Navigate Your Child’s Food Allergies and Avoid Food Intolerance Crisis, with Dr. Farah Khan

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[SPEAKER_02]: It kind of causes all of the symptoms that we hear about in the news and on social media, like, oh, my kids allergic to peanut butter, somebody accidentally gave him a bite, and then he had lips swelling and tongue swelling and voice changes and sneezing and coughing and vomiting and hives and all these things.

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[SPEAKER_00]: Are you raising your family while also feeling like you're still growing out yourself?

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[SPEAKER_00]: Do you wonder if you are getting it right?

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[SPEAKER_00]: Or do you ask, where's the roadmap to building a happy healthy life?

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[SPEAKER_00]: Welcome to Growing Up with Dr. Sarah.

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[SPEAKER_00]: She's a PD-retrition animal and she helps the whole family.

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[SPEAKER_01]: Hi, I'm Dr. Sarah Adams, a board certified pediatrician, but I'm not your pediatrician.

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[SPEAKER_01]: Feel free to use my podcast as helpful information, but in no way do I intend my podcast to replace the advice of your physician.

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[SPEAKER_01]: Your physician knows you and is in the best position to provide medical advice.

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[SPEAKER_01]: Welcome back to Growing Up with Dr. Sarah, the podcast that helps parents navigate the journey of raising healthy happy kids.

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[SPEAKER_01]: Today, we're tackling a topic that causes confusion, concern, and sometimes crisis food allergies.

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[SPEAKER_01]: Whether you're navigating school lunches or birthday parties or grocery aisles, food allergies are more common than ever affecting one and thirteen children in the US.

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[SPEAKER_01]: Will impact what food allergies are, how they differ from intolerances, and how they impact everything from eczema to emotional well-being.

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[SPEAKER_01]: Whether you're just starting to suspect in allergy or managing one already, this episode will leave you feeling informed and empowered.

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[SPEAKER_01]: Joining me is Dr. Ferrican, board certified allergist and immunologist from nationwide children's hospital.

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[SPEAKER_01]: She's medical writer and a member of the American Academy of Allergy, asthma, and immunology.

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[SPEAKER_01]: Welcome, Dr. Khan.

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[SPEAKER_01]: I'm so excited to be here.

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[SPEAKER_01]: It's good to see you, Sarah.

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[SPEAKER_01]: It's so good to see you.

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[SPEAKER_01]: It really is.

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[SPEAKER_01]: And this is such an important topic that we're going to be discussing today.

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[SPEAKER_01]: I know that so many people have questions about food allergies.

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[SPEAKER_01]: So I know I appreciate it, not only as a pediatrician,

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[SPEAKER_01]: but as a mom and even a grandmother.

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[SPEAKER_01]: So let's get started.

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[SPEAKER_01]: Yeah, I'm excited to be here.

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[SPEAKER_01]: Thank you for having me.

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[SPEAKER_01]: So let's start by just talking about what exactly is a food allergy?

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[SPEAKER_01]: Let's just go with the basics first.

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[SPEAKER_02]: So a food allergy is a cellular response to your immune system identifying something that's usually not dangerous, like peanut or egg.

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[SPEAKER_02]: as dangerous, and then it has this exaggerated response, and then you have an allergic reaction.

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[SPEAKER_02]: So that's a very basic rudimentary explanation, but that's how I want people to think about it.

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[SPEAKER_02]: So it's not like it's this nebulous thing.

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[SPEAKER_02]: Like we understand the mechanism of food allergies, food intolerances, we'll get to in a little bit, that we don't understand as well.

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[SPEAKER_02]: But there's a very exact definition to it, and there's a very specific antibody.

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[SPEAKER_02]: called the IGE antibodies, the allergy antibody that I sort of think and explain and talk about in clinic with patients and families.

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[SPEAKER_02]: And there's a very specific mechanism that happens when you are exposed to the allergen and it causes a cascade of events and it targets some of your allergy mass cells and then your mass cells release a bunch of things, including histamine.

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[SPEAKER_02]: And then it kind of causes all of the symptoms that we hear about in the news and on social media like oh my kids allergic to peanut butter somebody accidentally gave him a bite and then he had lip swelling and tongue swelling and voice changes and sneezing and coughing and vomiting and hives and all these things.

