The Ultimate Food Fight: Children with Food Allergies
Having a child with food allergies can be a battle. Not only can it be inconvenient and painful, but it can be scary. Dr. Michael Marcus discusses what causes food allergies, what symptoms to look for, and how to live with them.
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Learn more about Michael Marcus, MD
Michael Marcus, MD
Dr. Michael Marcus is the Director of Pediatric Pulmonary Medicine as well as Allergy/Immunology, caring for both children and adults. He is also the Vice Chair of the Pediatric Ambulatory Network, at Maimonides Medical Center in Brooklyn, NY. Dr. Marcus completed his residency at Nassau County Medical Center. Subsequently, he went on to do his fellowship in Allergy/Immunology and Pediatric Pulmonology at Children's Hospital of Philadelphia (CHOP). Dr. Michael Marcus is active in research and has published extensively throughout his career, with a focus on asthma and allergies. He has special interests in asthma, urticaria and food & environmental allergies as well as gastroesophageal reflux and its impact on lung disease. Currently, Dr. Marcus holds the academic title of Associate Professor of Pediatrics at SUNY Downstate. He is a member of ATS and AAAI, as well as a fellow of ACCP and lectures both locally and nationally to a variety of audiences on a many topics including asthma, chronic sinusitis and lung diseases of children. His treatment philosophy is based on family-centered care. Dr. Marcus believes in the importance in communicating with both child and family throughout the healthcare process, and partnering with the family for the continual well-being of the child.Learn more about Michael Marcus, MD
Transcription:
The Ultimate Food Fight: Children with Food Allergies
Joey Wahler (Host): Having a food allergy can be a challenge for adults, but what about for kids and their parents? We're discussing how to live with pediatric food allergies. This is Maimo Med Talk. Thanks for listening. I'm Joey Waller. Our guest from my minorities is Dr. Michael Marcus director of pediatric pulmonary medicine and allergy immunology, as well as vice chair of the Pediatric Ambulatory Network. Dr. Marcus, thanks for joining us.
Dr Michael Marcus: You're very welcome. Thank you for having me.
Joey Wahler (Host): So in a nutshell, what causes a food allergy?
Dr Michael Marcus: A food allergy is an abnormal immune response to a common substance. In this case of food, what turns on the process, we really don't know. Although food allergies do run in families as all allergies can.
Joey Wahler (Host): So generally speaking, what symptoms should parents look for in children to detect a possible food allergy?
Dr Michael Marcus: The symptoms can vary quite broadly. It can be classic allergy symptoms, such as sneezing, runny nose, coughing, or wheezing. The more common symptoms that families. Always think about our various rashes, such as eczema or hives, but these kinds of reactions are not always the reactions that identify a food allergy. Finally, in the most severe case, you can can develop something called anaphylaxis, which is the most severe type of allergic reac,tion where not only are there the skin reactions, but also there's a true difficulty breathing to the point where it could become quite dangerous.
Joey Wahler (Host): So, how do you usually go about testing for a food allergy?
Dr Michael Marcus: There are three basic ways that food allergies can be tested for. The first way that doctors tend to start with is with blood tests. Blood tests have the benefit of being able to be done across a broad range of ages, although the inconvenience of sticking a child with a needle is not small. The problem with blood work is that it can show reactions that are not true. Food allergies, so called false positives where it looks like a person is allergic to the food when they're really not. And it can also have false negatives where you can have no reaction at all in the blood.
Yet, still have a reaction to the food. The second type of test is the classic allergy skin testing. This is certainly more accurate than the blood test because you're actually introducing the purified protein of the food that we believe is the cause of the reaction directly under the skin with a small prick. This gives you a more accurate result. But is certainly a bit more uncomfortable for the child. The gold standard though, is a direct challenge. This is done only after one of the two previous tests are done.
With the direct challenge the child is given the tiniest quantity of the purified protein to see if a reaction actually occurs. It's such a small quantity that you won't get a serious reaction, but it needs to be done under a physician's care so that whatever reaction can be taken care of in a safe fashion.
Joey Wahler (Host): Gotcha. So what foods are children most typically allergic?
Dr Michael Marcus: In theory, you could be allergic to any food, but the things that children become allergic to more commonly are a group of five or six foods beginning with milk, eggs, peanuts soy and wheat fish also becomes an issue. But the thing to remember is that it is not common to develop a reaction to food the very first time they're exposed, there has to be some previous exposure of some type, so the child would become sensitive to the food. So that on the second or subsequent exposures, the actual allergic reaction develops.
