Roll out the Red Carpet....the winner is!

Each year the American Contact Dermatitis Society chooses an allergen of the year.  There's not as much pomp and circumstance as the Oscars but it's a big win.  This  award draws attention to allergens that are very common and/or under recognized.  Chemicals are chosen based on their prevalence in products and relevance of causing allergic reaction. 

The 2013 winner is..... 

Methylisothiazolinone

What is methylisothiazolone (MI)?

• MI was first introduced  in cosmetics, toiletry and suncreen products in 2005.
• It's used as a preservative to kill bacteria and fungus.
• In the 1980's, it was used in combination in high doses (15 ppm) with a preservative called methylcholoroisothiazolinine/methylisothiazolone in (MC/MI) "leave in" products like shampoo and conditioner
• After the MC/MI introduction about 8% of people had reactions to the recommended doses, and concentrations were reduced to 7.5 PPM in the late 80's and early 90's
• In 2000, MI was pulled out of the MC/MI combination with the hopes that it wouldn't be as strong of a cause of allergic reaction.  They thought it was a weaker sensitizer
• Even though they pulled it out, they didn't limit concentrations!  And concentrations increased by 25 X
• In 2004-5, the first case reports of MI allergy were described after wallpapering and using paint.
• Only 7 years ago, we started seeing reports of people developing allergic reactions in wet toilet paper
• Since 2007, the use of MI as a preservative has doubled along with reactions
• We currently don't know how common MI allergy is.

Where do you find  methylisothiazolone (MI)? - Almost any product that you'd put on your body.

• Cosmetics
• Baby products (lotions, oils, creams, and powder)
• Makeup
• Body Washes
• Hair care products (shampoo, conditioner, straighteners, rinses
• Hair coloring products 
• Nail care products
• Deodorants
• shaving products
• Skin care products
• Sunscreen
• Wet Wipes (babies, and moist towelettes)

When should you suspect you have a methylisothiazolone (MI) allergy?

• MI allergy is common but difficult to distinguish from other preservatives that are use in many personal care products.
• Consult an allergist/immunologist (Find an Allergist) or dermatologist if you have an itchy rash that won't go away.
• They'll perform patch testing and then you'll know!

Want more information?

• http://www.contactderm.org/i4a/pages/index.cfm?pageid=1
• http://www.allergeaze.com/PDFs/AP/AP123-124.pdf
• http://en.wikipedia.org/wiki/Methylisothiazolinone
• Info on Contact dermatitis

Foods to help support a healthy Immune System

Filling your diet with lots of fresh fruits, vegetables, whole grains, seeds and lean proteins will ensure that you are getting essential vitamins and nutrients that help your immune system work effectively. Our diet provides essential nutrients our immune cells need to fight off bacteria and viruses. Eat a colorful diet rich in fresh fruit, fiber, and plant based products. Teach your children to eat a rainbow of foods each day.  Vitamins, anti-oxidants and bacteria are natural ways to maintain this balance.  Vitamins are organic compounds our bodies need in limited amounts.  We get some vitamins only through our diet and bacteria manufacture others in our systems.  Critical vitamins involved in the immune reaction are Vitamin A, Vitamin C, Vitamin D,  Vitamin E and Zinc. 

VITAMIN C
Shoot for a goal of at least 500 mg of Vitamin every day to help prevent infections with cold and flu viruses.  Rose hip (the fruit of the rose plant) tea, orange juice and fresh fruits like mango are excellent sources of Vitamin C.

VITAMIN A

Orange colored vegetables like pumpkin, acorn and butternut squash, and carrots are rich sources of Vitamin A another key player in the immune system.  Milk and eggs are other great sources.

VITAMIN D

Don’t forget to get some sun to maintain healthy levels of Vitamin D.  Not able to make it out?  Dairy products are fortified with vitamin D.  Green leafy vegetables like spinach and kale also pack a punch of vitamin D and calcium.

ZINC

Order up a salad filled with spinach, pumpkin and squash seeds, chickpeas, and mushrooms to get your daily zinc, another key player in the immune system.  Oysters are fantastic sources of Zinc and just 5 oysters provides your daily dose.  

VITAMIN E

Vitamin E is a natural anti-oxidant, compounds that protect cells from the damaging effects of free radicals, found in nuts, seeds and vegetables oils.  Toss one ounce of sunflowers onto your spinach salad and your halfway towards your goal of 15 mg a day of Vitamin E.   

Hey Doc, my feet itch! Can I be allergic to my shoes? P-tert-butylphenol formaldehyde resin allergy

Everyone knows there's nothing worse than being itchy and itchy feet are no different. 

Recently I saw a young child who was scratching so much, their feet were left raw and irritated.  Her family had recently gone south to escape the winter blues, and her mom was convinced she was infected with something.  She'd gone diving during the trip for the first time and wore a wet suit all day long.  The rest of her body itched to, but her feet were the worst.  The poor child was having difficulty walking because her feet were so raw. At times she was using a sharp object to scratch her skin. She was irritated because she couldn't sleep and was getting trouble in school because she wanted to scratch her feet.    

And so they asked, can be allergic to your shoes????     YES.

What could be going on?