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[SPEAKER_02]: And so there's a very exact definition.

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[SPEAKER_02]: There is a way that food allergies typically present and there are a little bit different than food intolerances and sensitivities.

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[SPEAKER_01]: It sounds so complicating, doesn't it?

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[SPEAKER_01]: I'm sure you get a lot of questions in your clinic and from the community that you're part of.

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[SPEAKER_01]: So what are those signs and symptoms that parents can be looking for?

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[SPEAKER_02]: Yeah, so typically food allergies.

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[SPEAKER_02]: that are mediated by this allergy antibody, the IGE antibody.

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[SPEAKER_02]: They typically start pretty quickly.

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[SPEAKER_02]: It's not the kind of thing that it's going to start the next day or three weeks later.

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[SPEAKER_02]: It is usually very, very fast.

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[SPEAKER_02]: Sometimes you'll start to see the symptoms pop up within like ten, fifteen, twenty minutes of eating the thing that you're allergic to.

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[SPEAKER_02]: But it can take up to an hour or two sometimes.

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[SPEAKER_02]: So it's the immediacy that I always sort of want people to pay attention to rather than like, oh, I had something for breakfast and then at nine PM, I started to have a weird looking rash, probably not related.

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[SPEAKER_02]: And then some of the traditional symptoms are some of the stuff that I've already mentioned, which you can have lip and tongue swelling.

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[SPEAKER_02]: You can have trouble breathing or coughing or chest tateness.

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[SPEAKER_02]: You can have really severe abdominal pain that can lead to some vomiting and diarrhea as well.

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[SPEAKER_02]: Your blood pressure can drop.

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[SPEAKER_02]: You can have some hives.

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[SPEAKER_02]: There's a whole array of symptoms.

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[SPEAKER_02]: But the thing that I also want people to understand is that food allergy reactions can also be on a spectrum and no true reactions, even in the same person, maybe the same.

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[SPEAKER_01]: that's really good to note because a lot of times even within a family they might compare one child to the other or they might even compare like my nephew did this or that so that's really good to know yeah we hear that a lot and sometimes sometimes parents and especially for moms who have given birth that like two children will come out of the same woman be very very

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[SPEAKER_02]: You know, yes, same gene pool, right?

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[SPEAKER_02]: And one will have had like a really significant response to peanut and has a peanut allergy and on the other kid who doesn't have anything, right?

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[SPEAKER_02]: And then having to navigate all that stuff.

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[SPEAKER_02]: So it is kind of mind blowing how genetics in our environment kind of interplay to then cause food allergies.

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[SPEAKER_01]: Well, and that brings up a question that I would be worried, like if I have a child who does have a peanut allergy, what's the likelihood that my other children will?

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[SPEAKER_02]: That's such a good question and it comes up all the time.

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[SPEAKER_02]: And I would say the parents then will hesitate to introduce things to their clients because our intuition is like, well, my first kid had it.

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[SPEAKER_02]: Why won't my second or third or fourth kid?

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[SPEAKER_02]: But I think the data used to show that there was like a marginally higher risk, like two to three percent very, very low.

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[SPEAKER_02]: But we actually have had emerging data over the last five to ten years that your next kiddos are actually at lower risk of having a food allergy.

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[SPEAKER_02]: And I think it's because parents are just doing a really good job of being aware of it.

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[SPEAKER_02]: And then they're trying to do the early introduction.

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[SPEAKER_02]: which has been the guideline over the last ten years.

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[SPEAKER_02]: And so they're more cognizant of introducing and then keeping things in the diet to help prevent the allergy from developing.

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[SPEAKER_01]: Yeah, let's go to that introduction now that you segue into that.

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[SPEAKER_01]: I love it because I know as a pediatrician I've been doing this for a long time.

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[SPEAKER_01]: We used to say and I'm going to tell everybody we used to say so this is not the recommendation now and that is not to introduce some of these foods until they were two years old.

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[SPEAKER_01]: Can you imagine?

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[SPEAKER_01]: And now those recommendations are different.

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[SPEAKER_01]: Will you go over those for everyone listening?

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[SPEAKER_02]: Yeah, so that was the story a long time ago.

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[SPEAKER_02]: I wouldn't even say that those were necessary.

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[SPEAKER_02]: Those guidelines came out based on like hard fact.

