Lois Levine

On the second day of the virtual 2021 American Academy of Pediatrics National Conference & Exhibition, Dr. Hernandez-Trujillo, division director, Allergy and Immunology, and fellowship training program director, Allergy and Immunology at Nicklaus Children’s Hospital in Miami, Florida began her session on essential advice for preventing food allergies in children by explaining, “Food allergy affects approximately 8% of children, roughly 2 children per classroom in the United States. “With the pediatrician playing a key role in early nutrition, discussion with parents regarding solid food introduction is essential.”

New parents and families often ask about the need for dietary restriction during pregnancy, noted Hernandez-Trujillo, but there is in fact a lack of evidence supporting dietary restriction during both pregnancy and lactation. Having said that, Hernandez-Trujillo pointed out, “exclusive breastfeeding during the first 3 to 4 months of a child’s life does decrease incidence of eczema in the child’s first 2 years.” Breastfeeding beyond 3 to 4 months protects against wheezing in the first 2 years as well.

Other questions that parents often ask pediatricians is about formula choice and delayed introductions of food, says Hernandez-Trujillo. On these points, there is no convincing evidence for use of soy-based formula in allergy prevention, little evidence that hydrolyzed formula prevents atopic disease, and no evidence supporting delayed introduction of solid foods beyond 4 to 6 months in protection against atopic disease.

“The times are changing: the recommendations of avoidance of solids and ‘allergenic’ foods until 3 to 5 years old are no longer advised,’ says Hernandez-Trujillo, but breastfeeding for 4 to 6 months is recommended, with no introduction of solids until at least 4 months of age.” 

In noting the Learning Early About Peanut Allergy (LEAP) study, Hernandez-Trujillo said, “the take-home message of this study was that the early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk.”

Next, Hernandez-Trujillo pointed to the 2016 Enquiring About Tolerance (EAT) study, which was designed to investigate the best time to introduce 6 allergenic foods to the infant diet: cow’s milk, peanut, egg, sesame, fish, and wheat. The study proved that early introduction of this food group resulted in lower food allergy prevalence, was achievable and safe.

Hernandez-Trujillo went on to discuss the addendum guidelines for the prevention of peanut allergy in the United States, a report from the National Institute of Allergy and Infectious Disease. The summary guidelines state that infants with either egg allergy, severe eczema or both should be evaluated by testing to peanut prior to introduction; infants with mild to moderate eczema should be introduced to peanuts at 6 months; and infants with no eczema or egg allergy should be introduced at the preference of parents.

When it comes to peanut introduction, says Hernandez-Trujillo, “always keep in mind the form of food given to an infant or toddler, and remember the choking risk.” Additionally, “regular consumption early on is needed to ensure tolerance: encourage consumption of 2 teaspoons of peanut butter 3 times per week,” she said. 

There should be no food introduction if the child is sick, and finally, she adds, “Adults should spend at least 2 hours after feeding to monitor possible allergic reaction.” Good peanut products to try, she suggested, include peanut puffs, thinned smooth peanut butter, smooth peanut butter puree, and peanut flour or peanut powder. And “while allergic reactions are rare at the time of introduction,” she warns, “if there is a severe allergic reaction, child should avoid the food and be evaluated and tested, with no reintroduction until the testing is completed.” 

She also reminded health care professionals that “anaphylaxis can be difficult to diagnose in infants, since they are non-verbal, so adults need to be able to monitor and identify any potential allergic reaction.” 

Finally she noted, “be aware of panel testing. Broad food panels can result in unnecessary avoidance of foods. Furthermore, children who eat a food and are tolerating it should continue to consume that food, something to keep in mind because while panel testing may be easy, it really does lead to some unnecessary avoidance of food and can impact the overall nutrition of the child.”

Hernandez-Trujillo concluded the session with highlighting overall strategies for safe introductions of foods which included open communication with parents regarding the benefits of early introduction; offering in-office feedings for patients who may be at risk of reaction; review of signs and symptoms of allergic reactions; and steps to take if an allergic reaction occurs. 

She also reminded practitioners to discourage dietary restrictions during pregnancy or breastfeeding to prevent atopic disease and to remember, “if a child has developed food allergy, treatment requires identification of the allergen and dietary restriction.”

This article was originally published on Contemporary Pediatrics®.

1. Hernandez-Trujillo V. Essential advice on preventing food allergies. 2021 AAP National Conference & Exhibition, virtual. Accessed October 9, 2021.

