Thursday, March 20, 2014

Pediatric Allergy and Immunology

By: Dr. Prescott Atkinson_ Director of Pediatric Allergy and Immunology at Children’s of Alabama and a Professor of Pediatrics at UAB
Twenty or thirty years ago, few medicines other than antihistamines were available to treat allergies. Now, we have a vast and growing array of pills, sprays, inhalers and injections that provide increasingly effective treatment for a wide variety of allergic and immunologic illnesses.

At Children’s of Alabama, physicians in Pediatric Allergy and Immunology see children with allergic diseases ranging from simple hay fever to complex, potentially life-threatening conditions such as asthma and anaphylaxis, a severe reaction that can occur following exposure to stinging insects, foods or drugs such as penicillin. For instance, we treat chronic or acute hives, and we treat swelling disorders, particularly hereditary angioedema, which is marked by terrible, sometimes life-threatening swelling that can cause airway obstruction.

We also treat children with atopic dermatitis (allergic eczema) and we assist in the diagnosis and management of food allergies, which are often seen in children with atopic dermatitis.  Together with our pediatric gastroenterologists at Children’s, we are currently helping diagnose and treat patients with a severe inflammatory condition of the esophagus called eosinophilic esophagitis (EoE) that is associated with atopic dermatitis and food allergy. The condition isn’t as rare as you might think - there are hundreds of these patients in Alabama.  EoE is much like eczema of the esophagus. It is an allergic inflammatory process that causes pain, vomiting and more significantly, scarring of the esophagus so patients develop strictures or narrowing. This can cause food to get impacted in the esophagus and lead to a trip to the emergency room.

There’s much we don’t know about eosinophilic esophagitis. It is clearly related to hyper-sensitivity or allergy, often to foods. When the tissue is put under a microscope, it looks a lot like eczema. It’s not a pure allergic problem, but it has an allergic component. Cow’s milk is often the culprit.

We have many medications and techniques we can use to treat all these allergic illnesses. For example, we can provide immunotherapy shots to reduce a patient’s sensitivity to common aeroallergens such as pollen, house dust mites and animal dander and to insect stings. The treatment of severe insect sting allergy of the type that causes anaphylaxis with immunotherapy has been proven to work in numerous scientific studies, but many people, including those in the local medical community, are not aware of this important treatment option.

We’re getting more knowledgeable about how the immune system works, and many new biologic medical products are now coming onto the market. The first of these biologics to be approved by the FDA, a monoclonal antibody called omalizumab, or Xolair, is used in patients with allergic asthma. It’s moderately effective at blocking the allergic reaction. Unfortunately, it’s costly, so it’s not something to take for conditions like hay fever, but it becomes a cost-effective option for patients who have allergic asthma that is putting them in the hospital every other month.

Often, patients come to us with suspected food allergies, and right now all we can do is provide them with the right diagnostic testing and then give advice on how to best avoid their specific allergens – there aren’t any shots or specific treatments available. Food allergies have proven extremely difficult to treat, but that may be changing. Research is advancing into protocols to desensitize patients with these allergies. These treatment protocols are still being developed but if and when they become approved for use in dedicated centers, I’d certainly like our clinic to be one of those. For example, one of the latest studies shows that patients with severe peanut allergies may never get to the point where they can eat a bag of peanuts, but they may be able to safely eat a single peanut, which is sufficient to keep them from having a severe allergic reaction from an accidental exposure.

Of course, all these new treatments require a high degree of specialized skill. Our specialists are certified by the American Board of Allergy and Immunology. That means spending at least two years in a subspecialty program with a highly defined and monitored training curriculum to learn how to practice clinical allergy and immunology. This rigorous training is capped by a difficult examination. All graduates since 1990 have been required to participate in maintenance of certification to ensure continuing expertise with new medical discoveries.

For more information about our program or allergies in general, visit We have excellent content on the site specifically designed for children, teens and parents.

Dr. Prescott Atkinson is Director of Pediatric Allergy and Immunology at Children’s of Alabama and a Professor of Pediatrics at UAB. He is board certified in pediatrics, as well as pediatric allergy and immunology. He received his MD/PhD from Emory University in 1987, completed his pediatric residency at Georgetown University, and completed a fellowship in allergy and immunology at the National Institutes of Health in 1992. He joined the faculty at UAB that year.

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