Food allergies have increased dramatically over the past 15 years with more and more children affected.
In addition to traditional food allergies such as peanuts, dairy products and shellfish, there has been a increase in children with reactions to foods not previously considered part of the top eight allergens.
Specialists are now seeing allergies to sesame, fruits, and other foods as we are importing more foods and consuming more foods from other cultures.
The increase has been seen in both percentage of people with reactions and in the severity of reactions, and is particularly a problem in developed countries and among the children of immigrants.
How big is the problem? What is the reason for the increase? How do you prevent or treat these allergies?
Chitra Dinakar, MD is here to discuss the future with food allergy treatment and prevention?
Selected Podcast
New Emerging Food Allergies
Featured Speaker:
Learn more about Chitra Dinakar, MD
Chitra Dinakar, MD
Chitra Dinakar, MD is a pediatric allergy and Immunology specialist at Children’s Mercy Kansas City where she serves as Director for the Food Allergy Center and holds a faculty position as Professor in the Department of Pediatrics for the University of Missouri-Kansas City. Dr. Dinakar received her medical and pediatric training at Jawaharlal Institute of Post Graduate Medical Education and Research, Madras University and Pondicherry University, both in India. She completed a residency in pediatrics at Metrohealth Medical Center in Cleveland, Ohio and a fellowship in Pediatric Allergy and Immunology at the Cleveland Clinic Foundation, Cleveland, Ohio. In 2015 Dr. Dinakar was recognized by her peers with the American College of Allergy, Asthma and Immunology’s Woman in Allergy Award and in 2016 will serve as Director of the American Board of Allergy and Immunology.Learn more about Chitra Dinakar, MD
Transcription:
New Emerging Food Allergies
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I’m Dr. Michael Smith. Our topic is “New Emerging Food Allergies.” My guest is Dr. Chitra Dinakar. Dr. Dinakar is Director of the Food Allergy Center and holds a faculty position as professor in the Department of Pediatrics for the University of Missouri Kansas City. Dr. Dinakar, welcome to the show.
Dr. Chitra Dinakar (Guest): Thank you.
Dr. Smith: We’re going to talk about food allergies but let’s first get some basic definitions out of the way. Let’s talk about the difference between food allergy and then, a very common term that we’re hearing in the news and stuff, is food sensitivity. What’s the difference?
Dr. Dinakar: Great question. I actually would like to throw in one more term and that’s “sensitization” and I’ll explain what they all are. Food sensitization is when somebody does an allergy test on you and the blood test comes back positive or you went in for an environmental allergy and somebody did skin testing and it came back positive. That’s called “sensitization” which means your body is able to produce the allergy antibody to that particular food but it doesn’t necessarily mean that you have a clinical allergy which means when you eat the food, within minutes to two hours you get hives, rash, vomiting, diarrhea, wheezing. That is what we call a “clinical allergy” where every time you eat the food you get the response that is allergic in nature and is consistent. Food sensitivity is when, for some reason, your body just cannot handle the food in the amounts that you are normally used to eating. It doesn’t mean that small amounts of the food will cause a violent reaction in your body, which is what happens which is what happens with an allergic type of response. It just means that instead of drinking two cups of milk maybe all you can drink is ½ cup a milk and if you drink more than that you get more like intolerance symptoms. Does that help?
Dr. Smith: Yes. What we’re going to focus on is this new emergent of true food allergy, meaning after you’ve been exposed there’s the immune response and within a pretty short period of time you definitely develop symptoms and in some cases it can be life-threatening. So, that’s what we’re going to focus on. How big is this problem getting with food allergy?
Dr. Dinakar: It’s getting really big. Right now, there are about 15 million people in the United States with food allergies, nine million of them being adults and six million being children. Interestingly, of course, the incidence in children is higher. It’s about 8% right now and really increasing rapidly. For instance, a recent study in 2013 by the Centers for Disease Control and Prevention reported a staggering 50% increase between 1997 and 2011. So, it’s really increasing very rapidly.
Dr. Smith: So, you’ve even called it the new epidemic, right?
Dr. Dinakar: Right. That’s the terms that people have been using.
Dr. Smith: Yes. What’s going on? What are we doing? What is it? Our environment, the food, preservatives? Why do you think we are seeing such a dramatic increase?