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[SPEAKER_02]: It was just what we thought.

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[SPEAKER_02]: And it's really frustrating.

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[SPEAKER_02]: I think for parents, some parents and grandparents to hear that now because they're like, well,

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[SPEAKER_02]: That's not, that's not what it was twenty years ago.

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[SPEAKER_02]: That's not what it was twenty years ago.

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[SPEAKER_02]: That's not what it was twenty five years ago.

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[SPEAKER_02]: And then there's a sense of guilt, like did I cause the peanut allergy?

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[SPEAKER_02]: Because I didn't introduce until my child was two and we didn't do the early exposure.

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[SPEAKER_02]: And it's, it's really hard not to feel

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[SPEAKER_02]: guilty, like you're personally responsible, but you were doing the best that you can with the information that you had at the time.

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[SPEAKER_02]: And science is always evolving.

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[SPEAKER_02]: We're always, always learning from our patients and families and studies.

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[SPEAKER_02]: And it's important to keep that in perspective.

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[SPEAKER_02]: But the pivotal trial that came out was called the Leap Study.

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[SPEAKER_02]: And they basically looked at

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[SPEAKER_02]: The peanut allergy prevalence and what we realized is that Israeli babies, babies who were born in Israel, actually have a very, very low rate of a peanut allergy and it's because they were eating this thing called a bomb bites of peanut puff kind of a thing.

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[SPEAKER_02]: And they had early exposure.

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[SPEAKER_02]: And then when we looked at it in the study, we actually realized that if you

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[SPEAKER_02]: give babies the allergen early.

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[SPEAKER_02]: You are less likely to have an allergy.

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[SPEAKER_02]: So it's like, it's amazing.

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[SPEAKER_02]: Complete opposite of where we were for decades.

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[SPEAKER_02]: So that came out in twenty fifteen.

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[SPEAKER_02]: And I think you and I both know how slow change can be in clinical medicine and to get people to adapt new guidelines.

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[SPEAKER_02]: And some of it is like hesitancy to adapt new things.

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[SPEAKER_02]: We test physicians.

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[SPEAKER_02]: We tend to be pretty conservative.

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[SPEAKER_02]: I know.

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[SPEAKER_02]: especially when it comes to something as serious as this way.

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[SPEAKER_02]: Yes, and so it takes a little bit of time.

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[SPEAKER_02]: So maybe the first few years, you know, you're just like, I don't really know.

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[SPEAKER_02]: Who's doing this?

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[SPEAKER_02]: Is anybody else doing this?

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[SPEAKER_02]: I was there.

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[SPEAKER_02]: Yeah.

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[SPEAKER_02]: And it takes a long time.

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[SPEAKER_02]: And it's also the complete like diametrically opposed to what you've been doing for a long time, right?

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[SPEAKER_02]: And so then it's like how do you adapt these new changes?

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[SPEAKER_02]: But I think that's also a sign of a really good position is being able to incorporate new guidelines, new science to be flexible.

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[SPEAKER_02]: because our patients also don't follow textbooks and need sort of need to meet them where they are.

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[SPEAKER_02]: But it's been, it's been a little frustrating because the study has been out for more than ten years now and it's right.

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[SPEAKER_02]: And I still have families that come in and meet with me and they're like, well, our primary care provider said, don't introduce.

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[SPEAKER_02]: And that's frustrating to navigate not only as a parent myself, but then also as a pediatric allergist.

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[SPEAKER_01]: Absolutely, that is because it is hard, like we mentioned, it's to adapt and then also just take that chance with our own families or with our patients.

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[SPEAKER_01]: So when should we start?

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[SPEAKER_01]: I know you said early, if you're, let's start, if you're breastfeeding or getting breast milk, let's start there.

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[SPEAKER_01]: When should you start and what, what allergens or food should you start?

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[SPEAKER_02]: So the data isn't great with breast milk.

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[SPEAKER_02]: And you could argue either way, but the reality is that very, very small amounts of food protein actually get passed into the breast milk and then into the baby.

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[SPEAKER_02]: And I mean, let's face it when you're breastfeeding or pumping.

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[SPEAKER_02]: It's a full-time job.

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[SPEAKER_02]: You're putting in overtime every single day.

