Food Allergies

How many times have you heard someone say that they are allergic to a specific food? Food allergies are indeed common, affecting roughly 8% of kids and around 4% of adults. A true food allergy is an immune reaction to a food protein. There are many food REACTIONS (such as lactose intolerance, for example) that are not true allergies.The most common allergens are PEANUT, FISH, SHELLFISH and other TREE NUTS.

What are signs and symptoms? Food allergies show up within minutes to a couple hours after exposure to even small amounts of the offending protein. Itchy, red rashes, swelling, flushing, nausea, abdominal cramping and diarrhea, stuffy nose, wheezing, racing heart and metallic taste in your mouth are some of the possible presentations.

How do we diagnose food allergies? Mainly by history, to be honest. We combine the history with either skin or blood testing for more accuracy. Skin testing CAN be helpful, but there are many false-positives (which means the test says there IS an allergy, but there is not.) NEGATIVE results on a skin test, however, are very accurate that there is NO food allergy, so that can be very reassuring. Blood tests are also poorly predictive, being accurate only roughly half of the time. We do know, though, that high levels of blood tested antibodies are very suggestive of an allergy to that food.

We do not have a CURE for food allergies, but we can use antihistamines and epinephrine to treat acute reactions.
Of course, the mainstay of treatment is prevention through avoidance of that food protein.

BOTTOM LINE: If you think you may have a true food allergy, discuss it with your doctor and consider additional testing before permanently restricting your diet.

What a Chef! Sicola's in Austin

I need to take time today to have a "commercial" for Sicola's: A Culinary Experience in Austin, TX. Last night I was at a Journal Club meeting there, and the before our talk, the waitstaff was circulating with luscious looking appetizers. Since I am still GF (Gluten Free), I will admit to feeling a bit deprived as I politely passed them up. Not wanting to appear rude for turning down multiple choices, I told one of the waitresses that if I were not gluten-free, I'd grab them in a moment.

Within a few minutes, the same lovely waitress returned, letting me know that indeed, the rest of the evening's menu was completely GF. I was pleased she would go to that trouble, and happily sipped my wine. However, that was not all. A little bit later, another waitress came over and told me that the chef was excited to CREATE a GF appetizer just for me! Can you believe that? In the throws of preparing a gourmet meal for fifty people, he stopped and literally experimented simply to allow someone with a special diet to enjoy an appetizer. Amazing!

I wish I could tell you exactly what the appetizer was, but I CAN tell you that it involved goat cheese and a non-wheat crumb coating, and it was DELICIOUS! I have never felt so pampered. Apparently, Stephen Sicola (the amazing chef) is creating specialized dishes to cater for all kinds of special diets, including youth with diabetes. Very cool!

BOTTOM LINE: If you live in Austin and have a private dining party to plan, call Sicola's and book it now!
PS. If you follow a special diet, it never hurts to ASK for something a bit off the menu when you dine out, so give it a try!

The Flu: When to Treat?

Yesterday, I had a discussion with some friends about whether or not to treat the flu with antiviral medications (Tamiflu or Relenza). Conveniently, today the CDC posted expert commentary on the latest guidelines, so I thought I'd share them with you.
Basically it boils down to this:

People at risk of more severe illness should definitely be treated: pregnant women, the very old or very young, people with underlying medical issues that suppress their immune system (cancer, HIV)
People with severe or rapidly progressive flu symptoms should be treated.
Anyone hospitalized should be treated.

For the rest of the public- the otherwise healthy, non-pregnant population- the CDC has wisely left it up to the DOCTOR's discretion, as long as treatment is started within 48 hours of the onset of symptoms.

The antiviral medications have been shown to shorten the course of the flu by one day, and can limit the severity of the flu. However, side effects often include significant nausea or vomiting, as well as headache. It really depends on how sensitive you are to side effects as to whether or not it is "worth it" to treat for the flu.

Don't forget, though, that prevention with the flu vaccine and consistent hand-washing are your best first lines of defense!

BOTTOM LINE: If you develop flu symptoms (fever, chills, cough, sore throat, runny nose, muscle aches and headaches), see your doctor quickly so if you ARE a candidate for antiviral therapy, you can start it with 48 hours of your symptoms.

Cranberry Juice and Your Bladder

Once again, cranberry juice and its role in possible prevention of urinary tract infections is in the news. Several studies published recently tried to address whether or not cranberry juice or cranberry extracts are effective in prevention of recurrent bladder infections. The results? Not too impressive...and the jury is still out.

Urinary tract infections are relatively common, especially in women. Once you have an infection, the relapse rate is nearly 30%, so we are always looking for non-antibiotic methods to reduce that number. Cranberry juice is known to decrease the ability of bacteria to stick on to the surface of the bladder lining. If fewer bacteria stick, they are less likely to multiply to the point of establishing an infection. Scientists have tried to narrow down the active ingredient that yields this result, and most believe it to be the PACs (proanthocyanidins). However, recent trials based on this theory have not demonstrated success in reducing the number of infections.

