Challenge Testing (Oral Challenge)

Challenge testing is the gold standard for diagnosing allergy. Challenge tests commonly performed by allergists include food challenge, drug challenge, inhalation challenge and physical challenge (heat, cold, exercise).

Oral Challenge

Skin prick tests and specific IgE blood tests are often used to aid in the diagnosis of food allergies. However, having positive skin tests or specific IgE to foods does not necessarily mean that the patient is allergic to those foods. The reason is because the body can develop an immune response called oral tolerance that suppresses the food allergy while the skin or blood test remains positive. Therefore, young children with food allergies often develop tolerance when they grow older while their test results remain positive for a few more years. On the other hand, negative skin or blood tests can reliably exclude immediate-type food allergy.

Allergists therefore use food challenge to determine whether a patient is allergic to a particular food when there is suspicion that skin or blood test results are incorrect, or when the patient might have outgrown his/her food allergy. An open challenge is performed by simply giving the patient increasing amounts of the food under close medical supervision. However, a significant amount of psychological overlay is sometimes present, which will bias the result of the challenge. Therefore the food is often hidden in a vehicle such as apple sauce and given to the patient in a single-blinded (subject is blinded to the test condition) or double-blinded (both observer and subject blinded) manner, alternating with plain vehicle.

Reference information: www.allergy.hk/

The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.

Immunotherapy for allergic diseases (2)

 

 

So how do we treat allergies?  The most obvious answer is to avoid coming in contact with allergens.  To successfully practice allergen avoidance, we must first find out what the person is allergic to, and to confirm that these allergens are responsible for their symptoms.  A positive skin test will identify allergens that the patient responds to immunologically, but it still does not confirm that these allergens cause symptoms from day to day.   

 

A careful history will be very helpful, but sometimes, challenge studies might be needed.  Measuring the level of allergens in the patient’s living and working environment might also be useful.  For certain indoor allergens such as house dust mites and animal dander, avoidance measures can be extremely helpful.  The second line of treatment for allergies is drug treatment.   

 

Drugs such as antihistamines are used to counteract some of the symptoms of an allergic reaction.  They can be useful for mild cases but are frequently not successful in controlling more severe cases.  Steroid spray is also very useful in reducing the inflammation caused by an allergic reaction.  These treatments do not address the root of the problem, and symptoms promptly recur once the patient stops the treatments.

 

The only method to eliminate allergies is by immunotherapy.  This form of therapy aims to induce immunological tolerance to specific allergens, so that patients will no longer react to them when exposed.  Traditionally, immunotherapy (also called allergy injections or desensitization) is administered by repeated subcutaneous injections of purified allergen extracts.  

 

 This carries a risk of severe allergic reactions, and the injections must be administer under the supervision of an experienced allergist with adequate emergency support.  In experienced hands, immunotherapy is very safe, especially if standardized extracts are used.  In patients with insect sting allergy, immunotherapy is >99% effective in protecting the patients from future stings, and the effect appears to be lifelong after 3 to 5 years of continuous treatment.  The effectiveness of pollen immunotherapy has also been shown to last for at least 3 years after stopping treatment.

 

Newer forms of immunotherapy are being developed.  Sublingual immunotherapy uses a very high dose of allergen extract to be placed under the tongue for absorption.  Initial studies suggest that it might be effective for allergic rhinitis and possibly asthma.  More studies are needed to confirm its efficacy and also to determine its mechanism of action.  We are currently conducting a large clinical study, which will eventually involve 120 patients with allergic rhinitis, to evaluate sublingual immunotherapy against house dust mites.  

 

 Patients with moderate to severe allergic rhinitis will be recruited.  Skin tests to common allergens will be performed to confirm sensitization to house dust mites.  A nasal challenge study will be performed to confirm that house dust mites can indeed cause nasal symptoms.  The patients will first be given conventional drug therapy including an antihistamine and a nasal spray.   

