Children with severe Milk Allergy can Safely Drink Milk

Some children with a history of severe milk allergy can safely drink milk and consume other dairy products every day, according to research led by the Johns Hopkins Children’s Center and published in Journal of Allergy and Clinical Immunology.

Investigators followed up with a subset of children who were part of an earlier Hopkins Children’s-led study published in 2008 in which patients allergic to milk were given increasingly higher doses of milk over time. For many of them, continuous exposure to milk allergens – the proteins that trigger bad reactions – slowly and gradually retrained their immune systems to better tolerate the very food that once sent those systems into overdrive.

The follow-up of 18 children ages 6 to 16 whose severe milk allergies had eased or disappeared found that all children were able to safely consume milk at home, and that reactions, while common, were generally mild and grew milder and milder over time. The follow-up varied from three to 17 months, depending on how long it took patients to increase their milk intake.

These findings also suggest that regular use of milk and dairy foods may be needed for children to maintain their tolerance.

“We now have evidence from other studies that some children once successfully treated remain allergy-free even without daily exposure, while in others the allergies return once they stop regular daily exposure to milk,” says Robert Wood, M.D., the study’s senior investigator and director of Allergy & Immunology at Hopkins Children’s. “This may mean that some patients are truly cured of their allergy, while in others the immune system adapts to regular daily exposure to milk and may, in fact, need the exposure to continue to tolerate it,” he adds.

After up to 17 months of at-home consumption, 13 of the 18 children who could tolerate increasingly higher doses were asked to return to the clinic for milk-drinking tests. Of the 13, six showed no reaction after drinking 16,000 mg (16 ounces) of milk, twice the highest tolerated dose during the initial study. Seven children had reactions at doses ranging from 3,000 mg to 16,000 mg. The reactions ranged from oral itch to hives, to sneezing to mild abdominal pain, but none was serious. One child developed cough requiring medications.

Investigators also continued to follow three children who could not tolerate doses higher than 2,540 mg (2.5 ounces) – the cutoff set by the investigators at the beginning of the follow-up – which made them ineligible to continue the at-home part of the study. All three continued to drink milk daily with minimal reactions, and two of the children were eventually able to increase their consumption beyond 2,540 mg.

Sensitivity to milk was also measured with traditional skin prick testing, which showed gradual decreases in reactions over time. Seven children had no reactions at eight to 15 months of follow-up. Blood levels of milk IgE antibodies slowly decreased over time too, another sign of better tolerance to milk. At the same time, a different type of antibody, IgG4 – one that signals immunity to a particular allergen – went up over time, a maker of improved tolerance.

Children and their parents also kept daily logs of milk and dairy consumption and recorded symptoms, such as hives, abdominal pain, sneezing and cough. During the first three months, consumption of milk triggered reactions 49 percent of the time, with some children experiencing as few as two reactions for every 100 doses of milk consumed. The figure dropped to 23 percent in the subsequent three months, and some children had no reactions at all.

Milk allergy is the most common type of food allergy. Three million U.S. children have food allergies, according to the Centers for Disease Control and Prevention.

Co-investigators in the study include Satya Narisety, Robert Hamilton and Elizabeth Matsui, of Hopkins; Justin Skripak of the Mt. Sinai School of Medicine; and Pamela Steele and A. Wesley Burks of Duke University.

The research was funded by the National Institutes of Health.

Dr. Wood receives funding support from Genentech, manufacturer of Xolair, for the treatment of allergic asthma. He serves on the advisory board of the Food Allergy and Anaphylaxis Network.

Another Reason to Eat Well: a Healthy Diet

Researchers have found another reason to eat well: a healthy diet helps prevent kidney stones. Loading up on fruits, vegetables, nuts, low-fat dairy products, and whole grains, while limiting salt, red and processed meats, and sweetened beverages is an effective way to ward off kidney stones, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). Because kidney stones are linked to higher rates of hypertension, diabetes, increased body weight, and other risk factors for heart disease, the findings have considerable health implications.

Eric Taylor, MD (Maine Medical Center) and his colleagues at Brigham and Women’s Hospital conducted a large study to determine the effects of healthy eating habits on the formation of kidney stones. The investigators collected information from individuals enrolled in three clinical studies: the Health Professionals Follow-up Study (45,821 men followed for 18 years), the Nurses’ Health Study I (94,108 older women followed for 18 years), and the Nurses’ Health Study II (101,837 younger women followed for 14 years).

Dr. Taylor’s team assigned a score to each participant based on eight components of a DASH (Dietary Approaches to Stop Hypertension) style diet: high intake of fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains and low intake of salt, sweetened beverages, and red and processed meats. Individuals with higher DASH scores consumed diets that were higher in calcium, potassium, magnesium, oxalate, and vitamin C and lower in sodium.