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[SPEAKER_02]: There is no reason to take

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[SPEAKER_02]: any joy away from a mom in addition to all of the other things that she's having to go through, like, poor as part of them changes and keeping this tiny human alive.

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[SPEAKER_02]: And so the recommendation, I think, the conservative end ends up being, we'll just cut out dairy and cut out egg and cut out soy and cut out wheat and you're doing it all the time.

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[SPEAKER_02]: And you do all this stuff to the mom and then the poor mom is like eating beans and vegetables, which is fine, right?

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[SPEAKER_02]: But let her have a spine.

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[SPEAKER_01]: Meat potatoes.

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[SPEAKER_02]: Let her have a splash of godby creamer, right?

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[SPEAKER_02]: Or let her have a slice of pizza.

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[SPEAKER_02]: So I tend to not.

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[SPEAKER_02]: I definitely never start with that recommendation if a mom comes in and she's like, I'm okay, my quality of life hasn't been impacted.

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[SPEAKER_02]: Then I let her continue doing that elimination diet if she's okay with it.

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[SPEAKER_02]: In her own nutrition is okay in her own breast milk supply has been doing okay, but I never start there because it really has a huge impact on the mom.

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[SPEAKER_02]: And if the mom ain't doing well,

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[SPEAKER_02]: the baby ain't too well.

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[SPEAKER_01]: I say that all the time, Dr. Khan, I really appreciate you stating that it's so important.

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[SPEAKER_01]: I always say what's best for the baby is what's really best for the mom.

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[SPEAKER_01]: And so it trickles down, right?

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[SPEAKER_01]: And that's the whole point.

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[SPEAKER_01]: So when we're going to introduce these foods, orally, or by mouth,

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[SPEAKER_01]: when should a parent start with their baby?

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[SPEAKER_02]: Yeah, it's sooner than most people think.

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[SPEAKER_02]: So between four to six months is when a lot of babies will start to show signs of readiness, so you want to make sure that they are there developmentally, and it's appropriate.

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[SPEAKER_00]: Right.

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[SPEAKER_02]: To start feeding right, they have their coordinated, but their second swallow, and they're holding their head up, and they're interested in engaged, and some babies do that a little bit sooner than other babies, and that's okay.

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[SPEAKER_02]: But that's the window that we typically think about.

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[SPEAKER_02]: So it's as simple as like either taking some peanut butter and thinning it out and speeding that or using some peanut powder mixed into something that they're already taking.

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[SPEAKER_02]: Or just letting them stack on those bombas, those peanut pubs.

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[SPEAKER_02]: or scrambled eggs or yogurt or whatever it is that you're doing and I think most pediatricians and primary care providers do a fabulous job of like giving parents tips and tools and I think a lot of us are also parents and we're also not afraid to share those experiences in our clinic visits and I think parents and caregivers definitely appreciate that stuff but it's around that same window and then

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[SPEAKER_02]: The important piece is not just to introduce early, but then to also keep in your diet consistently, right?

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[SPEAKER_02]: So it's not just like, oh, I gave them scrambled eggs one time and then like nine months go by.

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[SPEAKER_01]: Yes, I do do that.

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[SPEAKER_02]: You want to keep it in the diet as frequently as possible.

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[SPEAKER_02]: So like two, three times per week.

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[SPEAKER_02]: And the idea is that the regular consistent exposure helps to prevent an allergy from developing.

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[SPEAKER_01]: I appreciate your comment about thinning out the peanut butter because if you give them peanut butter at that young infancy age, there's that

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[SPEAKER_01]: risk of choking so I appreciate you bringing that up so thank you for doing that but do you if we're trying peanut a peanut product for example how long do we do that before maybe we introduce eggs or does it matter it doesn't matter see that was a trick festin right

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[SPEAKER_01]: I knew what you're going to say, but I wanted everyone to hear it because that was an old school view.

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[SPEAKER_01]: Remember, we used to tell everybody, you know, wait, you know, a week or three, four days or two weeks before you introduce another food and bubble bus.

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[SPEAKER_01]: So thank you for sharing that.

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[SPEAKER_01]: Please expand on math.

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[SPEAKER_02]: doesn't matter, it was made up to begin with.

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[SPEAKER_02]: And I don't like I don't want to be facetious because some parents really did go by the guidelines and they were like, does I mean hated tuition for that, right?