 

Patients who do not derive satisfactory results from this treatment will be randomized to receive immunotherapy or placebo for one year.  The patients will be reevaluated every three months, and those that respond to treatment will have their nasal spray gradually withdrawn.  Patients will fill in a report of their symptoms every week.  At the end of one year, all patients on active treatment will continue for another year, and those on placebo will be switched to active treatment.  Immunological parameters in the blood and nasal washings will be evaluated at the beginning of the study and after one year.]

 

 

Reference information:  www.allergy.hk

The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.

Immunotherapy for allergic diseases (1)

 

 

 

Allergic diseases are some of the most common diseases in Hong Kong.  It has been estimated that up to 50% of school children suffer from symptoms of rhinitis, while about 15% of them have asthma and about 10% have eczema.  The incidence of allergic diseases is also increasing around the world, as a result of changes in our lifestyle and our environment.

 

Allergic rhinitis/conjunctivitis is a common problem that many sufferers simply ignore.  The symptoms include sneezing, itchy nose, itchy eyes, runny nose, watery eyes, congestion and post-nasal drip.  However, severe cases can be quite debilitating.  Children with allergic rhinitis have been shown to suffer from poor sleep, impaired learning, bad temper and hyperactivity.  Adults with allergic rhinitis are at risk of disorders of mood and sleep.  Severe allergic rhinitis might become complicated by sinus and middle ear infections, worsening of asthma, and might affect facial and dental development in children.

 

The cause of allergic rhinitis in any individual is dependent on his/her living and working environment.  In temperate climate, pollens are the most common causes.  However, in subtropical climates such as Hong Kong, indoor allergens such as house dust mites, mould spores, cockroaches and animal dander are the most common causes.  Exposure to allergens in the work environment is also very important.

 

Why do people develop allergies?  When we are first exposed to a foreign substance, through our skin, our respiratory tract or GI tract, our immune system will strive to recognize this substance.  In most cases, our immune system recognizes that these substances are harmless and ignores them.  This is a process called immunological tolerance.  Not only does the immune system ignore these antigens, it actually develops a response that actively suppresses any reaction to the antigens.  This active suppression can be passed on from one experimental animal to another by transferring immune cells called T cells.  In allergic individuals, this mechanism somehow failed to work for certain antigens (allergens), and they develop an immune response every time they encounter these antigens.  This immune response leads to allergic symptoms.

 

 

Reference information: www.allergy.hk

The information aims to provide educational purpose only. Anyone reading it should consult
physician before considering treatment and should not rely on the information above.

Sweat sensitivity and skin allergy

 

 

Many patients suffering from atopic dermatitis complain of itching and worsening of their rash after sweating. Many patients with atopic dermatitis have been found to have an allergic sensitivity to an as yet unidentified antigen in their own sweat. The majority of these patients develop positive skin test reactions to a 1,000 to 10,000-fold diluted preparation of their own sweat, whereas only 1% of the normal population has a similar reaction.

 

Another condition known as cholinergic urticaria has now been confirmed to be due to sweat allergy. These patients develop extremely itchy small hives on their skin when they are hot or when they exercise. The majority of these patients also have positive sweat skin test.

 

More interestingly, recent clinical studies in Japan suggest that sweat desensitization treatment might be effective for these conditions. Six Japanese patients with cholinergic urticaria underwent desensitization by intradermal injections of escalating doses of their own sweat. Five out of six patients showed significant symptomatic improvement.

 

We have started to offer sweat skin test to our patients who have symptoms of sweat allergy. In those patients with positive reactions, sweat desensitization might be a viable treatment option. This might be particularly valuable to those patients suffering from cholinergic urticaria, as there is currently no other viable treatment option for these patients except antihistamines.

Reference information: http://www.allergy.hk

The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.

Pollen Allergy

Activities like camping can be fun, but they can also expose you to outdoor pollen as well as to stinging insects like bees, yellow jackets and wasps. If you have these allergies, avoid camping during high pollen seasons, take your medications with you and carry injectable epinephrine to treat reactions to stinging insects. If you have a severe insect-allergic reaction, get immediate emergency medical treatment.

Walking, leisure biking and hiking are typically good activities for people with asthma or allergies. If you enjoy the mountains and have asthma, be careful if you are thinking of going above 5,000 feet, as oxygen levels decrease.