Dr. Dinakar: I know that’s really very puzzling and puzzling to all of us including allergists. It is really the focus of a lot of research. A few common themes and patterns are emerging that is explaining some of this increase. The most popular one that you may have heard of is called a “hygiene hypothesis.” It really reflects the balance of our immune system in our body. As you can imagine, the main job of the immune system is to fight foreign terrorists like bacteria or viruses or bugs which are trying to invade us. Instead, what is happening is we are getting more of an allergic response to normal things like foods or ragweed and that’s because our body is not getting exposed enough to the bacteria and viruses that are invading us because they are a little too clean. In one sense, we are becoming so good about maintaining hygiene, which is great for fighting infections, but, unfortunately, it’s shifting our immune system to becoming more allergic.
Dr. Smith: Now, Dr. Dinakar, is that a direct reference, then, to the explosion to hand sanitizers? Almost everything we use now to clean the kitchen can kill just about anything. Is that what we’re referring to by the “hygiene hypothesis”? We’re overusing some of those products? Is that what we’re talking about?
Dr. Dinakar: Yes. It is a reflection of some of the sanitation habits that people develop, which is very good for fighting infection – I still want to stress that. But, for instance, even a recent study looked a dish washing versus hand washing and showed that the people who used dishwashers tended to have more allergies because it is cleaner but there were less germs there for the body to react to. So, those are some theories that are looking at the hygiene hypothesis. We are also wondering if the common notion of delaying introduction of the highly allergenic foods, like the common practice of introducing peanuts only after you’re three years of age and egg after three years of age – maybe that is also not helpful. Maybe there’s a window of time between four and nine months or four and eleven months where we should be introducing these foods. That was recently looked at by something called the LEAP study that I would be happy to elaborate on a little bit later.
Dr. Smith: So, the LEAP study was specific to the peanut allergy, correct?
Dr. Dinakar: Exactly. You’re absolutely right. The LEAP study looked at peanut mainly because peanut is one of our biggest reasons for anaphylactic reactions that are severe. Therefore, looking at how can you prevent peanut allergy from developing is a very important question for all allergists and all of us.
Dr. Smith: In that study, what they did is they exposed at a younger age, what was it? Within six months? These infants were exposed to the peanut and what they found later down the line was less allergies in those that received the peanut earlier, is that correct?
Dr. Dinakar: Exactly. This looked at the introduction of peanuts between four to eleven months of age and they had a protocol on how to introduce it and they also chose the subjects carefully. It wasn’t people or children who were really likely to react, it was the ones with eczema or egg allergy who had mild reactions on skin testing, what I was referring to as sensitization, to the peanut then they introduced them to a protocol of gradual introduction of peanuts on a weekly basis regularly. They demonstrated a successful reduction, like 11-25% absolute reduction, in the high risk patients or infants, which is a very important group to target. That really led to a lot of encouragement that early introduction or there’s a window of time in the child’s life when you want to introduce these foods that actually result in a development of tolerance. This brings me back to your question of what are the other reasons for increase and one concept is that if you introduce a food through the oral route or through the mouth that maybe you get tolerance but if you happen to get exposed to it earlier on through the skin or through inhalation, as the severe eczema kids, if there is peanut oil exposure or other things in the ointment they’re using, maybe they are then tending to develop more peanut allergy. Maybe it’s a type of food. Maybe roasting peanut is worse than boiling peanut and we know that roasting is more allergenic. So, just different concepts to explain why this whole thing is increasing so much.
Dr. Smith: So, here we have the increase in cases; we have different theories in why. So, are we treating food allergies better today? What are some of the ways or options that you’re using to prevent and treat food allergies?
Dr. Dinakar: Great question. There’s no question that there is increased awareness of food allergies thanks to media and people talking about it and organizations like the Food Allergy and Research Education and other allergy networks. Many different organizations are spreading information so there’s definitely increased awareness which is great. Once the allergy has developed, though, there is no treatment right now except protocols are being developed regarding trying to help the patient to get desensitized to develop tolerance. Before that, the primary mainstay of therapy seems to be avoidance once the child has developed the allergy and then monitoring them over time to see if they outgrow the food allergy. The good news is that certain foods like milk and eggs and soy and wheat, you can outgrow it. Certain foods like tree nuts and peanuts are more resistant and take longer times to be outgrown. Even for the peanut, for instance--we can just take that as an example--once you’ve developed it and you’re not the type who’s tending to outgrow, which the doctor can monitor by testing you over time, then there are some protocols and studies that are occurring and there are couple of peanut desensitization protocols that are now FDA fast-tracked for approval that are ongoing. These are now Phase III studies. One involves a peanut patch on the skin and the other involves ingesting a special peanut powder extract that’s patented by this company. My center is intending to participate in these trials and we are hoping to offer that.
