Cheryl Martin (Host): What's the best way to manage peanut allergies in children with care and competence? We get some answers from Dr. Mehek Mehta, an Allergy and Immunology Specialist at Guthrie. She specializes in pediatric food allergies. This is Medical Minds, Conversations with Guthrie Experts, a podcast from the Guthrie Clinic.

I'm Cheryl Martin. Delighted to have you on with us, Dr. Mehta.

Mehek Mehta, MD (Guest): Thank you so much, Cheryl. I'm very excited to be here and to have the opportunity to share all the new things out there now for food allergy.

Host: Well, we are looking forward to hearing all about them. So, to start off, give us an overview of the current landscape regarding pediatric peanut allergies.

Mehek Mehta, MD (Guest): Yeah, absolutely. I mean, I find it fascinating how much over just the last four or five years, we've learned so much about food allergy, you may have learned that I think we've sort of flipped our guidelines. We used to, back in the 2000s, say that we shouldn't introduce peanut at all to our kids until they're three years of age, or even at least one year of age, and guidelines have completely flipped.

We're now seeing that kiddos as young as four months should be getting peanuts. So I think that comes along with a lot of research that has been going on, and a lot of new strides and understanding of the underlying immune system. So it's really exciting. I think we're heading in the direction of finally getting to the point of going beyond of, oh, well, you have a food allergy we need to avoid.

I think we're at the point where you know, what can we do more? Is there a way to prevent? Is there other therapies out there? So, it's an exciting time.

Host: So, what are some key considerations parents should keep in mind?

Mehek Mehta, MD (Guest): I think the biggest thing that I've been trying to get out there, just because of the recent change of guidelines is, early introduction of the major food allergens, and particularly peanut, has been shown to help prevent food allergy, and peanut allergy. So that's my biggest thing I try to get through to families and parents is, don't worry so much.

 If the kiddo's eating and, you know, drinking and they're ready to feed, then, start with the major allergens. Peanut's totally fine to start with. And if there are questions, concerns, then that's what I'm here for. I'm happy to kind of help families get through that process as well, but really just to kind of early introduce things.

Host: So, you're saying parents should not automatically assume that the child may be allergic to peanuts, and so it's okay to feed them peanuts.

Mehek Mehta, MD (Guest): Exactly. And, we have, peanut safe, forms, there's the peanut butter where you can mix it in into their oatmeal, or even nowadays there's peanut powder. So as long as it's safe for their age, so, coming away from the fear of peanut allergy and kind of moving towards actually early introduction so that our immune system can learn, and register, essentially, the food to be a benign food as it is. You know, I think the whole concept of food allergy developing comes along with abnormal responses to food. So how can we in a critical time of the child's immune system kind of help as much as we can with preventing food allergy?

Host: I'm glad you brought that up because specifically for peanut allergies, how would a parent know that their child is indeed allergic to peanuts?

Mehek Mehta, MD (Guest): So I can definitely go over the most common symptoms should occur within the first or second time that the food is introduced. Usually the second time and you might notice hives, things that look similar to mosquito bites, any trouble breathing, coughing, congestion, all those things can be subtle symptoms.

Of course, if it's more severe symptoms of trouble breathing, you'd be taking the child over to be seen in the emergency department. But those subtle symptoms of hives are usually the first things that come up and would warrant a further evaluation.

Host: Shed some light on advancements in treatment, such as oral immunotherapy.

Mehek Mehta, MD (Guest): This is a very exciting time and oral immunotherapy, basically the foundation lies in our better understanding of the immune system and what causes food allergies. So the goal becomes, immunotherapy is trying to build a tolerance with the immune system with early introduction and slow introduction to shift the immune system over from an allergy towards a tolerance.

So the goal becomes to induce a tolerance state. I like to compare it to allergy shots, but this is an oral form, of a very similar concept. So it's a lengthy process. We're not really at the point of understanding the nuances of this process, but it has been shown to be helpful in at least increasing the threshold of having a reaction, possibly curing. All this data and research that's out there does support, that the chances are better the younger this is started, especially if they're less than two years of age.

So there's definitely this critical period where the immune system is learning. So I can't really say too much in terms of how concrete all this is, but there's been a lot of great research, I think back in 2020 actually, was the first FDA approved immunotherapy.

So it has been around now for a good four years, and we're just kind of learning more, and I personally have tried to expand it down to the younger ages as well.