What CAN you do to reduce bladder infections?
1. Stay well-hydrated by drinking plenty of WATER.
2. Limit caffeine (it is a diuretic).
3. Women, make sure you wipe front to back after urination (to avoid bringing the rectal bacteria forward)
4. Urinate soon after sex (again, don't leave the moisture for the rectal bacteria to float forward)

Signs and symptoms of urinary infections are burning when you urinate, and urgency and/or frequency of urinating. As the infection progresses, you could develop back pain, nausea, vomiting and fever- all serious signs that it's past time to see your doctor!

Should you drink cranberry juice if you think you have an infection? Sure! But not to CURE it, just drink it because you ought to really hydrate with anything that does not have caffeine. It might help you (along with an antibiotic) to cure the infection, and it does no harm unless you don't like the taste.

BOTTOM LINE: Cranberry juice may slightly help to clear urinary tract infections, but there is not solid evidence that it helps prevent recurrences if you take it daily as a preventative treatment.

Doc, Have You Heard of This New Drug?

Often patients ask me about a new drug they heard or read about, and would like a prescription to "try it out". Sometimes, the new drug works wonders, but most of the time, there is no such luck. Obviously pharmaceutical companies are spending more money on direct advertising to the public, and it's working! Our country spends staggering amounts of money on drugs.
Today I'd like to share a pneumonic from the AAFP that helps doctors assess new medications: STEPS.

S: Safety- what are the drug interactions and side effects?
T: Tolerability- how many people stop taking the drug because of side effects?
E: Effectiveness-this may seem obvious, but really: does this drug not only change a LAB VALUE (or blood pressure, etc.) but DOES IT IMPROVE PATIENT QUALITY OF LIFE or HELP PATIENTS LIVE LONGER?
P: Price: Is it worth the cost?
S: Simplicity: How many times per day is it required? With or without food? Can it be taken with other medications?

BOTTOM LINE: Together with your doctor, discuss these issues before you add another medication to your daily routine. </span>

To Pap, or Not to Pap...

When I was in medical school (not THAT long ago), there was no question about when women should get Pap smears. We knew that this valuable test to screen for cervical cancer saved lives, and every woman should be tested at her annual exams. Subsequently, we learned that all cervical cancer comes from HPV- the Human Papilloma Virus, which is transmitted by intimate skin-to-skin contact, primarily through sex. With that knowledge, we modified the Pap requirements to only those women who had become sexually active.
Now we know that the majority of HPV infections occur upon initiation of sexual activity, and that most of these infections are cleared by the immune system within a couple years, and do not result in cancerous changes. We also realize that invasive cervical cancer is very rare in women younger than 21, and so the current guidelines tell us that women should start having Pap smears when they turn 21 (and have had intimate relations.)
Happily, we also have vaccines to help our immune systems fight off the HPV more effectively, so with Gardasil and Cevarix immunizations, we should be seeing even less cervical cancer!
What if you are over 21? Women aged 21-29 without high risk factors (HIV, organ transplant patients, DES exposure or previous abnormal Pap smears that showed early cancerous changes) should get screening Pap tests every other year in their twenties, and every third year beyond their 30's.
Women over 30 will be tested with both the traditional Pap test and a specific test that checks for the strains of HPV that cause cancer. If you test positive for these high risk strains, your screening will be more frequent (annually.)
When can we STOP? By 70, if you have had a decade of normal results, you are done. Yea!
BOTTOM LINE: Pap tests do not need to be an automatic part of your annual pelvic exam- but YOU STILL NEED ANNUAL PELVIC EXAMS to check for sexually transmitted diseases and other gynecologic concerns (ovaries, etc.)

Life or Death Advice! (& Another Medication Recall)

No need to panic. There is nothing terrible or scary going on, but McNeil Consumer Healthcare is recalling certain batches of Tylenol 8 hour, Tylenol Arthritis Pain, and Tylenol respiratory products (Tylenol Sinus, Allergy, etc.) as well as some lots of Benadryl, Sinutab, Sudafed and Rolaids. Go to McNeil's Product Recall Information site to check lot numbers on any of these products that you have in your medicine cabinet. These recalls are an admirable part of the company's internal scrutiny upon discovery that in some instances, cleaning procedures were considered insufficient or poorly documented. There have been no complaints of any adverse medical consequences...and goodness knows in our legal climate, we'd be aware of them if there were!

However, I wanted to use this medication recall as a REMINDER TO CLEAN OUT YOUR MEDICINE CABINET! Along with the bevy of New Year's resolutions, fresh starts should include your basic home pharmacy. It will do you little to no good to reach for your pain reliever or topical antibiotic cream if they are out of date. Just like your pantry (surely a topic for another day), I'd bet you will find old prescription medications along with numerous expired OTC cough and cold products. TOSS THEM OUT!

I think the most critical medication in the cabinet is diphenhydramine (Benadryl). If someone in your house is stung by a bee, or eats the wrong food or has another trigger for a severe allergic reaction, you want that Benadryl to be CURRENT! Now, this literally can be a matter of life and death.

BOTTOM LINE: Take a half hour TODAY and clean out your medication cabinet, checking expiration dates (and lots, if it is one of the meds noted above) and then head to the store and REPLENISH your supply!