), Pantoprazole (Protonix), Rabeprazole (Aciphex) and dexlansoprazole (Dexilant).
b.Side effects: These medications are generally well-tolerated. They may include headaches, diarrhea or constipation, feeling sick, abdominal (tummy) pain, dizziness and a rash. Long-term use may be associated with a slight increase in risk of bone fracture and vitamin B-12 deficiency
4. Medications to strengthen the lower esophageal sphincter
a. Example: Baclofen may decrease the frequency of relaxations of the lower esophageal sphincter and therefore decrease gastroesophageal reflux. It has less of an effect than do proton pump inhibitors, but it might be used in severe reflux disease.
b. Side effects: Baclofen can be associated with significant side effects, most commonly fatigue or confusion.
GERD medications are sometimes combined to increase effectiveness.

    Acid reflux Treatment 
       c.​​ Surgery

  Surgery and other procedures used if medications don't help
1. (Nissen fundoplication). This surgery involves tightening the lower esophageal sphincter to prevent reflux by wrapping the very top of the stomach around the outside of the lower esophagus.

Other procedures that appear to be safe, but not much is known about their long-term effects.
2. Surgery to strengthen the lower esophageal sphincter (Linx). The Linx device is a ring of tiny magnetic titanium beads that is wrapped around the junction of the stomach and esophagus
3. Endoscopic injection of bulking agents – where special filler is injected into the area between the stomach and oesophagus to make it narrower.
4. Endoluminal gastroplication – where folds are sown into the ring of muscles at the bottom of the oesophagus to restrict how far it can open.

5. Endoscopic augmentation with hydrogel implants – where implants containing special gel are placed into the area between the stomach and oesophagus to make it narrower.
6. Endoscopic radiofrequency ablation – where a tiny balloon is passed down to the bottom of the oesophagus and electrodes attached to it are used to heat it and make it narrower.

  ​Is it cold or allergy?​​

Is it cold or allergy?
Both can have similar symptoms but there are main differences
If you have a cold
1. You get fever, generalized aches and pain. These don’t happen with allergy
2. Sore painful throat usually comes with the colds.
3. They often take several days to show up after exposure to a virus/cold.
4. Colds tend to occur in the winter.
5. The symptoms of a cold typically last three to 14 days.
6. The nasal discharge might have a color.
If it is allergy 
1. You get itchy eyes.
2. They are seasonal.
3. Symptoms occur immediately after exposure to pollens in spring, summer or fall.
4. Allergy symptoms last longer, usually for weeks.
5. The nasal secretion is usually clear.
Common symptoms between both
1. Sneezing
2. Runny nose
3. Stuffy nose
4. Cough , but it is more common with colds
5. Fatigue and weakness (Sometimes)


Obesity and Asthma

Respiratory(lung) function in obese children without asthma
improved by reduction of body weight and fat.

Obesity ( increased bone mass index) is associated with increase allergy marker (IgE) and may contribute to allergy / Asthma in adults.