Dr. Smith: Nice. Well, Dr. Dinakar, I want to thank you for the work that you are doing and I want to thank you for coming on the show. You’re listening to Transformational Pediatrics at Children’s Mercy Kansas City. For more information you can go to ChildrensMercy.org. That’s ChildrensMercy.org. I’m Dr. Michael Smith. Thanks for listening.
New Emerging Food Allergies
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I’m Dr. Michael Smith. Our topic is “New Emerging Food Allergies.” My guest is Dr. Chitra Dinakar. Dr. Dinakar is Director of the Food Allergy Center and holds a faculty position as professor in the Department of Pediatrics for the University of Missouri Kansas City. Dr. Dinakar, welcome to the show.
Dr. Chitra Dinakar (Guest): Thank you.
Dr. Smith: We’re going to talk about food allergies but let’s first get some basic definitions out of the way. Let’s talk about the difference between food allergy and then, a very common term that we’re hearing in the news and stuff, is food sensitivity. What’s the difference?
Dr. Dinakar: Great question. I actually would like to throw in one more term and that’s “sensitization” and I’ll explain what they all are. Food sensitization is when somebody does an allergy test on you and the blood test comes back positive or you went in for an environmental allergy and somebody did skin testing and it came back positive. That’s called “sensitization” which means your body is able to produce the allergy antibody to that particular food but it doesn’t necessarily mean that you have a clinical allergy which means when you eat the food, within minutes to two hours you get hives, rash, vomiting, diarrhea, wheezing. That is what we call a “clinical allergy” where every time you eat the food you get the response that is allergic in nature and is consistent. Food sensitivity is when, for some reason, your body just cannot handle the food in the amounts that you are normally used to eating. It doesn’t mean that small amounts of the food will cause a violent reaction in your body, which is what happens which is what happens with an allergic type of response. It just means that instead of drinking two cups of milk maybe all you can drink is ½ cup a milk and if you drink more than that you get more like intolerance symptoms. Does that help?
Dr. Smith: Yes. What we’re going to focus on is this new emergent of true food allergy, meaning after you’ve been exposed there’s the immune response and within a pretty short period of time you definitely develop symptoms and in some cases it can be life-threatening. So, that’s what we’re going to focus on. How big is this problem getting with food allergy?
Dr. Dinakar: It’s getting really big. Right now, there are about 15 million people in the United States with food allergies, nine million of them being adults and six million being children. Interestingly, of course, the incidence in children is higher. It’s about 8% right now and really increasing rapidly. For instance, a recent study in 2013 by the Centers for Disease Control and Prevention reported a staggering 50% increase between 1997 and 2011. So, it’s really increasing very rapidly.
Dr. Smith: So, you’ve even called it the new epidemic, right?
Dr. Dinakar: Right. That’s the terms that people have been using.
Dr. Smith: Yes. What’s going on? What are we doing? What is it? Our environment, the food, preservatives? Why do you think we are seeing such a dramatic increase?
Dr. Dinakar: I know that’s really very puzzling and puzzling to all of us including allergists. It is really the focus of a lot of research. A few common themes and patterns are emerging that is explaining some of this increase. The most popular one that you may have heard of is called a “hygiene hypothesis.” It really reflects the balance of our immune system in our body. As you can imagine, the main job of the immune system is to fight foreign terrorists like bacteria or viruses or bugs which are trying to invade us. Instead, what is happening is we are getting more of an allergic response to normal things like foods or ragweed and that’s because our body is not getting exposed enough to the bacteria and viruses that are invading us because they are a little too clean. In one sense, we are becoming so good about maintaining hygiene, which is great for fighting infections, but, unfortunately, it’s shifting our immune system to becoming more allergic.
