What is a allergies definition
- Residency: University of South Carolina, Palmetto Health Richland Children’s Hospital
- Fellowship: Vanderbilt University, Allergy/Immunology
- Medical School: Medical College of Georgia
- College: University of Kansas, B.A., Psychology
Dr. Nicole Chadha received her B.A. in psychology from the University of Kansas, then returned to her southern roots in Georgia to pursue her career in medicine.
She graduated with her medical degree from the Medical College of Georgia in Augusta, GA. She subsequently completed her pediatric residency at Palmetto Health Richland Children’s Hospital associated with the University of South Carolina and fellowship in Allergy/Immunology at Vanderbilt University.
Upon completion of her fellowship, Dr. Chadha remained on faculty at Vanderbilt as an Assistant Professor within the Division of Pediatric Allergy, Immunology, and Pulmonary Medicine. Dr. Chadha is board certified in Pediatrics and Allergy and Immunology. She is a member of the American Academy of Allergy, Asthma, and Immunology, and the American College of Asthma Allergy and Immunology.
Chadha chose to specialize in Allergy in specific because she enjoys studying the intricacies of the immune system and likes that the specialty allows her to treat both children and adults. The chronic nature of allergic disease affords her the chance to build lasting relationships with her patients. She finds grand reward in providing care and education that results in an improved quality of life for her patients. Dr. Chadha has numerous interests in a variety of allergic and immunologic conditions, including food allergy, asthma, urticaria, allergic rhinitis, primary immunodeficiency and eosinophilic esophagitis.
She has contributed to research on eosinophilic esophagitis in children and has presented her work both locally and nationally.
Chadha lives in Charlotte with her husband, Ashley, a pediatric pulmonologist, 2 young sons, and 2 dogs. In her free time, she enjoys traveling, reading, cooking, interior design, volunteering and taking part in community events.
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After informed consent, subjects will be randomly assigned to ILIT group or placebo group in double-blind manner.
In both group, causal allergen or placebo will be injected into inguinal lymph node through guidance by ultrasonography three times with 4-week interval. In ILIT group, initial dose of allergen will be 1,000-fold diluted solution from maximal concentration of allergen extract for subcutaneous immunotherapy (Tyrosine S, Allergy Therapeutic, West Sussex, UK) in volume of 0.1ml. If skin is highly reactive in skin prick test, the initial dose will be 10-fold dilution from maximal concentration where diameter of wheal is less than that of histamine. After the first dose, allergen concentration will be escalated 3-fold at second dose, and 10-fold at third dose if there are no (or mild) local or systemic hypersensitivity reaction.
The allergen concentration will not change at second or third dose if there is moderate local or systemic reaction. The allergen concentration will decrease by 10 or 100-fold from previous concentration or further injection will be held if there is severe local or systemic reaction after sufficient explanation and discussion with subjects.
The investigators will assess allergic rhinitis symptom score before and 4, 12 months after the initial treatment. Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Sino-Nasal Outcome Test (SNOT-20) will be used. Visual analogue scale (VAS) of symptoms including rhinorrhea, sneezing, nasal obstruction, postnasal drip, eye/nose/ear/palate itching, dyspnea, wheezing, chest discomfort as well as urticaria, angioedema, and itching on exposed skin during exposure to causal allergen in daily life will be also evaluated.
Skin prick test (SPT), intradermal test (IDT), blood sampling for serum entire immunoglobulin E (IgE), allergen-specific IgE, and allergen-specific immunoglobulin G4 (IgG4), nasal lavage for Th1, Th2, and Treg cytokines, and nasal provocation test (NPT) with Df and/or Dp allergen (in subjects whose AR symptoms are provoked by Df and/or Dp) will be also performed before and 4, 12 months after the initial treatment.
In addition, the investigators evaluated the change of subjects’ recognition of causal allergens, their avoidance, and AIT during this study. Using VAS, subjects were requested to score the rate of agreement with "Allergen provokes allergic symptoms in daily life", "Allergen avoidance can reduce allergic symptoms", "Allergen-specific Immunotherapy (AIT) can reduce allergic symptoms", "I can pay 50,000 Korean Won (KRW)/month for allergen avoidance", "I can pay 100,000 KRW/month for allergen avoidance", "I can pay 200,000 KRW/month for allergen avoidance", "I can pay 150,000 KRW for each injection of ILIT", "I can pay 300,000 KRW for each injection of ILIT", "I can pay 600,000 KRW for each injection of ILIT" before and after SPT/IDT, after NPT, 4 months and 1 year after ILIT.
Adverse events will be recorded and graded according to Muller classification and Ring and Meissner classification.