A total of 5,645 incident kidney stones developed in the participants in the three studies. In each study, participants with the highest DASH scores were between 40% and 45% less likely to develop kidney stones than participants with the lowest DASH scores. The reductions in kidney stone risk were independent of age, body size, fluid intake, and other factors.

Because a DASH-style diet may affect the development of hypertension, diabetes, and other chronic diseases associated with kidney stones, the researchers also performed an analysis limited to study participants without hypertension or diabetes. Even among those individuals the DASH diet reduced the risk of kidney stones.

Many of the medications used to treat kidney stones have unpleasant side effects. This study indicates that adopting a DASH-style diet may be an effective alternative.

The authors report no financial disclosures. Study co-authors include Teresa Fung (Simmons College) and Gary Curhan, MD (Brigham and Women’s Hospital).

The article, entitled “DASH-Style Diet Associates with Reduced Risk for Kidney Stones,” will appear online at http://jasn.asnjournals.org/ on August 13, 2009, doi 10.1681/ASN.2009030276.

The American Society of Nephrology (ASN) does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, the American Society of Nephrology (ASN) is the world’s largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.

PA Department of Health Confirms the First Human Case of West Nile Virus in Pennsylvania for 2009

HARRISBURG, Pa., Aug. 12- State Health Secretary Everette James today reported this year's first confirmed human case of West Nile virus in Pennsylvania. The individual is a 21-year-old woman from Luzerne County.


"The number of cases of West Nile disease has declined significantly in the past five years but this season's first case is a reminder that the disease is still out there," Secretary James said. "You can take precautions to protect yourself from this deadly disease."


James recommended these simple precautions to prevent mosquito bites, particularly for those most at risk which include the elderly and those with compromised immune systems:

Make sure screens fit tightly over doors and windows to keep mosquitoes out of your home;
When possible, reduce outdoor exposure at dawn and dusk, the times of day when the mosquitoes that transmit West Nile virus are most active, during the warmer months of the year (usually April through October);
Consider wearing long-sleeved shirts, long pants and socks when outdoors, particularly at dawn and dusk, or in areas known for having large numbers of mosquitoes;
Use insect repellents according to the manufacturer's instructions. Effective repellents contain DEET. Consult a doctor if you have concerns about the use of repellent on young children, as repellent is not recommended for children under the age of two months. Two other insect repellants, Picaridin (KBR 3023) and oil of lemon eucalyptus, a plant based repellent, were tested against mosquitoes and provided protection similar to repellents with low concentrations of DEET.


Pennsylvanians can also reduce the risk of West Nile virus by eliminating the places where mosquitoes breed.

Here are some simple steps that can be taken around the house:

Dispose of tin cans, plastic containers, ceramic pots, discarded tires, or any object on your property that could collect standing water.
Drill holes in the bottom of recycling containers left outdoors.
Have roof gutters cleaned every year, particularly if the leaves from nearby trees have a tendency to clog the drains.
Turn over plastic wading pools and wheelbarrows when not in use.
Don't let water stagnate in birdbaths.
Aerate ornamental pools or stock them with fish.
Clean and chlorinate swimming pools and remove standing water from pool covers.
Use landscaping to eliminate standing water that collects on your property.
Standing water that cannot be eliminated should be treated with Bti products, which are sold at outdoor supply, home improvement, and other stores. Bti is a naturally occurring bacterium that kills mosquito larvae but is safe for people, pets, aquatic life and plants.


West Nile virus is spread to people and animals by infected mosquitoes. Usually, the infection does not result in any illness. Older adults and persons with compromised immune systems are at greatest risk of becoming ill after a West Nile infection.


The disease can take two forms; the milder of which is known as West Nile fever. In addition to fever, people with this form of the disease may also experience headache, body aches, skin rash, and swollen lymph glands. The more severe form of West Nile infection is known as encephalitis (an inflammation of the brain). People with encephalitis may experience high fever, headache, neck stiffness, disorientation, tremors, convulsions, paralysis, and coma. Anyone with any of these symptoms should immediately contact their health care provider.


There is no specific treatment for West Nile virus. For severe cases, hospitalization is needed and illness can be associated with long-term disabilities and death.


Since West Nile was first identified in Pennsylvania in 2000, the virus has been found in all areas of the state and has returned each summer.


In 2008, there were 14 human West Nile Virus cases that resulted in one death. In 2007, there were 10 human cases and no deaths. In 2006, there were nine human cases and two deaths. In 2005, there were 25 human cases and two deaths. In 2004, there were 15 human cases and two deaths.