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[SPEAKER_02]: And it was three to five days, but it was also kind of made up, right?

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[SPEAKER_02]: And

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[SPEAKER_02]: I think executing in real life is probably harder than people think.

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[SPEAKER_02]: It's very easy to say.

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[SPEAKER_02]: Every third day, and it's like, who's keeping track of that stuff?

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[SPEAKER_02]: Most of us are working.

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[SPEAKER_02]: If we're not working outside of the home, we're taking care of other children, it's just a lot.

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[SPEAKER_02]: So I always share my personal experience, so I have one kiddo, and I had him when I was in Fellowship.

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[SPEAKER_02]: which basically means I have very busy and I had a no time to keep track of like every three to five days that was just bananas I was like I'm not doing that and then even with the allergens you know generally what I tell parents especially if they're a little bit more nervous or uncomfortable or they've had a

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[SPEAKER_02]: They've had some emotional trauma from a previous allergic reaction with another kiddo that they're still processing and holding onto.

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[SPEAKER_02]: I tell them to do it on like a Saturday or Sunday morning when you don't have other things planned and you can just sort of keep eyes on your baby.

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[SPEAKER_02]: Most allergic reactions start pretty quickly, right?

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[SPEAKER_02]: So don't like feed them scrambled eggs for the first time and then like rush out to do a bunch of errands, right?

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[SPEAKER_02]: Like just hang out home for a couple of hours.

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[SPEAKER_02]: But I didn't wait and I introduced a lot of allergens in the evening to be honest because I was like, this is the only time we had of like I was on call during the weekends as well.

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[SPEAKER_02]: So at like six p.m.

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[SPEAKER_02]: when we were sitting down for dinner, I was like, very let's try this peanut butter.

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[SPEAKER_02]: Let's do it.

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[SPEAKER_02]: Let's do it.

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[SPEAKER_02]: Let's do it.

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[SPEAKER_02]: And sometimes you have to get a little creative to you because textures, textures, kids are learning, right?

17:07.428 --> 17:11.432
[SPEAKER_02]: So if they don't like the peanut butter, which my kid never did, he still doesn't really like it.

17:11.853 --> 17:20.181
[SPEAKER_02]: You find a different alternative if you can't like a peanut powder or peanut puffs, which I mean, we kept Trader Joe's in business because of how many bombas we bought from them.

17:20.381 --> 17:21.101
[SPEAKER_01]: So anyway.

17:21.882 --> 17:25.563
[SPEAKER_01]: That's awesome and I love your suggestion about doing it on the weekend.

17:25.683 --> 17:27.463
[SPEAKER_01]: I actually never thought about that.

17:27.523 --> 17:28.824
[SPEAKER_01]: That's such a great idea.

17:28.844 --> 17:40.067
[SPEAKER_01]: Because then you have more opportunity to keep an eye on them instead of relying on if you do have alternate daycare, relying on them to really understand or see what's going on.

17:40.327 --> 17:41.327
[SPEAKER_01]: That can be scary too.

17:41.751 --> 17:55.100
[SPEAKER_02]: Yeah, yeah, and I think, you know, I think what's unfortunately happened with like the guidelines changing is that like, I don't think we did an adequate job addressing the emotional piece of like all of the food.

17:55.700 --> 17:56.801
[SPEAKER_02]: Like, it's just hard.

17:56.861 --> 17:58.502
[SPEAKER_02]: It's a different way of living.

17:58.682 --> 18:07.488
[SPEAKER_02]: And if you think about how many times you go to feed yourself for your kid, you're making literally a thousand decisions around it every day.

18:07.608 --> 18:10.110
[SPEAKER_02]: And the fatigue that goes along with that is very real.

18:10.890 --> 18:14.152
[SPEAKER_02]: And then when we're just like, oh, it just keep entered it.

18:14.652 --> 18:19.435
[SPEAKER_02]: I think we've we've suffered a little bit and we haven't kept in top and we haven't kept.

18:20.955 --> 18:25.678
[SPEAKER_02]: We haven't kept kept up with where parents and families are like we're falling a little bit short.

18:25.758 --> 18:26.798
[SPEAKER_02]: I think we're getting better.

18:26.819 --> 18:29.260
[SPEAKER_02]: But it's it's very real.

