Dr. Jennifer S. Kim (NorthShore)
Sorry for the delay! I'm substituting for Rachel Story and due to the short notice I had to adjust my schedule. So... screening for food allergies -- I would not recommend screening unless there are specific symptoms. If families with a strong family history are very nervous, then you can consider consulting an allergist. The available tests are not great for screening and may overcall the potential for food allergy.

Dr. Jennifer S. Kim (NorthShore)
Nasal congestion can be a symptom of allergies, but there are other potential causes, such as enlarged adenoids. If you are suspicious of allergies, you can try an oral antihistamine over the counter (OTC) -- like Claritin (loratadine generic) or Zyrtec (cetirizine generic) -- to see if this alleviates symptoms. You can also try an intranasal steroid such as OTC Rhinocort -- 1 spray to each nostril once daily. Ultimately, you can consult an allergist to do some testing to see if allergies are playing a role. If there is significant snoring or a history of frequent ear infections, seeing an ENT may also be considered.

Dr. Jennifer S. Kim (NorthShore)
It depends on how well his asthma is currently controlled. If he is not having any symptoms despite not taking Singulair daily, then you may want to discuss with your physician as to whether daily use is necessary. The best results do come from daily use -- but if he's not that symptomatic, it may not matter. If he is using Albuterol more than 2 times a week for symptoms such as coughing, wheezing, shortness of breath, OR waking up from asthma more than once a month, OR requiring oral steroids or hospitalization for asthma in the past year, then regular use should be considered. Note, Singulair can also help with allergic rhinitis (nasal allergies), as well as exercise-induced asthma.

Dr. Jennifer S. Kim (NorthShore)
First of all, having a positive test means he is SENSITIZED, but does not necessarily predict severity of symptoms. If he has mild nasal or eye symptoms, then I would consider a daily oral antihistamine -- Claritin is a fine option. I wouldn't treat if he is asymptomatic. It's possible that continuous exposure can result in 'desensitization', but on the other hand, it can also result in more chronic inflammation -- resulting in chronic nasal congestion, frequent ear infections, snoring that interrupts sleep quality, etc. People respond differently.

Dr. Jennifer S. Kim (NorthShore)
How significant was the swelling? Would a stranger be able to tell that her lips were swollen? If the swelling was significant (i.e. disfiguring), then one of the culprits may be annatto -- a natural coloring/flavoring. It's from the annatto seed. I would have to look at the ingredients list directly to see if this was included. Skin and/or blood testing for annatto can be performed by an allergist.

Dr. Jennifer S. Kim (NorthShore)
Allergy shots are usually quite successful. We never promise a cure, but for the vast majority of patients, there is significant improvement. In my opinion, shots have a greater long-term impact when you start them in childhood. During the build-up, you may not notice significant improvement. Once he is on maintenance (goal dose) given on a monthly basis, I would expect to note improvement in symptoms and/or a decrease in the need for medication. I would give the shots at least 1 year on maintenance before you decide shots are not working. It is definitely a commitment to start shots, but for the most part, it's a worthwhile time investment.

Dr. Jennifer S. Kim (NorthShore)
I would NOT stop Flovent without having a discussion with the prescribing physician. I often find continue inhaled steroids in children with a history of asthma hospitalizations -- typically through the 1-year anniversary of the hospitalization. Other factors that I consider include how often Albuterol is used or needed, how easily asthma symptoms are triggered, the time of year it is and whether there are corresponding environmental allergies. I generally am very reluctant to step-down asthma medications this time of year -- heading into September and October -- which tend to be problematic months for asthmatics. Plus, the kids are heading back to school where viruses can spread quickly.

Dr. Jennifer S. Kim (NorthShore)
Overwhelmingly, food anaphylaxis is due to INGESTION. Casual contact (being near, smelling - especially peanut butter) generally will not induce severe reactions. Touching peanut butter and then touching the eyes, lips or skin may result in a localized reaction. If the hand that touched peanuts or peanut butter is then inserted into the mouth, that could induce a more significant reaction. The smell of peanut butter is NOT allergenic (but may induce a conditioned response). The exception is exposure to a highly concentrated amount of peanut dust -- if you are grinding and pulverizing peanuts in close proximity to the allergic person -- this may result in respiratory symptoms. After removal of the person from the environment, I would expect symptoms to resolve rather quickly.

Dr. Jennifer S. Kim (NorthShore)
This probably depends on how old your children are. Older (middle/high school) children can carry an OTC antihistamine to use for symptoms as needed. For younger children, it may be better to treat this in the morning before sending them off to school -- this way you have a better shot at preventing their symptoms from developing.

Dr. Jennifer S. Kim (NorthShore)
Lactose intolerance (which is not an allergy) is when someone doesn't have enough of the digestive enzyme that breaks down the sugars that are in milk and milk products. Symptoms include bloating, diarrhea, gas, etc. If there are no symptoms, then there are no tests to predict whether they will develop it. Generally however; lactose intolerance does become more prevalent with age (i.e. in adults) and in certain ethnic groups such as Asians, African Americans, and Native Americans. If they don't have any symptoms, I would not be overly concerned.

Dr. Jennifer S. Kim (NorthShore)
Good question. There is some variability in how allergists manage this particular situation. In the US, allergists tend to prescribe self-injectable epinephrine to the vast majority of kids having IgE-mediated food allergies. However; the risk is greater in certain people vs. others. Risk factors include: Having a peanut or tree nut allergy, having had a severe reaction in the past, having asthma and being a teen or young adult. Every patient is different and decision making for any individual requires a conversation with your physician.

Dr. Jennifer S. Kim (NorthShore)
By bad allergies, I'm assuming you mean hay fever symptoms -- sneezing, congestion, runny nose and itchy watery eyes. In general, I would not advise keeping children home from school for these symptoms. However; if symptoms are severe or persistent or interfering in their school or social life, then certainly consult an allergist to get symptoms under better control. Sometimes it's hard to differentiate between a cold and allergy symptoms, but I think most people don't find it necessary to keep their kids home from school for most colds either. Now if the child has asthma and his allergies are triggering respiratory symptoms - which become moderate to severe - then that is a different story.

Dr. Jennifer S. Kim (NorthShore)
I prescribe inhalers only if there are symptoms to suggest an inhaler would be helpful. If there is no history of a cough, wheezing, shortness of breath, etc, then I would not prescribe an inhaler just because the patient has a food allergy.