Cold weather sports such as cross-country skiing and ice hockey are more likely to make symptoms worse. Also, snorkeling is much safer than scuba diving.

An asthma treatment plan can help you keep your symptoms under control so that you can enjoy exercising or sports activities while traveling.

Bon voyage and safe travels!



Healthy Tips

• If your allergies or asthma are causing problems, have a pre-trip physical.
• Pack all medications, a peak flow meter and a copy of your physician's phone number.
• Consider buying travel medical insurance.

Reference information: www.aaaai.org,  www.allergy.hk/

The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.

Tips to Remember: Food Allergy

If you have a food allergy, your immune system overreacts to a food. This is caused by an antibody called IgE (Immunoglobulin E), which is found in people with allergies. Food allergy is more likely to develop in someone who has family members with allergies. Symptoms may occur after you consume even a tiny amount of the food.

Most allergens can cause reactions even after they are cooked or have undergone digestion in the intestines. There are some exceptions. For example, some allergens (usually fruits and vegetables) cause allergic reactions only if eaten in their raw form. Symptoms are usually limited to the mouth and throat.

The most common food allergens are the proteins in cow's milk, eggs, peanuts, wheat, soy, fish, shellfish and tree nuts.

In some food groups, especially tree nuts and seafood, an allergy to one member of a food family may result in the person being allergic to other members of the same group. This is known as cross-reactivity.

Cross-reactivity is not as common with foods from animal groups. For example, people allergic to cow's milk can usually eat beef, and patients allergic to eggs can usually eat chicken.

With shellfish, crustaceans (shrimp, crab and lobster) are most likely to cause an allergic reaction. Molluscan shellfish (clams, oysters, scallops, mussels, abalone, etc.) can cause allergic reactions, but reactions to these shellfish are less common. Occasionally, people are allergic to both types of shellfish.


 

Reference information: http://www.aaaai.org/
The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.

Challenge Testing (Oral Challenge)

Challenge testing is the gold standard for diagnosing allergy. Challenge tests commonly performed by allergists include food challenge, drug challenge, inhalation challenge and physical challenge (heat, cold, exercise).

Oral Challenge

Skin prick tests and specific IgE blood tests are often used to aid in the diagnosis of food allergies. However, having positive skin tests or specific IgE to foods does not necessarily mean that the patient is allergic to those foods. The reason is because the body can develop an immune response called oral tolerance that suppresses the food allergy while the skin or blood test remains positive. Therefore, young children with food allergies often develop tolerance when they grow older while their test results remain positive for a few more years. On the other hand, negative skin or blood tests can reliably exclude immediate-type food allergy.

Allergists therefore use food challenge to determine whether a patient is allergic to a particular food when there is suspicion that skin or blood test results are incorrect, or when the patient might have outgrown his/her food allergy. An open challenge is performed by simply giving the patient increasing amounts of the food under close medical supervision. However, a significant amount of psychological overlay is sometimes present, which will bias the result of the challenge. Therefore the food is often hidden in a vehicle such as apple sauce and given to the patient in a single-blinded (subject is blinded to the test condition) or double-blinded (both observer and subject blinded) manner, alternating with plain vehicle.

Reference information: www.allergy.hk/

The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.

Pet-specific IgG4 levels and the likelihood of symptomatic pet allergy

An increase in allergen-specific IgG4 (sIgG4) level often accompanies successful allergen immunotherapy. Studies have also suggested that chronic exposure to some allergens may lead to increased sIgG4 that may function as “blocking antibodies” and signal a degree of clinical tolerance.


In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Burnett and colleagues report on data from 500 teenage participants in a longitudinal birth cohort and describe the association of dog and cat specific IgE (sIgE), sIgG4, and the ratios of sIgG4/sIgE antibodies to self-reported symptoms when in contact with pets. Serum levels of the pet-specific antibodies were compared between symptomatic and asymptomatic teens.