18:30.874 --> 18:33.899
[SPEAKER_01]: It is, and I'm so glad you brought up the emotional aspect.

18:33.999 --> 18:35.221
[SPEAKER_01]: Let's talk about that.

18:35.601 --> 18:38.225
[SPEAKER_01]: And let's, let's fast forward now.

18:38.245 --> 18:46.458
[SPEAKER_01]: This child has an allergy to either peanuts or peanuts or other other allergens that

18:46.858 --> 18:47.779
[SPEAKER_01]: that you mentioned.

18:48.579 --> 18:50.820
[SPEAKER_01]: And that's that's really stressful.

18:50.980 --> 19:01.046
[SPEAKER_01]: I mean, not just worrying about what's going to happen to my child, but also realizing you can't keep your child in a bubble and they're going to live their life.

19:01.086 --> 19:02.146
[SPEAKER_01]: They're going to go to friends.

19:02.166 --> 19:03.227
[SPEAKER_01]: They're going to go to parties.

19:03.547 --> 19:06.249
[SPEAKER_01]: They're going to go to school, all the things.

19:06.790 --> 19:12.275
[SPEAKER_01]: And wow, I mean, there's so many different tracks that we can start with when it comes to this conversation.

19:12.615 --> 19:15.217
[SPEAKER_01]: But let's just talk about safety first.

19:15.338 --> 19:24.746
[SPEAKER_01]: And what are the most common questions you get that from parents so that we can help those that are listening right now, just kind of manage that.

19:25.090 --> 19:35.499
[SPEAKER_02]: Yeah, so I'll say that as an allergist, I'm probably thinking like if you're bringing in your one-year-old or nine-month-old to me, I'm already thinking about what it's going to be like in kindergarten for them, right?

19:35.539 --> 19:43.306
[SPEAKER_02]: So from the gecko, the goal of food allergy testing is not like prophylactic testing and let me test you to like forty different things.

19:43.486 --> 20:02.865
[SPEAKER_02]: right that is not evidence based medicine that all are just as not like please grab your stuff and run like that is my most candid advice because unfortunately there are still offices that that practice that way the goal of food allergy testing is to keep that list as narrow and tight as possible

20:03.345 --> 20:23.664
[SPEAKER_02]: So if you've had a suspicious reaction like maybe you had some hives the first time you gave scrambled eggs or a piece of toast or something like that is to test to that allergen and to not test a bunch of different things and then depending on the allergen it really helps I help frame that discussion from that diagnosis even at nine months of age or at one year of age.

20:24.204 --> 20:24.605
[SPEAKER_01]: Okay.

20:25.005 --> 20:38.479
[SPEAKER_02]: So, most kids, like, eighty percent will outgrow their egg or milk allergy by the time you're in elementary school, sometimes it's sooner than that, but I'm already thinking about, like, how is this parent going to navigate preschool or kindergarten?

20:39.580 --> 20:40.942
[SPEAKER_02]: or count, right?

20:42.043 --> 20:45.886
[SPEAKER_02]: And it's a different, it's just adds another layer.

20:45.926 --> 20:56.656
[SPEAKER_02]: Like you have to think about your Epipen prescriptions, you have to think about your emergency action plans, you have to like have a certain amount of trust that you now have to put into another institution or other people.

20:57.197 --> 20:58.958
[SPEAKER_02]: And it's very hard to do that.

21:00.460 --> 21:01.080
[SPEAKER_02]: Yeah, it is.

21:01.521 --> 21:09.269
[SPEAKER_02]: It's very hard because even if it if a school is like peanut or tree nut free, does it help the kid that has a milk allergy?

21:09.389 --> 21:10.150
[SPEAKER_02]: Like no, right?

21:10.170 --> 21:10.951
[SPEAKER_02]: It doesn't, right?

21:11.031 --> 21:14.855
[SPEAKER_02]: And milk and egg are the one number one and number two most common allergens and kids.

21:14.915 --> 21:15.015
[SPEAKER_02]: So

21:15.495 --> 21:20.639
[SPEAKER_02]: I start thinking about it sooner, much sooner than I think parents even sometimes realize.

21:20.939 --> 21:25.703
[SPEAKER_02]: But the goal is always to set up that conversation like, right now you're going to be stressed.

