Transcription:

Scott Webb (Host): Food allergies are common, especially in our kids. And my guest today is going to help us to understand the signs and symptoms of food allergies and how an allergist can help us to diagnose and treat them. Welcome to Right Beside You, a Reid Health podcast. I'm Scott Webb. And joining me today is Dr. Jason Casselman. He's an Allergist with Reid Health. Doctor, thanks so much for your time today. I have a couple of kids and they've had some food allergy issues along the way, and I'm sure many parents and children have as well. So great to have your time and expertise today. Just an easy one here as we get rolling. You know, what are the earliest signs of a food allergy in a child?

Jason Casselman, DO (Guest): Food allergy can really present at any age. Food allergy can present in any number of ways actually. Oftentimes the first thing that parents will notice in a child with food allergies will be some sort of a skin finding or skin rash specifically. Sometimes parents will first start to notice skin issues in children, in the form of some redness, swelling, sometimes even hives. At times, parents will notice children complaining of more dry itchy kind of rash. We call that eczema and food allergies come and present in that simple way. Oftentimes with food allergies, parents will start to notice specific food triggers. So early on in life, when parents are introducing foods into the diet, they'll start to notice these trends where every time the child is fed X, Y or Z foods, the patient will develop some sort of a symptom, whether it be skin or other more severe issues.

There certainly can be symptoms that are more concerning to parents. So other than just skin, patients can oftentimes develop more severe symptoms, such as shortness of breath, wheezing, coughing, swelling, that can involve the respiratory tract and airway, which can be certainly scary for parents. And that would require more intense treatment even emergency department visits and hospital stays and things like that. So at the first sign of something concerning, the parents should certainly act and get an evaluation with an allergist to kind of try to work that up and establish whether or not we think food allergy is the issue in that child.

Host: Yeah. And you do see that there would be a range there of some, you know, not as alarming signs and symptoms to the very alarming that might require sort of rushing to the emergency department to figure out what's going on. And if we suspect that there's a food allergy, and then we go to see our primary or an allergist, what kind of tests are involved? You know, how do you determine? Do we do elimination diets, maybe take us through this.

Dr. Casselman: It's really important to get a good clinical history. I always tell my patients history always will dictate testing. What you don't want to do if at all possible is to do a wide ranging panel. We want to have a solid history to establish what we really are looking for on an allergy test. So there's really two ways we do allergy testing. The most simple and easiest way to do allergy testing would be what's called scratch testing or skin prick testing. And this is a skin test that we can do very easily on any patient, whether it be child or adult. So this is simply a scratch with a little plastic device.

There's different types out there that we just simply scratch the allergen into the skin, allergen being the food, in this case of concern. And that test usually takes only a few seconds to put on and right around 15 minutes or so that we let it kind of sit on the skin. And what will happen is the child will develop a red kind of raised itchy bump, right where that allergan set if the child is found to be allergic to that food. So that's very easy. We can also do a testing through a blood test, which would be at the lab, and that would be a blood draw. That takes a little bit more time and is often a little bit more traumatic, especially for younger kids, poke at the lab, through the vein.

So we prefer starting with skin testing just because it's easier and a lot better tolerated for children. So once we establish that we have a good clinical history to support testing, we'll put the test on. And then if the testing, of course correlates with the clinical history, then we have our diagnosis of food allergy. In that instance, the treatment that's always recommended for food allergy is avoidance of that particular food.

Unfortunately, there's not a lot of really good treatment as far as desensitizations and induction of tolerance, types of treatment for food allergy. At this point, for the vast majority of foods, if a child or an adult is found to be allergic to a food, then we would always recommend strict avoidance of that food.

Then generally what I will do is I will have the child or adult back for repeat testing every so often, usually around once a year to see where that test is trending, whether it's is it getting bigger every time we test it, larger and more positive, or is it becoming less positive over time to the point where we think eventually we may be able to get this food back into the diet.

Host: Yeah, I see what you mean. And I'm sure you're aware and whether it's a social media or wherever people get their information, it just seems like people talk more about food allergies now. And I don't know that they are more common or not, or maybe we're just better at diagnosing them. What's your expert opinion on this? Are food allergies, just more common or do we just talk about it more?

Dr. Casselman: Well, I think probably both are true. We it's certainly becoming more prevalent. There's no doubt about that. The percentage of overall food allergy is higher. I believe it's right around three to 4% higher, even over the past decade. So it's certainly increasing. I think you're right in the sense that I think we're probably recognizing it more as well. There's more of a concern earlier on in life and parents are more on the watch for it, but I certainly think the prevalence has increased even outside of that as well. And there's different theories as to why that is, why that's occurring and why allergy in general is becoming more prevalent. But certainly you're correct in that.

Host: Yeah, and it seems to me, I'm 53 and I don't remember anybody ever being allergic to peanuts for example, when I was a kid, there probably were people who were allergic to peanuts, but we didn't talk about it. We didn't have social media, we didnt have Tik Tocs and all these things. Right. So I'm assuming there just actually are in fact more people allergic to peanuts today and other things, and maybe you can help us to try to understand, parents to understand, you know, why is that?

Are we exposing our children to things like peanuts too late or later, and then that's causing the problem or we sort of some respects kind of responsible for this ourselves that we're just not maybe doing the right things at the right time, or is it just one of those things that over time people become more allergic to things and we just have to figure out how to deal with it.

