oh, this is so, so bad

[Panserbjorne]

but that's just my opinion.  has anyone read the new standards for clinical practice for allergies? 

http://www.medscape.com/viewarticle/734431

[scsigrl]

Why is it bad?  It is trying to get everyone on a level field when answering questions on allergies. I don't see anything it in that causes me any worry.

[changingseasons]

I have it bookmarked... haven't read it yet. Will be back if I ever do!!

[Panserbjorne]

Originally Posted by scsigrl 

Why is it bad?  It is trying to get everyone on a level field when answering questions on allergies. I don't see anything it in that causes me any worry.

What are the implications of not being able to presumptively diagnose?  What does it mean that the only way to actually be "diagnosed" with an allergy is that a clinician has to witness an attack that requires an intervention? 

A big issue for me is that they are actively discouraging parents from removing foods that are causing issues.  That, and that nothing matters until it's hit the status of a disease...wait until your kid is REALLY sick, and even then...if it's not a reaction that elicits a multisystem response, dietary modification is not the way to go.  The new guidelines really lay the groundwork for significant challenges for people who have food sensitivities.  I also fear the misinformation and the reliance on "documentation."

"Allergen avoidance is recommended for individuals with documented IgE-mediated or non-IgE-mediated food allergy. The key is the word "documented." "We don't advise dietary restriction without a real cause. We don't want patients, especially children, put on restrictive diets unnecessarily, as that will negatively affect growth. The same goes for pregnant women - we don't want these women restricting their diets because of fears of sensitizing the fetus," explained Dr. Fenton. When dietary restriction is necessary, it should be accompanied by nutritional counseling, and for children, growth monitoring. Patients and parents must also be educated on how to read and interpret food labeling.^[2]

nutritional counseling by whom?  people educated in government standards and reliant on the food pyramid and subsidies?  Food that has NO value?  Good thing all those cereals have the check mark or whatever it is.  Argh.  There's more to my objection...but that's a start.

[changingseasons]

A big issue for me is that they are actively discouraging parents from removing foods that are causing issues.

I get the thought process behind this, because obviously there are some parents who would take things completely overboard, sometimes to the point where a child might be suffering nutritionally. BUT... I've met very few parents who, at hearing about elimination diet (for themselves or children), don't say, "wow- I could never do that!" and parents who have tried to do it and failed, because it's such a commitment from everyone in the family and so, so hard emotionally... I don't think that going overboard is the norm, in fact it's probably the opposite, imo.

Allergen avoidance is recommended for individuals with documented IgE-mediated or non-IgE-mediated food allergy.

So, ummm.... how are they proposing to "document" a non-IgE mediated allergy? I've yet to meet an allergist that believes in anything other than IgE-mediated allergies, let alone tests for them! blah.

Maybe I'll make some time over the holiday weekend to read the guidelines. I'm curious now.
Edited by changingseasons - 12/29/10 at 8:01pm

[Panserbjorne]

yeah...I hear you, but I don't even feel like that enters into this.  I admittedly feel very suspicious about all of it.  I mean-if eczema and asthma repeated respiratory infections and IBS and UTI's and ADD/ADHD and depression and the like aren't a result of food intolerances/allergies/sensitivities and people shouldn't remove food to reduce the burden, who ultimately benefits?  Where, logically, does that leave us?  How else do we manage the symptoms?

*to be clear I'm not saying that all of those conditions are a result of food allergies because I don't see things in that linear way.  However most people recognize that foods can negatively impact or exacerbate these and other conditions.  Removing gluten/dairy/soy/eggs or what have you have changed many a child's health and behavior.  I just see this as a slippery slope.  I don't expect everyone to agree!

[changingseasons]

How else do we manage the symptoms?

Yes- that for sure is the big question. If they're going to discount managing things through diet, then....???? Meds I suppose.