Compared to asymptomatic participants, those symptomatic upon cat exposure had higher cat sIgE, sIgG4, and lower ratios of sIgG4/sIgE. Those symptomatic after dog exposure had higher dog sIgE and lower ratios of sIgG4/sIgE, but similar levels of sIgG4 compared to asymptomatic participants. Higher cat and dog sIgG4/sIgE ratios were associated with a lower likelihood of reporting allergic symptoms. However, measurement of sIgG4 appeared to add little to the current clinical practice of using sIgE alone to determine the likelihood of clinical allergic responses when in contact with pets.

Based on these data, the authors do not recommend the routine measurement of sIgG4 as a useful supplementary test to sIgE during the diagnostic evaluation of potential pet allergy.






Reference information:  www.allergy.hk
The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.

Enjoy Your Stay with Allergies and Asthma

Hotel rooms often have a lot of dust mites and molds in carpeting, mattresses and upholstered furniture. Fumes from cleaning products may also cause problems. Ask for a "green" room if available. If you are allergic to dust mites, you may want to bring your own dust-proof, zippered covers.

 

 

If you are sensitive to molds, request a sunny, dry room away from areas near indoor pools. Also, if you have allergies to any animals, ask about the hotel's pet policy, and request a room that has been pet-free.
 
Visiting family and friends in their homes can be risky if you have allergies or asthma. For instance, during the holidays, dust mites on ornaments and decorations, molds on Christmas trees, wet leaves and logs for wood-burning stoves and perfumes from scented candles can all trigger allergy or asthma symptoms.

If you have pet allergies, your trip may be more enjoyable if you avoid staying in the homes of family or friends with pets.

People with food allergies should be careful about eating home-cooked foods that may contain hidden food allergens

Reference information: http://www.allergy.hk

The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.

Pollen Allergy

Activities like camping can be fun, but they can also expose you to outdoor pollen as well as to stinging insects like bees, yellow jackets and wasps. If you have these allergies, avoid camping during high pollen seasons, take your medications with you and carry injectable epinephrine to treat reactions to stinging insects. If you have a severe insect-allergic reaction, get immediate emergency medical treatment.

Walking, leisure biking and hiking are typically good activities for people with asthma or allergies. If you enjoy the mountains and have asthma, be careful if you are thinking of going above 5,000 feet, as oxygen levels decrease.

Cold weather sports such as cross-country skiing and ice hockey are more likely to make symptoms worse. Also, snorkeling is much safer than scuba diving.

An asthma treatment plan can help you keep your symptoms under control so that you can enjoy exercising or sports activities while traveling.

Bon voyage and safe travels!



Healthy Tips

• If your allergies or asthma are causing problems, have a pre-trip physical.
• Pack all medications, a peak flow meter and a copy of your physician's phone number.
• Consider buying travel medical insurance.

Reference information: www.aaaai.org,  www.allergy.hk/

The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.

Sweat sensitivity and skin allergy

 

 

Many patients suffering from atopic dermatitis complain of itching and worsening of their rash after sweating. Many patients with atopic dermatitis have been found to have an allergic sensitivity to an as yet unidentified antigen in their own sweat. The majority of these patients develop positive skin test reactions to a 1,000 to 10,000-fold diluted preparation of their own sweat, whereas only 1% of the normal population has a similar reaction.

 

Another condition known as cholinergic urticaria has now been confirmed to be due to sweat allergy. These patients develop extremely itchy small hives on their skin when they are hot or when they exercise. The majority of these patients also have positive sweat skin test.

 

More interestingly, recent clinical studies in Japan suggest that sweat desensitization treatment might be effective for these conditions. Six Japanese patients with cholinergic urticaria underwent desensitization by intradermal injections of escalating doses of their own sweat. Five out of six patients showed significant symptomatic improvement.

 

We have started to offer sweat skin test to our patients who have symptoms of sweat allergy. In those patients with positive reactions, sweat desensitization might be a viable treatment option. This might be particularly valuable to those patients suffering from cholinergic urticaria, as there is currently no other viable treatment option for these patients except antihistamines.

Reference information: http://www.allergy.hk

The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.

