TO THE EDITOR: The article, (1) "En...

TO THE EDITOR: The article, (1) "Environmental command of Allergic Diseases," in American Family Physician not absents an excellent organized schema for environmental check of common inhalants that contribute to asthma and allergic disease. However, the authors do not mention ingestants that also can trigger reactivity of the respiratory tract. For example, provisionss induce respiratory symptoms by the two reaginic and nonreaginic mechanisms; moreover, sustenance allergies commonly coexist with inhalant allergies. common study (2) showed that 43 percent of asthmatic patients who were placed onward a diet that eliminated public allergens substantially improved compared with and nothing else 6 percent of subjects in the govern group.

A fitting diagnosis of specific food allergies ofttimes requires screening tests for evidence of food-specific IgE allergy and demonstration of reactivity through elimination diets and oral victuals challenges. (3) Double-blind, placebo-controlled fodder elimination and rechallenge is considered the "gold standard" for diagnosis of sustenance allergies (4) in contrast to skin prick trials and radioallergosorbent tests, which are sensitive indicators of food-specific IgE antibodies if it be not that poor predictors of clinical reactivity. (5) In many situations, the diagnosis of subsistence allergy may rest simply in succession a history of an acute storm of typical symptoms, such as wheezing following the isolated ingestion of a suspected provender (6)

Robert Anderson, MD

614 Daniels Dr NE

East Wenatchee, WA 98802-4036

REFERENCES

(1) German JA, Harper MB Environmental rule of allergic diseases. Am Fam Physician 2002;66:421-6

(2) Hoj L Osterballe O Bundgaard A, Weeke B Weiss M A double-blind controll trial of elemental diet in harsh perennial asthma. Allergy 1981;36:257-62.

(3) Sampson HA. fodder allergy. Part 2: diagnosis and management. J Allergy Clin Immunol 1999;103: 981-9

(4) Eigenmann PA, Sampson HA. Interpreting skin prick standards in the evaluation of bread allergy in children. Pediatr Allergy Immunol 1998;9:186-91

(5) Sampson HA, Ho DG Relationship between food-specific IgE concentrations and the risk of positive aliment challenges in children and adolescents. J Allergy Clin Immunol 1997;100:444-51

(6) Sicherer SH meat allergy: when and how to perform oral nutrition challenges. Pediatr Allergy Immunol 1999;10:226-34

IN REPLY: Dr Anderson correctly points on the outside that we did not mention in our article (1) that ingestants can trigger reactivity of the respiratory tract. However, the massyness of the literature on this make liable indicates that the frequency of significant asthma exacerbation caused by dint of food allergy is low, (23) and the vast majority of reactions are caused at a small number of nutritions such as peanuts, fish, shellfish, harasss and cow's milk. (4) parts tend to outgrow allergies to milk and urges but not to nuts and fish; peanuts are the mostly common food allergen in children more than three years of age. (4) National and international asthma guidelines recognize that victuals allergy is an uncommon cause of asthma exacerbation. (35) Atopic dermatitis is greatly more likely than asthma to be caused by the agency of food allergy. One study (6) showed that united third of children with refractory atopic dermatitis had clinical reactivity to feed proteins.

JEFFREY A. GERMAN, MD

MICHAEL B HARPER, MD

Louisiana State University Health Sciences Center

1501 Kings Highway

Shreveport, LA 71130

REFERENCES

(1) German JA, Harper MB Environmental sway of allergic diseases. Am Fam Physician 2002;66:421-6

(2) James JM Bernhisel-Broadbent J Sampson HA. Respiratory reactions provok according to double-blind food challenges in children. Am J Respir Crit Care M 1994;149:59-64

(3) National Asthma Education and Prevention Program (National Heart, Lung and line Institute). Guidelines for the diagnosis and management of asthma: adroit panel report 2. Bethesda, Md: U Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung and kindred Institute, 1997;NIH Publication no. 97-4051

(4) Rance F Kanny G Dutau G Moneret-Vautrin DA. fodder hypersensitivity in children: clinical aspects and distribution of allergens. Pediatr Allergy Immunol 1999;10:33-8

(5) Global Initiative for Asthma. National Heart, Lung and offspring Institute. Global strategy for asthma management and prevention. Bethesda, Md: U Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung and kin Institute, 1997; NIH Publication no. 02-3659

(6) Eigenmann PA, Sicherer SH Borkowski TA, Cohen BA, Sampson HA. Prevalence of IgE-mediated victuals allergy among children with atopic dermatitis. Pediatrics 1998;101:E8

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