• There are many adhesives in shoes that are can cause an allergic reaction
• The most common adhesive used in shoes is p-tert-butylphenol formaldehyde resin (PTBPFR)
•  PTBPFR is commonly used in leather and rubber products because it works quickly, durability, flexibility and ability to resist heat
• We don't know the true incidence of PTBPFR allergy, but it's been increasing since it's introduction in 1950's
• Other common adhesives are in shoes are acrylates, colophony, and epoxy products

What are the other names of  p-tert-butylphenol formaldehyde resin?

• p-tert-Butylphenol formaldehyde (PTBP) or paraformaldehyde
•  formaldehyde
• p-tert-butylphenol 
• polymer; p-tert-butylphenol formaldehyde resin (PTBP FR)
• formaldehyde, p-tert-butylphenol polymer; 
• 4-(1,1-cimethylethyl)phenol
• formaldehyde polymer
• Neoprene adhesives

Where else is p-tert-butylphenol formaldehyde resin found?

• Glue and fingernail adhesives, tape, labels, dressings and electrodes
• Rubber sports equipment- writs guards, shin guards, goggles, and athletic tape
• The bonder used in hearing aids and prosthetic devices
• Rubber products like shoes, neoprene wet suits, and sauna shorts
• Leather products like shoes, watch straps, purses and belts.
• Varnishes

Who's at risk for developing p-tert-butylphenol formaldehyde resin allergy?

• Moisture and heat break down the PTBPFR in the product exposing the product; sensitization via the skin can then occur.
• There may be some association with sleeping on memory foam mattresses or using foam pillows
• Athletes who use sports equipement may be at greater risk

What should you do if you suspect you are allergic to p-tert-butylphenol formaldehyde resin?

• See your local allergist/immunologist or dermatologist for an evaluation.  http://aaaai.execinc.com/find-an-allergist/
• They will take a detailed history to determine the cause of your rash.
• They may recommend patch testing to determine what is causing the rash, prescribe medication and/or tell you how to modify your behavior to avoid contact with the offending chemical.

Want to read more?

•  http://www.truetest.com/PatientPDF/p-tert-Butylphenol-Formaldehyde-Resin-Patient-Info.pdf
• http://www.dermnetnz.org/dermatitis/paratertiarybutylphenolformaldehyde-allergy.html
• Check out this article in Dermatits: http://journals.lww.com/dermatitis/Abstract/2012/03000/p_tert_Butylphenol_Formaldehyde_Resin_and_Its.7.aspx

Potential Treatment for Peanut Allergy?... MAYBE!

Recently the first multi-center double blind placebo trial on sublingual immunotherapy for peanut allergy was released....and the results are promising!

What do we know about peanut allergy?

• Peanut allergy is on the rise in the US for unknown reasons and affects approximately 1-2% of the population.  
• This allergy causes havoc in families homes and schools.  Fear of accidental exposure leaves parents worried their child or love one will have a possible deadly reaction. 
• Sadly about 10 people a year die from fatal reaction to peanut.  
• Peanut allergy is rarely outgrown;about 20% of people will go on to tolerate peanut.  

Until recently there was little hope of treatment or prevention other than strict avoidance, changes to diet, and label reading.

For those allergic to peanut, good news may be around the corner....

The study:

• Recently researchers from 5 centers across the US introduced escalating doses of peanut powder over  44 weeks to 40 patients with history of anaphylaxis to peanut.   
• Most of the recruits had an allergic reaction with as little as <2 2="2" a="a" g="g" li="li" of="of" only="only" peanut="peanut" s="s">
• Groups were divided equally into 20:20.  The placebo group was given a placebo over 44 weeks and one was given escalating doses of peanut.
• They started with 0.000165 ug of peanut- this is REALLY REALLY tiny given by mouth. 
• The goal of the study was for the treatment group to be able to tolerate 16 peanuts (5 grams).

What happened?

• At 44 weeks, 70% (14/20) of the treatment group ended up being able to tolerate 496 mg of peanut powder (~ 1 2/3 of a peanut).
• At 68 weeks, 3/20 were able to tolerate 5 grams of peanut powder (~ 16 peanuts) and 2 tolerated 10 grams of peanut (32 peanut).
• At 44 weeks, 15% (3/20) people in the placebo group developed spontaneous tolerance and were able to tolerate 496 mg (1 2/3 of a peanut).

What does it mean?

• Sublingual immunotherapy with peanut does induce some level of desensitization in a majority of people with peanut allergy
• This may provide an important treatment method for kids who are exquisitely sensitive to peanut and worry about cross contamination

This is exciting news for families with peanut allergy and in the future may provide an important and life saving treatment. Please do not try desensitization at home.  This is not ready for prime time YET!

 Interested in reading the actual study?  You can access it here http://www.jacionline.org/article/S0091-6749(12)01824-6/abstract.   

Feeling Sick with a Cold or the Flu?

This season's flu is spreading quickly through offices and schools.  Many of my patients ask me how to get a good nights sleep when feeling sick.  People are often kept awake by cough, post nasal drip, and nasal congestion.  Some of the over the counter cold medications can leave you feeling drugged and jittery.  W

ant some tips on how to get a good nights sleep?  Check out this great article by Huffington Post's Sarah Klein on "How to Sleep Better While Sick". http://www.huffingtonpost.com/2013/01/17/sleep-better-while-sick-cold-flu_n_2487635.html