Workplace Yoga and Meditation Can Lower Feelings of Stress

Twenty minutes per day of guided workplace meditation and yoga combined with six weekly group sessions can lower feelings of stress by more than 10 percent and improve sleep quality in sedentary office employees, a pilot study suggests.
The study offered participants a modified version of what is known as mindfulness-based stress reduction (MBSR), a program established in 1979 to help hospital patients in Massachusetts assist in their own healing that is now in wide use around the world.
In this context, mindfulness refers in part to one’s heightened awareness of an external stressor as the first step toward relaxing in a way that can minimize the effects of that stress on the body.
While the traditional MBSR program practice takes up an hour per day for eight weeks supplemented by lengthy weekly sessions and a full-day retreat, the modified version developed at Ohio State University for this study was designed for office-based workers wearing professional attire.
The results of the pilot study are published in a recent issue of the journal Health Education & Behavior.
Participants attended one-hour weekly group meetings during lunch and practiced 20 minutes of meditation and yoga per day at their desks. After six weeks, program participants reported that they were more aware of external stressors, they felt less stressed by life events, and they fell asleep more easily than did a control group that did not experience the intervention.
“Because chronic stress is associated with chronic disease, I am focusing on how to reduce stress before it has a chance to contribute to disease,” said Maryanna Klatt, lead author of the study and an assistant professor of clinical allied medicine at Ohio State.
“My interest is to see whether or not we can get people to reduce their health care utilization because they’re less stressed. I want to deliver something low cost at the work site, something practical that can be sustained, that can help reduce health care costs,” Klatt said.
Klatt and colleagues are building on these preliminary findings and continuing to study the broader impact of the intervention in various populations, such as cancer survivors, intensive-care nurses and inner-city schoolchildren. In addition to gathering self-reported data from research participants, the scientists plan to collect biological samples to determine whether the intervention can lead to lower levels of stress hormones.
For the pilot study, the researchers recruited 48 adult office workers with body mass index scores lower than 30 who exercised less than 30 minutes on most days of the week. Half were randomized to the intervention and half were wait-listed to receive the intervention later. Forty-two people completed the study.
Those who received the intervention participated in weekly one-hour group sessions during which breathing, relaxation and gentle yoga movement were designed to coax participants toward a meditative state. Participants also discussed work-related stress. As part of the pursuit of mindfulness, they were coached to contemplate a specific topic in each session that explored their response to a specific type of stress over the past week.
“It doesn’t matter what the stress is, but how you change the way you perceive the stress,” Klatt noted. “I like to describe mindfulness as changing the way you see what’s already there. It’s a tool that teaches people to become aware of their options. If they can’t change the external events in their life, they can instead change the way they view the stress, which can make a difference in how they experience their day-to-day life.”
The weekly sessions were supplemented by 20 minutes each day of movement and meditation guided by verbal cues and music provided on compact discs that Klatt designed and recorded. The entire intervention lasted six weeks.
The study analyzed participants’ responses to the intervention using data from established research questionnaires that measured perceived stress, or the degree to which situations in life are considered stressful; a number of components of sleep quality; and what is called mindful attention awareness, which refers to how often a person is paying attention to and is aware of what is occurring in the present.
All participants completed the questionnaires before and after the intervention. Twenty-two adults completed the intervention. Their pre- and post-test results were compared to those reported by the 20 control participants.
Mindful attention awareness increased significantly and perceived stress decreased significantly among the intervention group when compared to the control group’s responses. Overall sleep quality increased in both groups, but three of seven components of sleep were more affected in the intervention group.
On average, mindfulness increased by about 9.7 percent and perceived stress decreased by about 11 percent among the group that experienced the intervention. These participants also reported that it took them less time to fall asleep, they had fewer sleep disturbances and they experienced less daytime dysfunction than did members of the non-intervention group.
The researchers also took saliva samples to test for the presence of cortisol, a stress hormone, but found no significant changes in average daily levels of the hormone over time for participants in both groups. Klatt said the design of this part of the pilot study could have affected the result, and the sample collection technique will be changed in subsequent studies.
Klatt said mindfulness-based stress reduction, developed by Jon Kabat-Zinn at the University of Massachusetts Medical Center, has been studied widely and determined to be useful in lowering symptoms ranging from depression and anxiety to chronic pain. But the time commitment required in the program makes it impractical for busy working professionals, and adding a stress-reduction class outside of work could add stress to these people, she said.
So Klatt set out to develop what she calls a “low dose” of the program that is suitable for the workplace and still offers stress-reduction benefits. She specifically scheduled weekly sessions during lunch to avoid interfering with work time or home time, and combined movement with verbal prompts and music that are cues for participants to relax.
“As I’ve been working on the program, I heard so many of the participants say they wish they had learned this earlier,” Klatt said.
Because the low-dose program remains a work-in-progress that is still under investigation, it is not available for public use, Klatt noted.
This work was supported by the National Institute of Health-funded General Clinical Research Center at Ohio State.
Co-authors of the study are Janet Buckworth of the College of Education and Human Ecology and William Malarkey of the College of Medicine, both at Ohio State.