[scsigrl]

Originally Posted by Panserbjorne 

"Allergen avoidance is recommended for individuals with documented IgE-mediated or non-IgE-mediated food allergy. The key is the word "documented." "We don't advise dietary restriction without a real cause. We don't want patients, especially children, put on restrictive diets unnecessarily, as that will negatively affect growth. The same goes for pregnant women - we don't want these women restricting their diets because of fears of sensitizing the fetus," explained Dr. Fenton. When dietary restriction is necessary, it should be accompanied by nutritional counseling, and for children, growth monitoring. Patients and parents must also be educated on how to read and interpret food labeling.^[2]

nutritional counseling by whom?  people educated in government standards and reliant on the food pyramid and subsidies?  Food that has NO value?  Good thing all those cereals have the check mark or whatever it is.  Argh.  There's more to my objection...but that's a start.

Right there is says it is documentation of IgE AND non-IgE.  It says the dx needs to be made not just with testing but also history.  It does not say it has to be seen by the Dr.  

It also said there are no meds for it, that avoidance is the only treatment.  We already knew that so I am not sure why you are saying meds.

Parents of allergy kids DO go overboard.  I see it here, KFA and other allergy sites.  "My kids pooped sideways!"  Must be allergies.  "My kid won't eat XYZ!" Oh, that HAS to be an allergy!  Take the food out.  There are some kids who are on 5-7 foods but they are few and far between!  I think people here take things overboard.  I say that knowing I do it too!  I have a kid with Celiacs, Top 8 and FPIES. I am ALWAYS "looking" for allergy things going on but in reality, they aren't there.

[changingseasons]

hmmm... well, by those standards I am definitely one of those moms going "overboard". I look for allergy symptoms everywhere, and I do see them. DD stops eating a food? Yes- it is an allergy (for her. This certainly doesn't apply to every kid.) She has a bad day and cries if anyone looks at her sideways? Yes- allergy. And I'm not just basing this on guesses. We've done eliminations and trial after trial after trial before declaring a food fail. And when we pull a food, those weird, subtle, not-normally-food-allergy-related symptoms mysteriously vanish, never to return.

And DD is one of those kids on about 5 foods. But she also has a number of eosinophilic disorders, and some of her symptoms are very subtle. If I didn't take out every food that I suspected of causing a minor symptom, I'm convinced that she would have a LOT more damage in her body than she already does. We're lucky that she has any foods left, and isn't on elemental formula and meds to control further esophagus damage. So you can't just assume that parents who are chasing subtle symptoms are going "overboard". Maybe some are, yes. But definitely not all.

And I'm the one who mentioned meds. Just being cynical. Like I said, I've bookmarked the guidelines but haven't read them yet.

[Panserbjorne]

Originally Posted by scsigrl 

Originally Posted by Panserbjorne 

"Allergen avoidance is recommended for individuals with documented IgE-mediated or non-IgE-mediated food allergy. The key is the word "documented." "We don't advise dietary restriction without a real cause. We don't want patients, especially children, put on restrictive diets unnecessarily, as that will negatively affect growth. The same goes for pregnant women - we don't want these women restricting their diets because of fears of sensitizing the fetus," explained Dr. Fenton. When dietary restriction is necessary, it should be accompanied by nutritional counseling, and for children, growth monitoring. Patients and parents must also be educated on how to read and interpret food labeling.^[2]

nutritional counseling by whom?  people educated in government standards and reliant on the food pyramid and subsidies?  Food that has NO value?  Good thing all those cereals have the check mark or whatever it is.  Argh.  There's more to my objection...but that's a start.

Right there is says it is documentation of IgE AND non-IgE.  It says the dx needs to be made not just with testing but also history.  It does not say it has to be seen by the Dr.  

It also said there are no meds for it, that avoidance is the only treatment.  We already knew that so I am not sure why you are saying meds.

Parents of allergy kids DO go overboard.  I see it here, KFA and other allergy sites.  "My kids pooped sideways!"  Must be allergies.  "My kid won't eat XYZ!" Oh, that HAS to be an allergy!  Take the food out.  There are some kids who are on 5-7 foods but they are few and far between!  I think people here take things overboard.  I say that knowing I do it too!  I have a kid with Celiacs, Top 8 and FPIES. I am ALWAYS "looking" for allergy things going on but in reality, they aren't there.

testing in COMBINATION with history.  "A detailed medical history and physical examination are the starting points in a patient with possible food allergy, although the findings of neither can be considered diagnostic of food allergy...The guidelines emphasize that diagnosing food allergy on the basis of history or physical examination alone can lead to erroneous diagnosis of food allergy and result in unnecessary dietary restriction that could have adverse nutritional consequences."