Update on peanut allergy

 

 

Food allergy is consistently one of the most anxiety-provoking illnesses for patients or their caregivers, especially if the problem is life-threatening. Eating is something we do several times a day, and the fear that danger lurks within every bite can seriously affect one’s mental well-being. Whereas desensitization treatment has been used for the treatment of allergic rhinitis and asthma for many decades, previous attempts to develop vaccines for food allergy have ended in failure. 

In the last two years, several studies of oral peanut desensitization have been published. While the majority of patients could be successfully desensitized, this treatment is limited by the high rate of adverse reactions and the need for close monitoring.

Sublingual desensitization is a new method of administering desensitization treatment for patients suffering from house dust mite and pollen allergies. Recent studies have shown effectiveness for patients suffering from allergic rhinitis and asthma. The advantages of this form of treatment include convenience and safety.

 A recent study of sublingual desensitization for peanut allergy shows encouraging results. The study was carried out at Duke University in North Carolina and Massachusetts General Hospital in Boston. Eighteen children were given sublingual drops of a peanut allergen extract or placebo at increasing doses. None of the patients suffered severe adverse reactions, with only oral itching as the most significant side effect.

After 12 months of treatment, those who took the extract could tolerate 20 times the amount of peanut given in an oral challenge than those who took placebo. The average amount tolerated was 1700mg, which was equivalent to 6 – 7 peanuts. Presumably, these patients could continue to eat peanuts regularly to maintain their desensitized state thereafter.

We have started to perform sublingual peanut desensitization using the same extract recently and several patients have been successfully desensitized. We are hopeful that this would become a viable alternative for the majority of patients suffering from peanut allergy.

Reference information: www.allergy.hk/

The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.

Enjoy Your Stay with Allergies and Asthma

Hotel rooms often have a lot of dust mites and molds in carpeting, mattresses and upholstered furniture. Fumes from cleaning products may also cause problems. Ask for a "green" room if available. If you are allergic to dust mites, you may want to bring your own dust-proof, zippered covers.

 

 

If you are sensitive to molds, request a sunny, dry room away from areas near indoor pools. Also, if you have allergies to any animals, ask about the hotel's pet policy, and request a room that has been pet-free.
 
Visiting family and friends in their homes can be risky if you have allergies or asthma. For instance, during the holidays, dust mites on ornaments and decorations, molds on Christmas trees, wet leaves and logs for wood-burning stoves and perfumes from scented candles can all trigger allergy or asthma symptoms.

If you have pet allergies, your trip may be more enjoyable if you avoid staying in the homes of family or friends with pets.

People with food allergies should be careful about eating home-cooked foods that may contain hidden food allergens

Reference information: http://www.allergy.hk

The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.

Peanut allergy treatment

Food allergy is consistently one of the most anxiety-provoking illnesses for patients or their caregivers, especially if the problem is life-threatening. Eating is something we do several times a day, and the fear that danger lurks within every bite can seriously affect one’s mental well-being. Whereas desensitization treatment has been used for the treatment of allergic rhinitis and asthma for many decades, previous attempts to develop vaccines for food allergy have ended in failure. 

In the last two years, several studies of oral peanut desensitization have been published. While the majority of patients could be successfully desensitized, this treatment is limited by the high rate of adverse reactions and the need for close monitoring. 

Sublingual desensitization is a new method of administering desensitization treatment for patients suffering from house dust mite and pollen allergies. Recent studies have shown effectiveness for patients suffering from allergic rhinitis and asthma. The advantages of this form of treatment include convenience and safety. A recent study of sublingual desensitization for peanut allergy shows encouraging results. The study was carried out at Duke University in North Carolina and Massachusetts General Hospital in Boston. Eighteen children were given sublingual drops of a peanut allergen extract or placebo at increasing doses. None of the patients suffered severe adverse reactions, with only oral itching as the most significant side effect. After 12 months of treatment, those who took the extract could tolerate 20 times the amount of peanut given in an oral challenge than those who took placebo. The average amount tolerated was 1700mg, which was equivalent to 6 – 7 peanuts. Presumably, these patients could continue to eat peanuts regularly to maintain their desensitized state thereafter.