Dr. Smith: Now, Dr. Dinakar, is that a direct reference, then, to the explosion to hand sanitizers? Almost everything we use now to clean the kitchen can kill just about anything. Is that what we’re referring to by the “hygiene hypothesis”? We’re overusing some of those products? Is that what we’re talking about?
Dr. Dinakar: Yes. It is a reflection of some of the sanitation habits that people develop, which is very good for fighting infection – I still want to stress that. But, for instance, even a recent study looked a dish washing versus hand washing and showed that the people who used dishwashers tended to have more allergies because it is cleaner but there were less germs there for the body to react to. So, those are some theories that are looking at the hygiene hypothesis. We are also wondering if the common notion of delaying introduction of the highly allergenic foods, like the common practice of introducing peanuts only after you’re three years of age and egg after three years of age – maybe that is also not helpful. Maybe there’s a window of time between four and nine months or four and eleven months where we should be introducing these foods. That was recently looked at by something called the LEAP study that I would be happy to elaborate on a little bit later.
Dr. Smith: So, the LEAP study was specific to the peanut allergy, correct?
Dr. Dinakar: Exactly. You’re absolutely right. The LEAP study looked at peanut mainly because peanut is one of our biggest reasons for anaphylactic reactions that are severe. Therefore, looking at how can you prevent peanut allergy from developing is a very important question for all allergists and all of us.
Dr. Smith: In that study, what they did is they exposed at a younger age, what was it? Within six months? These infants were exposed to the peanut and what they found later down the line was less allergies in those that received the peanut earlier, is that correct?
Dr. Dinakar: Exactly. This looked at the introduction of peanuts between four to eleven months of age and they had a protocol on how to introduce it and they also chose the subjects carefully. It wasn’t people or children who were really likely to react, it was the ones with eczema or egg allergy who had mild reactions on skin testing, what I was referring to as sensitization, to the peanut then they introduced them to a protocol of gradual introduction of peanuts on a weekly basis regularly. They demonstrated a successful reduction, like 11-25% absolute reduction, in the high risk patients or infants, which is a very important group to target. That really led to a lot of encouragement that early introduction or there’s a window of time in the child’s life when you want to introduce these foods that actually result in a development of tolerance. This brings me back to your question of what are the other reasons for increase and one concept is that if you introduce a food through the oral route or through the mouth that maybe you get tolerance but if you happen to get exposed to it earlier on through the skin or through inhalation, as the severe eczema kids, if there is peanut oil exposure or other things in the ointment they’re using, maybe they are then tending to develop more peanut allergy. Maybe it’s a type of food. Maybe roasting peanut is worse than boiling peanut and we know that roasting is more allergenic. So, just different concepts to explain why this whole thing is increasing so much.
Dr. Smith: So, here we have the increase in cases; we have different theories in why. So, are we treating food allergies better today? What are some of the ways or options that you’re using to prevent and treat food allergies?
Dr. Dinakar: Great question. There’s no question that there is increased awareness of food allergies thanks to media and people talking about it and organizations like the Food Allergy and Research Education and other allergy networks. Many different organizations are spreading information so there’s definitely increased awareness which is great. Once the allergy has developed, though, there is no treatment right now except protocols are being developed regarding trying to help the patient to get desensitized to develop tolerance. Before that, the primary mainstay of therapy seems to be avoidance once the child has developed the allergy and then monitoring them over time to see if they outgrow the food allergy. The good news is that certain foods like milk and eggs and soy and wheat, you can outgrow it. Certain foods like tree nuts and peanuts are more resistant and take longer times to be outgrown. Even for the peanut, for instance--we can just take that as an example--once you’ve developed it and you’re not the type who’s tending to outgrow, which the doctor can monitor by testing you over time, then there are some protocols and studies that are occurring and there are couple of peanut desensitization protocols that are now FDA fast-tracked for approval that are ongoing. These are now Phase III studies. One involves a peanut patch on the skin and the other involves ingesting a special peanut powder extract that’s patented by this company. My center is intending to participate in these trials and we are hoping to offer that.
Dr. Smith: Nice. Well, Dr. Dinakar, I want to thank you for the work that you are doing and I want to thank you for coming on the show. You’re listening to Transformational Pediatrics at Children’s Mercy Kansas City. For more information you can go to ChildrensMercy.org. That’s ChildrensMercy.org. I’m Dr. Michael Smith. Thanks for listening.