WRT the point you mentioned: "Therefore, the guidelines state that single-blind and open-food challenges may be used in the clinical setting.^[2] A negative oral food challenge rules out food allergy, whereas a positive oral challenge supported by medical history and laboratory tests is diagnostic of food allergy." 

WRT meds, I think you missed the point.  No one is saying there are meds for allergies.  There are, however, plenty of meds for the symptoms of allergies.  My point is that so many of these reactions that are present with IgG mediated reactions, and at times IgE that aren't classified as allergies based on the clinical guidelines lead to chronic issues that can, for many, be managed through dietary modification.  If you aren't allergic by their standards and therefore don't modify the diet, how will you manage the symptoms?

[kjbrown92]

I haven't read the article yet either, but based on my DS, who has been intolerant to milk since birth (with the first pediatrician who saw him at 2 weeks telling me that it was perfectly normal to projectile vomit bile during and after every feeding was perfectly normal and just because I took milk out of my diet and it went away, I shouldn't restrict my diet because I NEEDED milk), I highly suspect most things written about allergy since there is so much they don't know, most allergists don't believe in non-IgE "allergies" and they say the tests aren't even all that accurate. I had the allergist test DS for egg allergy a few months ago because I was worried that it had gone from an intolerance to IgE because it has progressively gotten worse (trialing every 6 months) and she was very worried that he was restricted on any food, and she asked him what he wanted back the most. He said dairy (well duh) and she said, then you should bring him back and we'll do an in-office challenge. Well that would be fine except that his reaction is the night of the day that he's tried the food, for 3 consecutive nights. So is he going to live at the allergist's office for 3 days? I don't think  so. What was funny was that as we left, DS said to me, "She's crazy. I'm not trying milk." Now I have to go read it.

So that was an article about the Guidelines, not the Guidelines themselves... do you have a link to those?

It doesn't seem so bad from the article's standpoint. Of course it doesn't say anything about the failure rate of the RAST or skin testing which is apparently pretty bad. And there was one paragraph about food intolerances and how they're a real disease but basically not mentioned at all in the rest of the guidelines. And I don't like that food journals were poo-pooed when it's showing an oral challenge and the reproducability of results, and that's just what they want. So to say that they're uninformative is ludicrous to me. When the pediatric GI saw mine she was like "You did an excellent job of showing results".

Edited by kjbrown92 - 12/30/10 at 10:09am

[DevaMajka]

If this is the thing I read the other day, and I'm sure it is, I thought the exact same thing. They seem to really emphasize that you shouldn't take any foods out unless you have tested positive on and IgE test, or at least that's how I read it. Interested if anyone else has an opinion...

[chlobo]

My son's pediatrician refused to order an IgG blood test because he feels they are not 100% accurate (duh!) and he doesn't believe in removing suspected foods and limiting your child's diet.  You know, wheat is essential to growth.

[Panserbjorne]

Originally Posted by chlobo 

You know, wheat is essential to growth.

well, I'm glad you understand that.

[changingseasons]

You guys are cracking me up.  

[kjbrown92]

Originally Posted by chlobo 

My son's pediatrician refused to order an IgG blood test because he feels they are not 100% accurate (duh!) and he doesn't believe in removing suspected foods and limiting your child's diet.  You know, wheat is essential to growth.

The IgE blood tests aren't that accurate either, especially under 2. Yeah, people should just keep eating food when it makes them feel horrible. How silly of me. I thought you'd want to avoid the poison ivy if you got a rash every time you rolled in it. (I'm just trying to keep Jessica laughing while laughing at the ridiculousness of these people; I like it when doctors actually admit they (the medical establishment) knows almost nothing about food intolerances).