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1/20/2018: Are hormones in our food causing kids to become to become sexually mature faster?

As parents, we enjoy observing the growth and development of our children.  One such, frequently challenging, developmental milestone is puberty—that rite of passage from children to adulthood.  Statistics support children are entering puberty at earlier ages.  Since the 1990’s, medical journals report increasing numbers of children (both girls and boys =) with abnormally early puberty.

  • 1/3 of American boys are starting puberty at an average age of 9 to 10 years old (up to 2 years earlier than decades ago).
  • American girls (especially African American girls) are entering puberty at least 1 year earlier than previously observed.  The physical changes of puberty are occurring in girls as young as 8 years old.  As of 2010, twice as many girls were experiencing early puberty compared to a decade ago.  When girls younger than 6 or 7 years old show puberty development, this is considered “precocious puberty” and deserves a medical evaluation.
  • The time interval to reach full sexual maturity varies from 2.5 years to 6 years.  Just because a child starts puberty sooner, does not necessarily mean he or she will complete it sooner!

What is causing these changes?

While the reasons for these changes are unclear, the trend in earlier puberty development seems to correlate with:

  • Soy formula in infants:  Since isoflavones in soy are phytoestrogens (act like estrogen from plants), concern has been raised on possible effect on infants— especially after studies on laboratory animals show adverse effects on development.  A study published in Pediatric Perinatal Epidemiology in 2012 studied 2920 white girls (no twins or preemies) and found those children fed soy formula had a 25% increased risk of early menarche (first menstruation).  They concluded the soy may have a mild endocrine disrupting effect.  In 2004, a small study (only 48 children) was published where soy formula for 6 months had no changes on bone metabolism or precocious puberty.  A 2008 American Academy of Pediatrics (AAP) report states there are few indications for the use of soy protein-based formula in place of cow’s milk-based formula in infants.  According to the AAP, the only real indications for soy formula use are for infants with congenital galactosemia (a very rare genetic disorder), for use by families who are strict vegans, or infants who are truly lactose intolerant.
  • Diet: Our body is fueled by what we eat, and what we eat has changed over the years.  This includes more convenience foods and ready-made products.  According to the FDA (Food and Drug Administration) no steroid hormones are approved for growth purposes in dairy cattle, veal calves, pigs or poultry.  However, since the 1950’s, the FDA has allowed synthetic and naturally occurring steroid hormones in our food including estrogen, progesterone and testosterone.  While the FDA feels these slight amounts of added hormones creates minimal risk (compared to the naturally occurring hormones already within the animals) and safety testing has been performed, some scientists argue that no lowest level of hormones has been established as being “safe” as young children tend to be extremely sensitive to even very low levels of estrogen.
  • Obesity:  Estrogens (female hormone) are made and stored in fat tissue, thus exposing overweight children to these hormones.  Physical inactivity may lead to decreased melatonin that triggers pubertal development.
  • Xenoestrogens:  Refers to chemicals that “act like” or mimic estrogen. There is concern that parabens found in soaps, shampoos, cosmetics and cleaning products, as well as pesticides and polychlorinated biphenyls, can be found in breast tissue and even breast milk because of increased exposure to those chemicals.

What can we do?

  • Use soy based infant formula according to AAP recommendations.
  • Strive for a healthy and nutritious diet.  If possible, buy organic to avoid synthetic pesticides.
  • Maintain an appropriate weight including exercise.
  • Avoid processed and high caloric foods.
  • If precocious puberty is diagnosed, a full medical examination should be undertaken by a knowledgeable and trained pediatric specialist.
  • While early puberty development is becoming more common, it doesn’t necessarily translate into being healthier as this creates a gap between a child’s sexual maturity and their emotional and mental maturity.

Remember: “We are what we eat (and drink).”  Choose wisely!

At Family Allergy Asthma & Sinus Care, we think about healthy living even beyond allergies and asthma.

Cheers to a healthy 2018!

Decoding Food Allergies: Break the Code

Do you want to know how severe your milk, egg or peanut allergy can be?  These tests can help!

Allergies to egg, peanut and cow’s milk are among the most common food allergies affecting children. These reactions can range from serious, life threatening reactions (such as anaphylaxis) to milder reactions such as hives.  But, how do you know if the reaction will be mild or severe?

While testing for egg, peanut and milk allergies have been available for many years, there have been limitations.  Allergy skin testing has been very useful but only offers insight into how likely a reaction will be.  A large skin test reaction suggests a reaction is “highly likely,” but is unable to predict how severe a reaction will be.  A negative reaction is helpful in predicting that a food allergy is not present.  Advances in food protein science have made it possible for allergists to now help predict the severity of food allergies to milk, egg and peanut.  A blood test where serum IgE (the allergic antibody) is measured to certain specific proteins in milk, egg, and peanut is now available.  This is called “component testing”.  Having these answers may alleviate the fear many patients and their families face every day.

The two major egg proteins individuals with egg allergy may be allergic to are ovalbumin and ovomucoid.

  • If a person is allergic to ovalbumin, serious reactions may occur if undercooked egg is ingested but most will tolerate egg in baked goods.  Furthermore, the likelihood of resolution of egg allergy is high.
  • In contrast, if a person is sensitized to the ovomucoid protein, he/she is at risk for a severe reaction and unlikely to develop tolerance over time.  Strict egg avoidance is necessary if allergy to ovomucoid is identified while a food challenge in the allergist’s office may be helpful if ovomucoid testing is negative.

There are 2 major classes of milk proteins that can be used in differentiating severity of milk allergy.

