Question:
What is the earliest reasonable age to achieve adequate allergy testing results? Is radioallergosorbent test (RAST) equivalent to skin testing at an early age?

Answer:
For immunoglobulin (Ig) E-mediated allergy, there is no minimum age for testing, although it is important to consider age-related changes in patterns of sensitization. Sensitization to foods can occur in babies who are only a few weeks old. On contrast, it is unusual to develop sensitization to respiratory allergens before 2 or 3 years of age. Furthermore, in preschoolers, sensitization to indoor allergens (eg, cat, dog, dust mites) is more common than sensitization to pollens. Considering these patterns, it is certainly reasonable to test children for food-specific IgE in early infancy if the history suggests food allergy. Preschoolers with symptoms suggestive of respiratory allergies can be tested for IgE, although the panel is usually limited in scope.

The choice of which technique to use is based on several considerations. Skin tests are generally quicker and may be more sensitive, but are dependent on technique, and can be affected by certain medications or the presence of a generalized skin rash. RAST also detects allergen-specific IgE, and results are not affected by skin diseases or medications. In addition, it may be safer to perform RAST in the evaluation of severe anaphylaxis, as there have been a few case reports of systemic allergic reactions to skin-prick testing with foods or latex.

Response from James E. Gern, MD
Associate Professor of Pediatrics, University of Wisconsin, Madison Medical School. He is also a fellow of the American Academy of Pediatrics, and a member of the American Thoracic Society and the American Academy of Allergy, Asthma, and Immunology.

Higher intake of vitamin D may be associated with a lower risk of rheumatoid arthritis (RA) in older women, according to the results of a prospective cohort study published in the January issue of Arthritis & Rheumatism .

"Few studies have examined dietary or nutritional intake prior to RA onset, and none have assessed the association of vitamin D with disease onset," write Linda A. Merlino, MSc, and colleagues from the College of Public Health at the University of Iowa in Iowa City.

Investigators obtained information on respondents' vitamin D and calcium intake by multiplying the frequency of consumption of each unit of food by the calcium or vitamin D content of the specified portions. Researchers also calculated intake by looking at use of multivitamins (brand name, frequency of use) and on the use of supplements containing only vitamin D or only calcium (including range of dose on a daily basis).

The correlation between total vitamin intake and total calcium intake was moderate. Higher total calcium intake was not associated with risk of RA.

Individual food items high in vitamin D content and/or calcium were not strongly associated with RA risk; however, a composite score of servings of milk products combined was inversely associated with risk of RA.

Investigators also found a trend toward an inverse association with RA in smokers with high vitamin D intake, whereas smokers with low vitamin D intake were at increased risk for RA.

Researchers acknowledge that because subjects were not clinically examined some may have been misclassified. In addition, older adults such as the women in the IWHS tend to have low levels of vitamin D intake, which may have influenced the results of the study. They also note that sun exposure, a potentially important source of vitamin D, was not measured in this study.

"While the immunomodulatory effects of vitamin D are not yet fully elucidated, the results from this study suggest a possible role for vitamin D in reducing the risk of an immunologic disorder," Dr. Merlino and colleagues write. "These results are largely hypothesis generating; further studies will be required to corroborate or refute our findings."

This study was supported by a grant from the Arthritis Foundation. The Iowa Women's Health Study was supported by a grant from the National Cancer Institute.

Arthritis Rheum. 2004:50:72-77

Research News:

Ginger Helpful for Nausea and Vomiting of Pregnancy

Ginger is safe and mildly effective for the treatment of nausea and vomiting of pregnancy (NVP), according to the results of a prospective comparative study published in the November issue of the American Journal of Obstetrics and Gynecology .

"Many women are hesitant to take medicinal drugs for fear of harming the fetus, so consequently they are often interested in nonmedicinal options such as acupressure, acupuncture, and ginger," write Galina Portnoi, MD, from the University of Toronto in Ontario, Canada, and colleagues. "Despite the years of the use of ginger in many cultures, there remains little information regarding its safety and efficacy during pregnancy."

The investigators compared pregnant women who were taking ginger during the first trimester of pregnancy with a group of women who were exposed to nonteratogenic drugs that were not antiemetic medications.

"The results also suggest that ginger is somewhat helpful in alleviating the symptoms of NVP, more so with the capsules than any other preparation," they write. "This evidence-based information can be helpful to women and their health professionals when making the decision regarding the treatment of nausea and vomiting with ginger during pregnancy."

Duchesnay Inc. supported the Motherisk NVP Helpline used to enroll women in this study. Mead Johnson/Canada also supported this study through an unrestricted grant.

Am J Obstet Gynecol. 2003;189:1374-1377

An analysis of data from the Nurses' Health Study, published in the Jan. 7 issue of the Journal of the National Cancer Institute , suggests that regular use of aspirin for 20 years or more is associated with an increased risk of pancreatic cancer. Because this differs from findings in other studies, the editorialist suggests that there are no easy answers, but that the conflict should be an impetus to additional research.

Earlier studies have shown that use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce risk of some cancers and precancerous lesions, and in vitro and animal models have suggested that aspirin and NSAIDs may inhibit the development of pancreatic cancer. However, studies analyzing the association between analgesic use and pancreatic cancer in humans have been infrequent and have yielded inconsistent results.

"Our findings do not support a protective effect of analgesic use on the risk of pancreatic cancer," write Eva S. Schernhammer, MD, DrPH, from the Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts, and colleagues. "Rather, aspirin appears to increase the risk of pancreatic cancer after extended periods of use."

As part of the Nurses' Health Study, beginning in 1980, 88,378 women completed biennial questionnaires, including items about aspirin use. Of these women, 34% were current regular aspirin users, defined as consumption of two or more 325 mg aspirin tablets weekly, and 66% consumed fewer than two tablets weekly.

Higher pancreatic cancer risk linked to aspirin use seemed to be confined to women with a higher body mass index, suggesting that obesity may have served as a marker for inflammation. "Risks and benefits associated with the use of aspirin have to be weighed carefully in any recommendations made by health care providers," the authors write.

"There are no easy answers to the question of what aspirin and other NSAIDs do to pancreatic carcinogenesis," he writes. "Fortunately, conflicting data from diverse threads of research are often a very effective push toward scientific progress."

J Natl Cancer Inst. 2004;96:4-5, 22-28

By Katrina Lewis, BHK, PFLC
Registered Kinesiologist

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