Dr. Casselman: Yeah, you're absolutely right. It's little a head-scratching isn't it to think about why this is occurring, but you know, there are different theories on it. And I think it's probably not a simple answer. I think there's a lot of factors that play into it. I think there's genetic predisposition certainly, whereas some kids are set up for developing allergic disease more than other kids. Certainly that, that plays a role. I can understand that, I'm empathetic to that, that's why I'm on high blood pressure medicine because you know, that's a family history of that in my family. It's setting me up for that.

And kids are no different in the sense that they are more likely to develop allergic disease than other kids, but there are environmental factors as well, that certainly play a role. There's a hypothesis that we call the hygiene hypothesis. Where essentially, our environment is becoming more hygienic. You know, there's more air purifiers, there's more keeping kids in cleaner environments, more sanitizers and more clean environments than there used to be. And by eliminating our children's exposure to these microbes, these bacteria, viruses and other things, that's actually leading to more allergic disease.

The other thing to consider would be siblings. Nowadays, families on average are smaller in size. And what we've found is that the kids with more siblings tend to have less allergic disease because they're being exposed to more of those microbes that I was talking about, especially the gut microbes, the bacteria that exist in our gut and are actually normal and good for us. We have more exposures to that if we have siblings, multiple siblings in the house and with smaller families, that's of course leading to more allergic disease because we have less of that overall. But like I said before, I think it's a very complicated answer. I think we're still trying to figure out exactly why that is. And there's probably multiple factors that play into that, certainly.

Host: It's so interesting hearing you kind of unpack all of that. It's like my dad had seven brothers and sisters, right. So there just was a lot of, I don't know, germs and things going on in that house. whereas I only have two kids and I was going to ask you, is it just that maybe you know, kids are just more predisposed and sort of during COVID, with the push towards sanitizer, it kind of flew in the face of some things I've heard from other experts, which is the more sanitizer we use, the more sort of sanitized our environments are, the more trouble we may be causing, especially for our kids, if they are in fact already predisposed to allergies.

So there's just so much to unpack there. My head's kind of spinning a little bit and I think you're right. I think it's just could be a multitude of factors and work continues to try to figure it all out. And, naturally if an allergy is determined in one of our kids, what's next? And I think the one that I always want to know, and I'm sure a lot of parents do as well, is this is just something that kids grow out of. Can you be allergic to peanuts or something like that when you're a kid and then you get older and you're fine?

Dr. Casselman: Like I said before, once we identify that a child is allergic to a specific food, the treatment is always going to be avoidance. So you want to keep that kid safe. And so we want to educate our families, educate other family members that watch the child, whether it be grandparents, daycare, things like that, to be sure that this child does not get exposed to X, Y, or Z food. We certainly will continue to follow this child. So you're right. Often times children can lose that, we call allergic sensitization. Basically what that means is lose that food allergy and no longer become allergic to it.

So I would generally repeat testing around once every year to kind of trend that allergy test to see which way, which direction it's going. Is it getting larger or smaller or staying about the same? The longer the child or young adult holds on to that allergy, meaning the skin test or blood work is positive, the less likely they are to eventually be able to get that food back into the diet. I don't like to use the term outgrow. I think that's probably not an accurate assessment of what's going on. But I think, you're correct in the sense that eventually we can oftentimes get these foods back into the diet.

I think that's more common than actually having a lifelong allergy where they can never get it back. So we're always going to try to give that child the opportunity to eventually get this food back into the diet. Now there's different approaches to doing that. Certainly want to get a skin test or a laboratory test as close to a negative as possible.

But even in some circumstances, we will do what's called an in-office food challenge, if we get a borderline positive test, because oftentimes even if the test is positive, if it's a low level postitive, we may opt to go through with the challenge. And often times the kids are able to tolerate the food.

So it's really going to be dependent on what food you're testing, what the history is with the child, how old the child is. There's a lot of factors and that's why it's so important to see an allergist who is a specialist in that field to really make that clinical decision for the patient. So once we have a negative or borderline test and we're comfortable with proceeding with the next step, we'll have the child in for what's called an in-office challenge.

And basically what that means is that child will consume a small amount of that food in a controlled setting in my office. And we will just simply watch the child to make sure there's no reactions that occur. If reactions do occur, of course, we'll treat that in the office with medicine to reverse those issues. And if they don't occur, then that's really good news for the child. And that's essentially the gold standard at ruling out food allergy and getting that back into the diet permanently.

Host: Yeah, I see what you mean. And, so much good stuff there, obviously education, which we hope, things like this, this podcast helps and a good to understand your perspective, which is you don't just sort of age out of an allergy, work has to be done, including these food challenges there in the office. And so great for kids that have missed out on things like peanut butter and jelly sandwiches or something like that to eventually be able to have a food challenge and find that they can tolerate it and get those things back into their diet or for the first time into their diets. So really educational and informative today. Thanks so much. You stay well.

Dr. Casselman: Thank you.

Host: And if you think your child might have a food allergy call Reid Allergy at (765) 966-6360 for help. And if you found this podcast helpful, please do share it on your social media. And thanks for listening to Right Beside You, a Reid Health podcast. Hoping your health is good health. I'm Scott Webb.