Early exposure to food and food allergy in children

Question I have been under the impression that infants should avoid potential allergenic foods such as nuts, cow’s milk, and eggs in order to avoid developing allergic reactions. What advice should I give parents regarding the introduction of food in infancy and the development of food allergy?Answer There is no evidence that delaying the introduction of any specific food beyond 6 months of age helps to prevent allergy. A recent Canadian Paediatric Society statement recommends no delay in the introduction of food in infancy. Recent research also appears to suggest that early introduction of potentially allergenic foods (at 4 to 6 months of age) might actually provide a form of protection and help prevent allergy, but more research is needed.Food allergy is a subject of great concern for parents and clinicians caring for children. The incidence of food allergy has increased dramatically over the years, affecting 1% to 10% of children worldwide.^1,2 In the United States, the prevalence of reported food allergy in children younger than 18 years of age increased 18% (P < .01) and ambulatory visits caused by food allergy tripled between 1993 and 2006 (P < .01).³ In Canada, the prevalence of food allergy is approximately 7% based on self-reported data.⁴ The economic consequences of this health concern are substantial, as the diagnosis and management of food allergy come at a cost to health care systems.     

Diagnosing and managing food allergy in children

The prevalence of food allergy in children in the UK is now around 5%. The number of children put on restricted diets by their parents because of presumed allergy is likely to be much higher. Accurate diagnosis of food allergy is essential in order to ensure that the correct foods are carefully avoided while safe foods are not excluded unnecessarily. IgE-mediated (immediate type) reactions are the result of mast cell degranulation leading to histamine release. The typical signs of lip swelling, urticaria and possible progression to respiratory compromise (anaphylaxis) are usually clearly described, occurring within minutes of exposure to the food. Non IgE-mediated (delayed type) responses tend to start 2-6 hours, occasionally longer, after exposure and cause less specific signs/symptoms, less obviously allergic in origin. Where an immediate type allergic reaction is suspected on clinical history, allergy testing should be performed to confirm the diagnosis. This could involve either skin prick testing or specific IgE blood tests. Results must be interpreted in the context of the clinical history. The mainstay of management is allergen avoidance. The child and carers also need to know how to recognise and treat any future allergic reactions. There should be a written emergency plan in place. The plan should include advice to take a fast-acting antihistamine if any accidental exposure and reactions occur. Where there is a history of anaphylactic reaction or ongoing asthma, adrenaline auto-injectors should be prescribed as these are the major risk factors for future severe reactions. Non IgE-mediated food allergy is most common in early infancy. The diagnosis of non IgE-mediated food allergy relies on a two-stage process: strict exclusion of suspected allergen(s), only one at a time; re-challenge with suspected allergen(s), one at a time, to see if symptoms recur.     

Adverse reactions to acupuncture

Acupuncture is frequently used as an alternative therapy to drugs in the treatment of pain patients. In this review we discuss adverse reactions to acupuncture by means of case reports and our own clinical experience. Frequent side effects of acupuncture are local pain, autonomic nervous system reactions (including fainting) and small local bleeding or hematomas. There are, however, some case reports of serious adverse reactions. Since 1980, there have been 18 pneumothoraces post acupuncture therapy reported in the literature. Hepatitis due to inadequate hygiene standards has also been reported. Some patients with valvular heart disease have developed endocarditis after acupuncture. Ear acupuncture with permanent needles can cause chondritis or perichondritis. For any acupuncture treatment, a careful case history and exact diagnosis are necessary. In particular, it should be determined whether wound-healing disorders, immunosuppression, coagulation defects, valvular heart disease or pregnancy are present, as all of these constitute relative contraindications to acupuncture. Hygiene standards have to be observed. Bearing these points in mind, acupuncture is a reliable method with few side effects.     

Adverse reactions to foods

Food allergy encompasses a variety of immune-mediated adverse reactions to foods. IgE-mediated, cell-mediated, and mixed-mechanism food allergy disorders are recognized. Over the past 2 decades, the prevalence of food allergy doubled and its phenotypic expression increased in Westernized societies. Major food allergens have been identified for many common foods. Laboratory diagnosis of food allergy relies heavily on the detection of food-specific IgE antibodies, but novel approaches include tests for T-cell-mediated disorders and tests for prediction of tolerance. OFC remains the diagnostic standard for food allergy. Management of food allergy focuses on avoidance of the offending foods, nutritional support, and prompt recognition and treatment of acute food allergic reactions. Anti-IgE monoclonal antibody is the first potential therapy for food allergy that is under-going testing in clinical trials.     

Adverse reactions to wound dressings

This article describes the potential risks to patients' skin from the use of wound dressings and how to minimise those risks. Guidance is provided on the steps to be taken once an allergic reaction is suspected.     

Adverse reactions to contrast media

Knowledge of the physiological effects of contrast media helps radiology nurses to prepare patients fully. Hypersensitive reactions can progress rapidly so immediate nursing interventions and medical assistance are required. Pre-assessment, psychological support, vigilance, integrated monitoring and decision-making are the most effective prophylaxis.     

Adverse drug reactions to anthelmintics

BACKGROUND: Anthelmintics are commonly used in tropical areas, but are also prescribed in Western countries with other climates. However, pharmacoepidemiologic studies of these drugs are rare. OBJECTIVE: To investigate adverse drug reactions (ADRs) due to anthelmintics. METHODS: All spontaneous reports of ADRs associated with albendazole, diethylcarbamazine, flubendazole, ivermectin, mebendazole, niclosamide, praziquantel, pyrantel pamoate, and thiabendazole were identified in the French Pharmacovigilance Database from January 1, 1985, to August 31, 1999. For each case, the following data were recorded: age, gender, weight, ADRs, drug, dosage, and indication. RESULTS: A total of 243 cases were found corresponding to 291 ADRs. Serious ADRs (hematologic or hepatic injury) to albendazole most often occurred when the drug was used for the treatment of echinococcosis or cysticercosis, thus requiring both high dosage and long duration of therapy. Our data show that the profile and seriousness of anthelmintic-induced ADRs vary according to their use. Furthermore, the low number of spontaneous reporting of ADRs suggests a high rate of underreporting for these drugs, which are often considered in France as orphan drugs. CONCLUSIONS: The improvement of reporting of serious or unrecognized (unlabeled) anthelmintic-induced ADRs will increase our knowledge of the benefit/risk ratio associated with these agents and optimize their use.     

Adverse drug reactions: 'six rights' to ensure best practice for children

In the second of a two-part article on adverse drug reactions Agnes Kanneh describes the six 'rights' of the recipient of a drug. These are: that the right person should receive the right drug, in the right dose, at the right time within the right intervals, via the right route, followed by the right (correct) documentation. The author argues that the observance of these 'rights' by children's nurses ensures the best pharmacotherapeutic practice, thus a robust practical safeguard in adverse drug reactions and threats to the good reputation of the nursing profession.