How to Stay Healthy, Breathe Easier, and Feel Energetic This Winter
Indoor allergies, freezing weather, less sunlight — winter can make it hard to stay well mentally and physically.
Discover out how to protect yourself against seasonal allergies, the winter blahs, freezing winds, comfort-eating traps, and fatigue this year.
Learn More About the Ultimate Winter Wellness Guide
Sinusitis can be a confusing thing to treat for anyone. Because a sinus infection can be so easily confused with a common freezing or an allergy, figuring out the best way to alleviate your symptoms can be difficult.
Even more challenging, a sinus infection can evolve over time from a viral infection to a bacterial infection, or even from a short-term acute infection to a long-term chronic illness.
We own provided for you the best sources of information on sinus infections to assist you rapidly define your ailment and get the best and most efficient treatment possible.
- American Board of Allergy and Immunology
- American Board of Pediatrics
Favorite Resources for Finding a Specialist
American Rhinologic Society
Through research, education, and advocacy, the American Rhinologic Society is devoted to serving patients with nose, sinus, and skull base disorders.
Their website’s thorough coverage of sinus-related issues includes rarer conditions, such as fungal sinusitis, which are often excluded from other informational sites. It also provides a valuable search tool to discover a doctor, as well as links to other medical societies and resources that are useful for patients.
Their website contains an exhaustive guide on sinusitis and an easy-to-use «Find a Doctor» search tool.
ENThealth provides useful information on how the ear, nose, and throat (ENT) are all connected, along with information about sinusitis and other related illnesses and symptoms, such as rhinitis, deviated septum, and postnasal drip.
As part of the American Academy of Otolaryngology — Head and Neck Surgery, this website is equipped with the ability to assist you discover an ENT specialist in your area.
Frequently Asked Questions about Food Protein-Induced Enterocolitis Syndrome (FPIES)
Does FPIES Require Epinephrine?
Not generally, because epinephrine reverses IgE-mediated symptoms, and FPIES is not IgE-mediated. Based on the patient’s history, some doctors might prescribe epinephrine to reverse specific symptoms of shock (e.g., low blood pressure).
However, this is only prescribed in specific cases.
What is Shock and What are the Symptoms?
Shock is a life-threatening condition. Shock may develop as the result of sudden illness, injury, or bleeding. When the body cannot get enough blood to the vital organs, it goes into shock.
Signs of shock include:
Weakness, dizziness, and fainting.
Cool, pale, clammy skin.
Weak, quick pulse.
Shallow, quick breathing.
Low blood pressure.
Extreme thirst, nausea, or vomiting.
Confusion or anxiety.
How Do You Treat an FPIES Reaction?
Always follow your doctor’s emergency plan pertaining to your specific situation.
Rapid dehydration and shock are medical emergencies. If your kid is experiencing symptoms of FPIES or shock, immediately contact your local emergency services (9-1-1). If you are uncertain if your kid is in need of emergency services, contact 9-1-1 or your physician for guidance. The most critical treatment during an FPIES reaction is intravenous (IV) fluids, because of the risk and prevalence of dehydration. Children experiencing more severe symptoms may also need steroids and in-hospital monitoring.
Mild reactions may be capable to be treated at home with oral electrolyte re-hydration (e.g., Pedialyte®).
How Do I know If My Kid Has Outgrown FPIES?
Together with your child’s doctor, you should determine if/when it is likely that your kid may own outgrown any triggers. Obviously, determining if a kid has outgrown a trigger is something that needs to be evaluated on a food-by-food basis. As stated earlier, APT testing may be an option to assess oral challenge readiness. Another factor for you and your doctor to consider is if your kid would physically be capable to handle a possible failed challenge.
When the time comes to orally challenge an FPIES trigger, most doctors familiar with FPIES will desire to schedule an in-office food challenge.
Some doctors (especially those not practicing in a hospital clinic setting) may select to challenge in the hospital, with an IV already in put, in case of emergency. Each doctor may own his or her own protocol, but an FPIES trigger is something you should definitely NOT challenge without discussing thoroughly with your doctor.
Be aware that if a kid passes the in-office portion of the challenge, it does not mean this food is automatically guaranteed «safe.» If a child’s delay in reaction is fairly short, a kid may fail an FPIES food challenge while still at the office/hospital. For those with longer reaction times, it may not be until later that day that symptoms manifest.
Some may react up to three days later. Delay times may vary by food as well. If a kid has FPIES to multiple foods, one food may trigger symptoms within four hours; a diverse food may not trigger symptoms until six or eight hours after ingestion.
How Do You Care for a Kid With FPIES?