Articles

At the virtual 2021 American Academy of Pediatrics National Conference & Exhibition, Vivian Hernandez-Trujillo, MD, FAAP, FAAAAI, FACAAI, division director, Allergy and Immunology, and fellowship training program director, Allergy and Immunology at Nicklaus Children’s Hospital in Miami, Florida presents a session on best practices for preventing food allergies in newborns and infants.

Essential advice to prevent food allergies

ZetrOZ, a medical technology company that produces wearable ultrasound devices to reduce pain and inflammation, now comes under a new FDA category, created for just these types of therapeuties.

ZetrOZ's sustained acoustic medicine device is an at-home, long-duration ultrasound therapy instrument, where patients, such as teenage and adult athletes recovering from sports injuries get trained on the use of the device, and then can apply it directly at home. The device can treat inflammation, pain, and other unresolved medical issues such as cartilage degeneration, miniscus injuries and ankle sprains. The localized treatment allows healing without a surgical procedure, and is typically applied once a day for 6 to 8 weeks.

The FDA initially cleared ZetrOZ's sustained acoustic medicine device in 2013, with expanded indications in 2020.

This article was originally posted on Contemporary Pediatrics®. 

The US Food and Drug Administration created a new category for ZetrOZ's Acoustic Medicine device.

Ultrasound pain management device makes way for new FDA category

Barry S. Zuckerman, MD, founder of Reach Out and Read, hopes to personalize the patient-doctor relationship with a new app called Small Moments.

When pediatrician Barry S. Zuckerman decided to create the app, Small Moments, aimed at parents of babies aged 0 to 6 months old, he knew he wanted to do something different. He did so with the very first question the app asks: “How are you feeling as a mom?” His goal is to personalize what he sees as an increasingly depersonalized patient-doctor health care system.

Zuckerman is no stranger to startups. He is the co-founder of 

, a national literacy program that reaches 4.5 million children in the United States; co-founder of Health Leads and Healthy Steps, 2 programs designed to assist lower-income families in getting the best pediatric health care possible; and the author of more than 250 scientific publications addressing the importance that a mother’s health and well-being influences her child’s health outcomes.

, Zuckerman discusses the app, why he created it, and his thoughts on the current state of health care for parents of infants, particularly in lower-income groups.

What prompted you to create Small Moments?

 I have always been full of ideas about helping patients. Most of my career has been in the inner-city [and] I wanted to make a difference there. When I saw problems—wonderful, young children going to school and falling behind in reading, parents telling me there are no bookstores in the area, that books are too expensive, or because of their immigrant culture they simply didn’t buy books and read to their children—I needed to do something. And so we created programs to help, like Health Leads and Healthy Steps. But these were the steps to help with patients. I wanted to do something else that would connect the emotional experience with their caregivers, the low-income mothers. Something without finances being a barrier. So I created this app, which is free and also a tool for practitioners, to make the birth experiences and on more meaningful. I didn’t want to create a “how to” or “answers to common questions” app: There are plenty of those out there. I wanted something that would connect new mothers with their own emotions. More and more pediatricians, as a result of Electronic Health Records and issues with time, have had to depersonalize the relationship with the parents of babies.

Parents and clinicians are using it. The app can be downloaded from the app store, and [then the new parent can] answer a series of questions about how they are feeling, what they think will help them at home, in terms of the new baby. There are also videos to watch, such as learning baby cues. Users can also create their own videos that they can share and discuss with their practitioner. In one case, a baby was having some trouble swallowing and so the grandmother moved in to help her daughter. The pediatrician thought it was terrific that she was getting help. And so, together, they watched a video on the app of a grandmother helping with her daughter’s baby. The patient’s response to this was a surprise for the physician, “Oh, my mother is driving me nuts. She is feeding what she wants to the baby. She is blaming me for the baby’s problems.” The practitioner would never have learned this backstory without the app.

I really hope parents and clinicians can get deeper into the experience of what a mother is going through: That is when the health care provider can be the most helpful. Doctors can choose certain videos to send to a particular patient. For example, if a woman is feeling depressed after giving birth, she can see a video on that. It can be used for both in-office and telehealth visits for an increased connection. It’s part of real people dealing with real life. And I think that message is spreading.

You can download the app under Small Moments, Big Impact in the iPhone app store or on the website, 

. Health care providers, click on the link below to view guidelines for using the app with patients.

Lois Levine

Articles

Essential advice to prevent food allergies

Ultrasound pain management device makes way for new FDA category

A new app for new mothers