Host: Any other treatments you'd want to discuss?

Mehek Mehta, MD (Guest): I will just mention, just a few weeks ago, there was a new biologic approved for food allergy called omalizumab. This is one of the first of its kind, you know, besides the EpiPen, the emergency meds we have, this medication is an injection medication approved to I wouldn't say prevent, but at least, hopefully protect children and adults from anaphylaxis or having a severe allergic reaction to food ingestion or an accidental food ingestion.

So there's a lot of new things. So this medication can help protect them, maybe help them get through oral immunotherapy in a safer way, or simply just add that layer of cushion for folks who may be very allergic.

Host: Now, considering the emotional impact of pediatric peanut allergies on families, what advice do you have for parents and caregivers in supporting their children through this journey?

Mehek Mehta, MD (Guest): Absolutely. Food allergy is very hard. It's very hard on our families, the patients, the kiddos, school, what they get to do, travel. So it has a huge impact on our lives. So the biggest thing that I like to talk about and convey is as much as you can try to learn about food allergy, learn about that food allergy that your child has. There is this network FARE, F-A-R-E, that has a lot of great resources, to learn more about it and to also, at least normalize as much as you can their day to day. The actual rates of having a life threatening or fatal reaction to a food allergy are very low, down in the 0.2%. So it's, very low and it's even lower for children. So once we understand the prognosis, and the true risk involved, I think that can help with instead of living in this constant fear, understanding how we can be safe, but still allowing our children to be out there and explore in a safe way.

So, along those lines, I will mention one last thing about really advocating. Advocating in our schools, advocating for our children in terms of just them being able to have that normal experience. I think because of the shift of guidelines, learning that kids should be able to eat next to other folks who may have food allergies, there does not need to be that same type of fear after we've learned so much. So I think, ask questions, advocate and be prepared, if things do happen, be prepared to treat them and things will be okay.

Host: Now, what about preventing peanut allergies in children? Is this possible?

Mehek Mehta, MD (Guest): So it's hard to say. I would say simple answer is yes. There is some hope and possibility. I think the biggest thing that helps us get to that point is this very large, research study that was done. It was the LEAP trial and it showed that prevention was possible.

And that sort of takes me back to that early introduction I was talking about. That was the biggest thing that really did help prevent the development of peanut allergy was if we were able to introduce things early. Of course, there are many factors that play a role in food allergy, from family history, genetics, other atopic and allergy conditions that can affect our risk in developing food allergy.

But in the end, it's a complicated question but I will say there is some that we can do to help prevent as much as we can.

Host: Okay, and the main thing is to introduce peanuts at an early age?

Mehek Mehta, MD (Guest): Correct. Yeah, I feel like that would be the biggest takeaway is, you know, the earlier you can get the major food allergens into the diet, the earliest we can have the immune system see them the best.

Host: And once again, you say as early as infancy.

Mehek Mehta, MD (Guest): Yeah, yeah, exactly. So, the infant is ready to eat around four months, they can go ahead and get it that early. So four to six months of age is totally safe for them to move forward with food introduction and allergen introduction.

Host: What are the key takeaways you would like us to remember when it comes to pediatric peanut allergies?

Mehek Mehta, MD (Guest): The early introduction is biggest one. The other major one that I would actually, I don't think we've spoken too much about, but I'll mention it, we briefly talked about the signs and symptoms of an allergic reaction. Food allergy does not seem to be associated with eczema as strongly as we used to think.

So if there are questions, concerns about an allergic reaction, always seek out an evaluation rather than avoiding completely the food as that can go along the lines of potentially contributing to a food allergy developing. So a lengthy period of avoidance, food avoidance, can sometimes put us at risk of developing the food allergy.

So it sort of ties in that introduce early, let the immune system see it, keep it in the diet somewhat regularly. And, if there are concerns, then seek out help and we can sort of be there to work through things together.

 Yeah, so

Host: Dr. Mehta, thanks so much for sharing some great information on this important topic. Good information. Thanks.

Mehek Mehta, MD (Guest): Yeah thank you so much for having me.

Host: To learn more, visit Guthrie.org/allergy. If you found this podcast helpful, please share it on your social media and be sure to check out the entire podcast library for other topics of interest to you.

This is Medical Minds, conversations with Guthrie experts, a podcast from the Guthrie Clinic. Thanks for listening.