Treatment varies, depending on the patient and his/her specific reactions. Often, infants who own reacted to both dairy and soy formulas will be placed on hypoallergenic or elemental formula. Some children do well breastfeeding. Other children who own fewer triggers may just strictly avoid the offending food(s).
New foods are generally introduced extremely slowly, one food at a time, for an extended period of time per food.
Some doctors recommend trialing a single food for up to three weeks before introducing another.
Because it’s a rare, but serious condition, in the event of an emergency, it is vital to get the correct treatment. Some doctors provide their patients with a letter containing a brief description of FPIES and its proper treatment. In the event of a reaction, this letter can be taken to the ER with the child.
What Does FPIES Stand For?
FPIES is Food Protein-Induced Enterocolitis Syndrome. It is commonly pronounced «F-Pies», as in «apple pies», though some physicians may refer to it as FIES (pronounced «fees», considering food-protein as one word).
Enterocolitis is inflammation involving both the little intestine and the colon (large intestine).
What is FPIES?
FPIES is a non-IgE mediated immune reaction in the gastrointestinal system to one or more specific foods, commonly characterized by profuse vomiting and diarrhea. FPIES is presumed to be cell mediated. Poor growth may happen with continual ingestion. Upon removing the problem food(s), every FPIES symptoms subside. (Note: Having FPIES does not preclude one from having other allergies/intolerances with the food.) The most common FPIES triggers are cow’s milk (dairy) and soy.
However, any food can cause an FPIES reaction, even those not commonly considered allergens, such as rice, oat and barley.
A kid with FPIES may experience what appears to be a severe stomach bug, but the «bug» only starts a couple hours after the offending food is given. Numerous FPIES parents own rushed their children to the ER, limp from extreme, repeated projectile vomiting, only to be told, «It’s the stomach flu.» However, the next time they feed their children the same solids, the dramatic symptoms return.
Is FPIES A Lifelong Condition?
Numerous children outgrow FPIES by about age three. Note, however, that the time varies per individual and the offending food, so statistics are a guide, but not an absolute. In one study, 100% of children with FPIES reactions to barley had outgrown and were tolerating barley by age three. However, only 40% of those with FPIES to rice, and 60% to dairy tolerated it by the same age.
What are Some Common FPIES Triggers?
The most common FPIES triggers are traditional first foods, such as dairy and soy.
Other common triggers are rice, oat, barley, green beans, peas, sweet potatoes, squash, chicken and turkey. A reaction to one common food does not mean that every of the common foods will be an issue, but patients are often advised to proceed with caution with those foods. Note that while the above foods are the most prevalent, they are not exclusive triggers. Any food has the potential to trigger an FPIES reaction. Even trace amounts can cause a reaction.
When Do FPIES Reactions Occur?
FPIES reactions often show up in the first weeks or months of life, or at an older age for the exclusively breastfed kid. Reactions generally happen upon introducing first solid foods, such as baby cereals or formulas, which are typically made with dairy or soy.
(Infant formulas are considered solids for FPIES purposes.) While a kid may own allergies and intolerances to food proteins they are exposed to through breastmilk, FPIES reactions generally don’t happen from breastmilk, regardless of the mother’s diet. An FPIES reaction typically takes put when the kid has directly ingested the trigger food(s).
What Does IgE vs Cell Mediated Mean?
IgE stands for Immunoglobulin E. It is a type of antibody, formed to protect the body from infection, that functions in allergic reactions. IgE-mediated reactions are considered immediate hypersensitivity immune system reactions, while cell mediated reactions are considered delayed hypersensitivity.
Antibodies are not involved in cell mediated reactions. For the purpose of understanding FPIES, you can disregard every you know about IgE-mediated reactions.
How is FPIES Diagnosed?
FPIES is hard to diagnose, unless the reaction has happened more than once, as it is diagnosed by symptom presentation. Typically, foods that trigger FPIES reactions are negative with standard skin and blood allergy tests (SPT, RAST) because they glance for IgE-mediated responses.
However, as stated before, FPIES is not IgE-mediated.
Atopy patch testing (APT) is being studied for its effectiveness in diagnosing FPIES, as well as predicting if the problem food is no longer a trigger.
Thus, the outcome of APT may determine if the kid is a potential candidate for an oral food challenge (OFC). APT involves placing the trigger food in a metal cap, which is left on the skin for 48 hours. The skin is then watched for symptoms in the following days after removal. Please consult your child’s doctor to discuss if APT is indicated in your situation.
What is a Typical FPIES Reaction?