Joey Wahler (Host): So what's the normal course of treatment if there is an allergy present?
Dr Michael Marcus: Well, the first step is to avoid the food. If a patient is known to have analogy to peanuts or milk, then you have to totally avoid that food. And clearly such as in the case of milk finds an appropriate substitute to the child has proper nutrition. If a child develops an actual reaction to a food that's taken in accidentally, or perhaps on purpose. Proper treatment would be the treatment of the symptoms. So if you have reactions in the skin, you would wanna use antihistamines.
You may need a skin cream, such as a topical steroid, but if you develop something called anaphylaxis that most severe reaction, you would wanna use a device called an EpiPen. As an immediate short term safety measure, and then have the child immediately brought to a hospital emergency room for further care.
Joey Wahler (Host): How does treating food allergies differ if at all, between kids and adults?
Dr Michael Marcus: It really doesn't differ for a great deal, only that since children are smaller, they could have more severe reactions more quickly. And so in the most severe case, you need to act promptly, not hesitate to use the emergency medications and get to an urgent or emergency room quickly so that the child can be kept in a safe Condition.
Joey Wahler (Host): Do kids ever grow out of a food allergy, so to speak?
Dr Michael Marcus: Absolutely. We're really not sure why, but many children will outgrow the majority of their food allergies that they develop at early ages. To give you one example, children with a milk allergy are found to have about 90% outgrowing it by the time they're age two and more than 95% outgrow it by the age of 10. Some food allergies tend to linger longer and are less likely to be outgrown such as peanut allergi or shellfish or other trio allergies, where more common foods such as milk, eggs wheat and soy, most children will outgrow over time.
One of the keys that I like to advise is that the best way to minimize the risk of a reaction continuing or a food allergy continuing is to try to completely avoid the food for as long, a period of time as possible. And then when you want to try the food again, under direct supervision of allergist, go through an oral challenge with slowly increasing quantities, being administered in a medical setting so that if a severe reaction does occur, it could be cared for.
Joey Wahler (Host): Interesting. Good to know. So what makes Maimonides the right place for children to be treated for food allergies would you say?
Dr Michael Marcus: At my Maimonides, we have an extensive experience with food allergies. We care for children who have allergies from the youngest age, right on through adolescents and even adulthood. We care for the children in terms of both evaluating the testing, by being able to do all three types of testing that we talked about earlier, as well as the slow reintroduction of foods, there's also a relatively newer product on the market specifically for peanut allergies And this product has been approved in children who have diagnosed severe peanut allergies.
And by administering it, we can decrease the risk of developing one of the more severe reactions anaphylaxis. It doesn't allow the patient to go around and start eating peanut butter for lunch every day. But it does minimize the risk of that severe reaction. Putting the child in the parent at ease and allowing them to resume a bit more of a normal, life in school and among friends and family.
Joey Wahler (Host): And of course, many kids do love peanut butter. Well, doc, you led me perfectly into my next question. Is there anything else new in the field of kids' allergies that you're particularly excited about?
Dr Michael Marcus: Two things first there's some new work that has been published and that many pediatricians are starting to work with. Where if a child has a high risk of developing food allergies, based on their parents' history or other siblings, that will allow less of a risk. It is a form of introduction of foods where instead of delaying the introduction of foods until a later age, there's actually an earlier introduction of foods as early as 4, 5, 6 months of age. And so things like peanuts are actually introduced at an earlier age, in a safe fashion, to try to desensitize the child, even before an allergic reaction occurs.
This work is exciting and we're hoping that it'll extend to other foods beyond peanuts, but the data right now is only in the peanut range. We also know that there's lots of work being done. Other food desensitization. And so where we now have a successful treatment for peanut allergies decreasing the risk of anaphylaxis. There's a number of studies underway, looking at the other common food causing allergies in children, such as wheat, soy, and eggs. Looking forward to that research and having those treatment options in the future.
Joey Wahler (Host): Couple of other things before we wrap up, as a specialist in pediatric allergy and immunology, what got you interested in that field would you say, in the first place?
Dr Michael Marcus: I became interested in the field because I realized early on that the immune system is a very basic part of the normal function of the body. In helping us fight infections and also in keeping the body in a safe, functional fashion. It also became clear that abnormalities of the immune system were the cause of many of the illnesses and problems that we care for. So regardless of what organ system was involved, regardless of what specialty was involved, the immune system crosses over all of those areas.