  • Casein protein in cow’s milk is responsible for severe allergic reactions and less likely to be “outgrown.”
  • In contrast, whey proteins (alpha-lactalbumin and beta-lactoglobulin) tend to be associated with less severe reactions and the milk protein allergy typically resolves over time.  A milk challenge in the allergist’s office using baked goods containing milk can be a useful tool to assess tolerance.

The proteins in peanuts, Arachis hypogaea, are identified as Ara h and divided into Ara h 1,2, 3, 8 and 9.

  • Those individuals allergic to Ara h 1, 2, 3 are more likely to have severe allergic reactions (anaphylaxis) and need to strictly avoid all contact with peanuts and carry self-injectable epinephrine (EpiPen®).
  • However, if the allergy is to Ara h 8, the risk is moderate and if sensitized to Ara h 9, the risk is low for anaphylaxis.

Why perform food component testing?

  • Testing for the specific protein components of milk, egg or peanut, can help predict the severity of an allergic reaction which can impact the recommendations by allergists when advising patients about safety, lifestyle, and long term risk.  While allergy skin testing is still valuable, the availability of component testing via the Pharmacia ImmunoCAP® test by ThermoFisher Scientific offers additional information on which to make important medical decisions and even long term predictions.

At Family Allergy Asthma & Sinus Care, we help patients understand their food allergy and get to the answer— 1 component at at time!  These pearls of information were brought to you by Jared Bozeman, Senior Medical Student at The Medical College of Wisconsin. Go Packers!

New Treatments for Asthma: Change Your Lifestyle

While the diagnosis of asthma has not changed significantly, the treatment has (and should).  Asthma affects 25 million people (including 7 million children) in the U.S.  The incidence of asthma has increased in the last few decades, and while the exact reason for this is unclear, evidence suggests a link between nutrition/diet, weight, air pollution and allergies.  The treatment for asthma is not just taking medications!

Think of the new asthma treatments as “lifestyle” changes.


  • Antioxidants: While no diet will eliminate or cure asthma, evidence suggests those who embrace diets high in Vitamin C and E, beta-carotene, flavonoids, magnesium, selenium, and omega-3 fatty acids have lower rates of asthma.  Foods high in carotenoids include carrots, watermelon, mango and tomatoes.  Children who grew up eating a “Mediterranean Diet” high in nuts and fruits (grapes, tomatoes, apples) had less asthma symptoms.  Studies show a low Vitamin D level has been linked to asthma attacks and low lung function.  Vitamin D supplements may improve asthma control.  A high fat meal (over 48 grams) can lead to more lung inflammation and less recovery of low lung function with albuterol.
  • Obesity is associated with severe asthma (requiring ER visits) and decreased lung function. Inhaled steroid medications don’t work as well in patients with body mass index (BMI) over 25.  How much weight do you need to lose to help improve asthma?  Only 5 to 10%, and aim for a BMI less than 25.
  • Acid reflux is associated with asthma symptoms.  Heartburn is more likely if a person eats too much, too fast, or too late at night.

Exercise:  Although exercise can sometimes be a trigger of asthma, this is no excuse to be a couch potato.  Exercise has been shown to improve quality of life in persons with asthma with more symptom-free days, better oxygen consumption, and less inflammation.  How much exercise is enough?  At least 30 minutes three times a week, with a goal of 150 minutes per week (30 minutes minutes a day, 5 times a week).  Exercise can also be helpful with weight control.

Stress control:  Individuals with asthma who have anxiety and depression are at increased risk of asthma attacks.  A disorder called vocal cord dysfunction triggered by anxiety can complicate asthma but not respond to asthma medications.  Interventions may include counseling, breathing relaxation techniques, and sometimes anti-anxiety medications.

Allergen control: Up to 90% of children with asthma may have allergies and these allergies can trigger asthma.  In adults, about 70% of patients with asthma have allergies.  By treating your allergies, the asthma can improve.

Air pollution.  Air pollutants that include small particles can trigger asthma.  Sources include cigarette smoking, wood smoke (campfires, wildfires, poorly ventilated indoor stoves), diesel exhaust, soot and ash.  Strong chemicals and fumes are also triggers.

Vaccines:  viruses such as influenza, RSV, and the common cold virus called Rhinovirus can trigger asthma.  The flu vaccine is recommended for all individuals over 6 months old, but especially for those with asthma according to the CDC.

Medications:  They are still important!

  • Quick relief:  albuterol is still the most common inhaler in use today to help relieve symptoms of asthma and prevent exercise-induced asthma when used 15 minutes before exercise.  Whether it is by a nebulizer or inhaler, keep it on hand.  The newer devices have dose counters and are easier to use.
  • Daily controller:  this group includes the inhaled corticosteroids deemed the most effective treatment for asthma.  When combined with long-acting bronchodilators, the combination is even better for those with moderate to severe asthma.  The newest combination medications are taken only once a day.  Medications like Singular® block an inflammatory pathway without being a steroid medication and are taken as a pill once a day.  Spiriva, an inhaled medication long known to be used for COPD (chronic lung disease from smoking), was recently approved for treating asthma.
  • Biologicals:  The injectable medication Xolair® has been available since 2003 and blocks the allergic antibody IgE.  Mepolizumab marketed as Nucala® and approved in 2015 is monthly injection that works by blocking the protein interleukin-5 to prevent buildups of white blood cells called eosinophils in the lungs that can trigger asthma.

Individuals with asthma have choices.  While there is no cure for asthma, the available treatment options and lifestyle changes can help control asthma so individuals can lead healthy, productive lives.  By controlling asthma, it will not control you! Go Panthers!!!

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These educational information does not take the place of your physician's advice.

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