As with every things, each kid is diverse, and the range, severity and duration of symptoms may vary from reaction to reaction. Unlike traditional IgE-mediated allergies, FPIES reactions do not manifest with itching, hives, swelling, coughing or wheezing, etc.
Symptoms typically only involve the gastrointestinal system, and other body organs are not involved.
FPIES reactions almost always start with delayed onset vomiting (usually two hours after ingestion, sometimes as tardy as eight hours after). Symptoms can range from mild (an increase in reflux and several days of runny stools) to life threatening (shock). In severe cases, after repeatedly vomiting, children often start vomiting bile. Commonly, diarrhea follows and can final up to several days. In the worst reactions (about 20% of the time), the kid has such severe vomiting and diarrhea that s/he rapidly becomes seriously dehydrated and may go into shock.
How is FPIES Diverse From MSPI, MSPIES, MPIES, Etc.?
MPIES (milk-protein induced enterocolitis syndrome) is FPIES to cow’s milk only.
MSPIES (milk- and soy-protein induced enterocolitis syndrome) is FPIES to milk and soy. Some doctors do create these subdivisions, while others declare that milk and soy are simply the two most common FPIES triggers and give the diagnosis of «FPIES to milk and/or soy.»
MSPI is milk and soy protein intolerance. Symptoms are those of allergic colitis and can include colic, vomiting, diarrhea and blood in stools. These reactions are not as severe or immediate as an FPIES reaction.
Fogg MI, Brown-Whitehorn TA, Pawlowski NA, Spergel JM. (2006). Atopy Patch Test for the Diagnosis of Food Protein-Induced Enterocolitis Syndrome. Pediatric Allergy and Immunology 17: 351–355.
Retrieved on December 31, 2007 from http://pediatrics.aappublications.org/cgi/content/abstract/120/Supplement_3/S116.
Burks, AW. (2006). Don’t Feed Her That! Diagnosing and Managing Pediatric Food Allergy. Pediatric Basics. Gerber Products Company: 115. Retrieved on December 31, 2007 from http://www.gerber.com/content/usa/html/pages/pediatricbasics/articles/115_01-dontfeed.html.
Moore, D. Food Protein-Induced Enterocolitis Syndrome. (2007, April 11). Retrieved on December 31, 2007 from http://allergies.about.com/od/foodallergies/a/fpies.htm.
Sicherer, SH. (2005).
Food Protein-Induced Enterocolitis Syndrome: Case Presentations and Management Lessons. Journal of Allergy and Clinical Immunology Vol. 115, 1:149-156. Retrieved on December 31, 2007 from http://www.jacionline.org/article/PIIS0091674904024881/fulltext.
Nowak-Wegrzyn, A., Sampson, HA, Wood, RA, Sicherer, SH. MD, Robert A. Wood, MD and Scott H. Sicherer, MD. (2003). Food Protein-Induced Enterocolitis Syndrome Caused by Solid Food Proteins. Pediatrics. Vol. 111. 4: 829-835.
Retrieved on December 31, 2007 from http://pediatrics.aappublications.org/cgi/content/full/111/4/829#T1.
Nocerino, A., Guandalini, S. (2006, April 11). Protein Intolerance. Retrieved on December 31, 2007 from http://www.emedicine.com/ped/topic1908.htm. WebMD Medical Reference from Healthwise. (2006, May 31). Shock, Topic Overview. Retrieved on December 31, 2007 from http://www.webmd.com/a-to-z-guides/shock-topic-overview.
American Academy of Allergy, Asthma and Immunology. (2007). Tips to Remember: What is an Allergic Reaction? Retrieved on December 31, 2007 from http://www.aaaai.org/patients/publicedmat/tips/whatisallergicreaction.stm.
(2006). Understanding and Managing Your Child’s Food Allergies. A Johns Hopkins Press Health Book. 336.
Medical Review February 2008.
“This discovery reverses food allergies in mice, and we own numerous people with allergies volunteering their own cells for us to use in lab testing to move this research forward,” said professor John Gordon, lead scientist behind the discovery just published in the current issue of the Journal of Allergy and Clinical Immunology.
The findings open the door to test this new allergy treatment in “humanized mice”—mice with non-existent immune systems implanted with cells from a human immune system, for example, from a peanut-allergic person.
With Health Canada approval, the first human trial could start in about one year, Gordon said.
“If we can reliably ‘cure’ food allergies, or related conditions such as asthma or autoimmune diseases such as multiple sclerosis with this new therapy, it would be life-changing for affected individuals.”
Roughly 2.5 million Canadians self-report having at least one food allergy. Anaphylaxis, defined as a severe rapid-onset allergic reaction, can be life-threatening and treatment options are limited.