And so I became interested because if I wanted to have the greatest impact across medical fields, in terms of helping patients, then I would need to understand and treat problems that affected the immune system in a consistent, knowledgeable fashion.
Joey Wahler (Host): Interesting. And of course, needless to say nowadays with COVID and vaccines in the news, it's something that is on just about everyone's mind. Well, folks, we trust you are now familiar with food allergies and children, Dr. Michael Marcus. Thanks so much again.
Dr Michael Marcus: You're very welcome. It's been a pleasure.
Joey Wahler (Host): Same here. To make an appointment, please do call 718-283-7500. Again, 718-283-7500. For more information, please visit maimo.org. Again, that's maimo.org. If you found this podcast helpful, please do share it on your social media. And thanks again for listening to Maimo Med Talk. Hoping your health is good health. I'm Joey Wahler.
The Ultimate Food Fight: Children with Food Allergies
Joey Wahler (Host): Having a food allergy can be a challenge for adults, but what about for kids and their parents? We're discussing how to live with pediatric food allergies. This is Maimo Med Talk. Thanks for listening. I'm Joey Waller. Our guest from my minorities is Dr. Michael Marcus director of pediatric pulmonary medicine and allergy immunology, as well as vice chair of the Pediatric Ambulatory Network. Dr. Marcus, thanks for joining us.
Dr Michael Marcus: You're very welcome. Thank you for having me.
Joey Wahler (Host): So in a nutshell, what causes a food allergy?
Dr Michael Marcus: A food allergy is an abnormal immune response to a common substance. In this case of food, what turns on the process, we really don't know. Although food allergies do run in families as all allergies can.
Joey Wahler (Host): So generally speaking, what symptoms should parents look for in children to detect a possible food allergy?
Dr Michael Marcus: The symptoms can vary quite broadly. It can be classic allergy symptoms, such as sneezing, runny nose, coughing, or wheezing. The more common symptoms that families. Always think about our various rashes, such as eczema or hives, but these kinds of reactions are not always the reactions that identify a food allergy. Finally, in the most severe case, you can can develop something called anaphylaxis, which is the most severe type of allergic reac,tion where not only are there the skin reactions, but also there's a true difficulty breathing to the point where it could become quite dangerous.
Joey Wahler (Host): So, how do you usually go about testing for a food allergy?
Dr Michael Marcus: There are three basic ways that food allergies can be tested for. The first way that doctors tend to start with is with blood tests. Blood tests have the benefit of being able to be done across a broad range of ages, although the inconvenience of sticking a child with a needle is not small. The problem with blood work is that it can show reactions that are not true. Food allergies, so called false positives where it looks like a person is allergic to the food when they're really not. And it can also have false negatives where you can have no reaction at all in the blood.
Yet, still have a reaction to the food. The second type of test is the classic allergy skin testing. This is certainly more accurate than the blood test because you're actually introducing the purified protein of the food that we believe is the cause of the reaction directly under the skin with a small prick. This gives you a more accurate result. But is certainly a bit more uncomfortable for the child. The gold standard though, is a direct challenge. This is done only after one of the two previous tests are done.
With the direct challenge the child is given the tiniest quantity of the purified protein to see if a reaction actually occurs. It's such a small quantity that you won't get a serious reaction, but it needs to be done under a physician's care so that whatever reaction can be taken care of in a safe fashion.
Joey Wahler (Host): Gotcha. So what foods are children most typically allergic?
Dr Michael Marcus: In theory, you could be allergic to any food, but the things that children become allergic to more commonly are a group of five or six foods beginning with milk, eggs, peanuts soy and wheat fish also becomes an issue. But the thing to remember is that it is not common to develop a reaction to food the very first time they're exposed, there has to be some previous exposure of some type, so the child would become sensitive to the food. So that on the second or subsequent exposures, the actual allergic reaction develops.
Joey Wahler (Host): So what's the normal course of treatment if there is an allergy present?
Dr Michael Marcus: Well, the first step is to avoid the food. If a patient is known to have analogy to peanuts or milk, then you have to totally avoid that food. And clearly such as in the case of milk finds an appropriate substitute to the child has proper nutrition. If a child develops an actual reaction to a food that's taken in accidentally, or perhaps on purpose. Proper treatment would be the treatment of the symptoms. So if you have reactions in the skin, you would wanna use antihistamines.
You may need a skin cream, such as a topical steroid, but if you develop something called anaphylaxis that most severe reaction, you would wanna use a device called an EpiPen. As an immediate short term safety measure, and then have the child immediately brought to a hospital emergency room for further care.