We have started to perform sublingual peanut desensitization using the same extract recently and several patients have been successfully desensitized. We are hopeful that this would become a viable alternative for the majority of patients suffering from peanut allergy.

Reference information: http://www.allergy.hk

The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.

Pollen Allergy

Activities like camping can be fun, but they can also expose you to outdoor pollen as well as to stinging insects like bees, yellow jackets and wasps. If you have these allergies, avoid camping during high pollen seasons, take your medications with you and carry injectable epinephrine to treat reactions to stinging insects. If you have a severe insect-allergic reaction, get immediate emergency medical treatment.

Walking, leisure biking and hiking are typically good activities for people with asthma or allergies. If you enjoy the mountains and have asthma, be careful if you are thinking of going above 5,000 feet, as oxygen levels decrease.

Cold weather sports such as cross-country skiing and ice hockey are more likely to make symptoms worse. Also, snorkeling is much safer than scuba diving.

An asthma treatment plan can help you keep your symptoms under control so that you can enjoy exercising or sports activities while traveling.

Bon voyage and safe travels!



Healthy Tips

• If your allergies or asthma are causing problems, have a pre-trip physical.
• Pack all medications, a peak flow meter and a copy of your physician's phone number.
• Consider buying travel medical insurance.

Reference information: www.aaaai.org,  www.allergy.hk/, 

The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.

Preventing the eczema itch is the main goal of treatment.

Treatment for allergic contact dermatitis depends on how severe the symptoms are. Cold soaks and compresses can offer relief for the acute, early, itchy blistered stage of your rash. You may also be prescribed topical corticosteroid creams. To prevent the reaction from returning, avoid contact with the offending substance. If you and your allergist cannot determine the substance that caused the reaction, your allergist may conduct a series of patch tests to help identify it.

Eczema
A common allergic reaction often affecting the face, elbows and knees is atopic dermatitis or eczema. This red, scaly, itchy rash is more common in young infants and those who have a personal or family history of allergy.

Common triggers include aeroallergens like cat dander or house dust, overheating or sweating, and contact with irritants like wool or soaps. In older individuals, emotional stress can cause a flare-up. For some patients, usually children, certain foods can also trigger eczema. Skin staph infections can cause a flare-up in children as well. Eczema patients usually have very dry skin and “allergic shiners” (an extra crease, called a Dennie’s line, across their lower eyelids). They are also more at risk for other skin infections.

Preventing the eczema itch is the main goal of treatment. Do not scratch or rub your rash. Applying cold compresses and creams or ointments is helpful. Also remove all irritants that aggravate your condition from your environment. If a food is identified as the cause, it must be eliminated from your diet.

Topical corticosteroid cream medications and topical calcineurin inhibitors are most effective in treating the rash. Antihistamines are often recommended to help relieve the itchiness. In severe cases, oral corticosteroids are also prescribed. If a skin staph infection is suspected to be a trigger for your eczema flare-up, antibiotics are often recommended.

Reference information: www.aaaai.org , www.allergy.hk 

The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.

Enjoy Your Stay with Allergies and Asthma

Hotel rooms often have a lot of dust mites and molds in carpeting, mattresses and upholstered furniture. Fumes from cleaning products may also cause problems. Ask for a "green" room if available. If you are allergic to dust mites, you may want to bring your own dust-proof, zippered covers.

If you are sensitive to molds, request a sunny, dry room away from areas near indoor pools. Also, if you have allergies to any animals, ask about the hotel's pet policy, and request a room that has been pet-free.
Visiting family and friends in their homes can be risky if you have allergies or asthma. For instance, during the holidays, dust mites on ornaments and decorations, molds on Christmas trees, wet leaves and logs for wood-burning stoves and perfumes from scented candles can all trigger allergy or asthma symptoms.

If you have pet allergies, your trip may be more enjoyable if you avoid staying in the homes of family or friends with pets.

People with food allergies should be careful about eating home-cooked foods that may contain hidden food allergens

Reference information: http://www.aaaai.org/

The information aims to provide educational purpose only. Anyone reading it should consult physician before considering treatment and should not rely on the information above.