The discovery involves generating a type of naturally occurring immune cell that sends a signal to reverse the hyper-immune response present in allergic reactions. That signal triggers another “off switch” that turns off reactive cells further along the allergic pathway.
“We predict the treatment could be on the market within the next five to 10 years,” said Gordon, who is also a research leader in the Allergy, Genes and Environment (AllerGen) Network.
AllerGen—part of the federally funded Networks of Centres of Excellence program—aims to assist Canadians address the challenges of living with asthma, allergies, anaphylaxis and related immune diseases.
Gordon’s team will collaborate with other AllerGen investigators located at the U of S, McGill University, Queen’s University, McMaster University, and University of Alberta to pilot the new technique.
“This discovery portends a major breakthrough towards a therapeutic reversal of food allergen sensitivity,” said Dr.
Judah Denburg, scientific director and CEO of AllerGen. “The treatment prevents anaphylactic responses in what were previously fully sensitive mice, opening the door for translating this therapy into the clinic.”
There is compelling evidence this technique could be effective in humans. In 2010, Gordon’s team demonstrated they could reverse an asthmatic response in human cells in a test tube. Using three applications of a similar therapy in a 2012 study, the researchers effectively eliminated asthma in afflicted mice, within only eight weeks.
“Even if we only cure 25 per cent of subjects, we will dramatically improve the health of those individuals, and also reduce healthcare system expenses,” said Gordon, who worked with Wojciech Dawicki, a research associate and the primary author and lead researcher in this study.
Master’s student Chunyan Li and lab technicians Xiaobei Zhang and Jennifer Town also worked on the project.
Here’s how the technique works:
- Gordon’s pioneering treatment involves producing dendritic cells in a test tube and then exposing them to a unique stir of proteins, a vitamin A-related acid naturally occurring in the human gut, and to the allergen, in this case, peanut or ovalbumin (egg white protein).
The modified dendritic cells are then reintroduced into the mouse.
- The key component of this research is dendritic cells, which serve as the gate-keepers of the immune system and are present in tissues in contact with the external environment, such as the skin and the inner lining of the nose, lungs, stomach and intestines.
- Using this technique, the researchers were capable to almost eliminate the allergic reaction by converting allergen-sensitive immune cells into cells that mimic the response seen in healthy, non-allergic individuals.
The treatment reduced the observed symptoms of anaphylaxis, and lowered other key protein markers in the allergic response by up to 90 per cent.
Food allergy is a growing public health issue in Canada.
Currently, there is no known cure. According to the Canadian Institute for Health Information, an estimated 171,000 Canadians visited emergency rooms for allergic reactions from 2013 to 2014, the rate of anaphylaxis visits increased by 95 per cent from 2006 to 2014, and the severity of reactions is increasing.
Gordon said the new technique also shows promise for treating autoimmune disorders such as multiple sclerosis. “It would take extremely little to adapt the therapy for autoimmune diseases,” he said.
Funding for the research was provided by the Canadian Institutes of Health Research and the AllerGen Networks of Centres of Excellence.
For more information, contact:
Media Relations Specialist
University of Saskatchewan
Director of Communications and Knowledge Mobilization
AllerGen NCE Inc.
The Best Research Resources
American Academy of Allergy, Asthma, and Immunology
This academy’s website provides valuable information to assist readers determine the difference between colds, allergies, and sinusitis. A primer guide on sinusitis also provides more specific information about the chronic version of the illness. Additional resources include a «virtual allergist» that helps you to review your symptoms, as well as a database on pollen counts.
American College of Allergy, Asthma, and Immunology (ACAAI)
In addition to providing a comprehensive guide on sinus infections, the ACAAI website also contains a wealth of information on allergies, asthma, and immunology.
The site’s useful tools include a symptom checker, a way to search for an allergist in your area, and a function that allows you to ask an allergist questions about your symptoms.
Asthma and Allergy Foundation of America (AAFA)
For allergy sufferers, the AAFA website contains an easy-to-understand primer on sinusitis. It also provides comprehensive information on various types of allergies, including those with risk factors for sinusitis.
Centers for Disease Control and Prevention (CDC)
The CDC website provides basic information on sinus infections and other respiratory illnesses, such as common colds, bronchitis, ear infections, flu, and sore throat.
It offers guidance on how to get symptom relief for those illnesses, as well as preventative tips on practicing good hand hygiene, and a recommended immunization schedule.
U.S. National Library of Medicine
The U.S. National Library of Medicine is the world’s largest biomedical library. As part of the National Institutes of Health, their website provides the basics on sinus infection. It also contains a number of links to join you with more information on treatments, diagnostic procedures, and related issues.