Joey Wahler (Host): How does treating food allergies differ if at all, between kids and adults?
Dr Michael Marcus: It really doesn't differ for a great deal, only that since children are smaller, they could have more severe reactions more quickly. And so in the most severe case, you need to act promptly, not hesitate to use the emergency medications and get to an urgent or emergency room quickly so that the child can be kept in a safe Condition.
Joey Wahler (Host): Do kids ever grow out of a food allergy, so to speak?
Dr Michael Marcus: Absolutely. We're really not sure why, but many children will outgrow the majority of their food allergies that they develop at early ages. To give you one example, children with a milk allergy are found to have about 90% outgrowing it by the time they're age two and more than 95% outgrow it by the age of 10. Some food allergies tend to linger longer and are less likely to be outgrown such as peanut allergi or shellfish or other trio allergies, where more common foods such as milk, eggs wheat and soy, most children will outgrow over time.
One of the keys that I like to advise is that the best way to minimize the risk of a reaction continuing or a food allergy continuing is to try to completely avoid the food for as long, a period of time as possible. And then when you want to try the food again, under direct supervision of allergist, go through an oral challenge with slowly increasing quantities, being administered in a medical setting so that if a severe reaction does occur, it could be cared for.
Joey Wahler (Host): Interesting. Good to know. So what makes Maimonides the right place for children to be treated for food allergies would you say?
Dr Michael Marcus: At my Maimonides, we have an extensive experience with food allergies. We care for children who have allergies from the youngest age, right on through adolescents and even adulthood. We care for the children in terms of both evaluating the testing, by being able to do all three types of testing that we talked about earlier, as well as the slow reintroduction of foods, there's also a relatively newer product on the market specifically for peanut allergies And this product has been approved in children who have diagnosed severe peanut allergies.
And by administering it, we can decrease the risk of developing one of the more severe reactions anaphylaxis. It doesn't allow the patient to go around and start eating peanut butter for lunch every day. But it does minimize the risk of that severe reaction. Putting the child in the parent at ease and allowing them to resume a bit more of a normal, life in school and among friends and family.
Joey Wahler (Host): And of course, many kids do love peanut butter. Well, doc, you led me perfectly into my next question. Is there anything else new in the field of kids' allergies that you're particularly excited about?
Dr Michael Marcus: Two things first there's some new work that has been published and that many pediatricians are starting to work with. Where if a child has a high risk of developing food allergies, based on their parents' history or other siblings, that will allow less of a risk. It is a form of introduction of foods where instead of delaying the introduction of foods until a later age, there's actually an earlier introduction of foods as early as 4, 5, 6 months of age. And so things like peanuts are actually introduced at an earlier age, in a safe fashion, to try to desensitize the child, even before an allergic reaction occurs.
This work is exciting and we're hoping that it'll extend to other foods beyond peanuts, but the data right now is only in the peanut range. We also know that there's lots of work being done. Other food desensitization. And so where we now have a successful treatment for peanut allergies decreasing the risk of anaphylaxis. There's a number of studies underway, looking at the other common food causing allergies in children, such as wheat, soy, and eggs. Looking forward to that research and having those treatment options in the future.
Joey Wahler (Host): Couple of other things before we wrap up, as a specialist in pediatric allergy and immunology, what got you interested in that field would you say, in the first place?
Dr Michael Marcus: I became interested in the field because I realized early on that the immune system is a very basic part of the normal function of the body. In helping us fight infections and also in keeping the body in a safe, functional fashion. It also became clear that abnormalities of the immune system were the cause of many of the illnesses and problems that we care for. So regardless of what organ system was involved, regardless of what specialty was involved, the immune system crosses over all of those areas.
And so I became interested because if I wanted to have the greatest impact across medical fields, in terms of helping patients, then I would need to understand and treat problems that affected the immune system in a consistent, knowledgeable fashion.
Joey Wahler (Host): Interesting. And of course, needless to say nowadays with COVID and vaccines in the news, it's something that is on just about everyone's mind. Well, folks, we trust you are now familiar with food allergies and children, Dr. Michael Marcus. Thanks so much again.
Dr Michael Marcus: You're very welcome. It's been a pleasure.
Joey Wahler (Host): Same here. To make an appointment, please do call 718-283-7500. Again, 718-283-7500. For more information, please visit maimo.org. Again, that's maimo.org. If you found this podcast helpful, please do share it on your social media. And thanks again for listening to Maimo Med Talk. Hoping your health is good health. I'm Joey Wahler.