21:25.743 --> 21:27.344
[SPEAKER_02]: Your grocery shopping is going to change.

21:27.384 --> 21:30.086
[SPEAKER_02]: How you cook, how you go out to eat, how you travel is going to change.

21:30.527 --> 21:38.833
[SPEAKER_02]: But I don't want this list to be like twelve foods that you're avoiding because things are going to get complicated very quickly when you're navigating day care and school.

21:40.252 --> 21:51.278
[SPEAKER_01]: So backtracking to what you first said, when you start to suspect, what are you seeing is start to keep a list, a very specific list of the things that you are suspicious.

21:51.678 --> 22:01.503
[SPEAKER_01]: And then when you go to see the allergist, your goal is to really focus on a smaller amount or more significant allergens.

22:02.303 --> 22:11.229
[SPEAKER_01]: ones that maybe are more common and also ones that parents have noticed about their own children and then that's what you focus on in regards to testing.

22:11.669 --> 22:12.129
[SPEAKER_02]: Correct.

22:12.309 --> 22:13.930
[SPEAKER_02]: So there's no blanket.

22:13.990 --> 22:26.178
[SPEAKER_02]: I'm going to put some forty foods on your that is that is not good medicine and it's not good for the kiddo right and I think the instinct is well I just want to know I just want to know so I know how to safely do this at home and I totally understand

22:26.758 --> 22:32.543
[SPEAKER_02]: anxiety piece of this on like how to feed our kiddos because we have scared the pejises out of parents and caregivers.

22:33.063 --> 22:46.874
[SPEAKER_01]: Well, Dr. kind of really appreciate you specifying like what to test and and when to start these foods and we've brought up the topic of food intolerance and let's go there.

22:46.974 --> 22:53.639
[SPEAKER_01]: Let's talk about what is the difference between an actual allergy, would you explain in the beginning that

22:54.640 --> 22:58.202
[SPEAKER_01]: IGE mediated response, very complicated, right?

22:58.782 --> 23:00.423
[SPEAKER_01]: And a food intolerance.

23:00.483 --> 23:02.904
[SPEAKER_01]: And how can a family tell the difference?

23:04.244 --> 23:07.766
[SPEAKER_02]: It's a lot of trial and error in keeping track of symptoms.

23:07.826 --> 23:17.670
[SPEAKER_02]: So a food diary can be really helpful because we think we know how often the symptoms are happening or what the potential triggers are, but to put it in writing sometimes can be a really good starting place.

23:18.250 --> 23:20.451
[SPEAKER_02]: And what I always tell parents and families is that

23:21.051 --> 23:24.754
[SPEAKER_02]: no one allergy or intolerance is like better or worse or harder.

23:24.934 --> 23:29.397
[SPEAKER_02]: It's all kind of difficult when you're having to manage any kind of dietary or food restriction.

23:29.857 --> 23:32.119
[SPEAKER_02]: It's just as a definition is different.

23:32.259 --> 23:36.161
[SPEAKER_02]: So food intolerance is, I'll touch on lactose intolerance in a second here.

23:36.201 --> 23:41.085
[SPEAKER_02]: But honestly, we don't even really understand the mechanism for a lot of it.

23:41.165 --> 23:44.227
[SPEAKER_02]: Like gluten intolerance or gluten sensitivity rates.

23:44.267 --> 23:50.371
[SPEAKER_02]: Some people just feel better when they don't have a giant bowl of pasta or mac and cheese and they're not eating ice cream

23:50.491 --> 23:54.456
[SPEAKER_01]: But there's dairy and in some ice cream there's egg, right?

23:54.476 --> 23:56.618
[SPEAKER_02]: Yeah, that's true.

23:56.878 --> 24:06.289
[SPEAKER_02]: So keeping track of symptoms and it doesn't mean that you're a it's harder because you have celiac disease or IG mediated wheat allergy or it's just a gluten intolerance.

24:06.990 --> 24:07.911
[SPEAKER_02]: It's all difficult.

24:08.271 --> 24:10.734
[SPEAKER_02]: What I want people to understand is that oftentimes

24:11.375 --> 24:15.857
[SPEAKER_02]: food intolerances and food sensitivities cause a lot of digestive symptoms.

24:15.897 --> 24:24.461
[SPEAKER_02]: So you'll have bloating and abdominal pain and cramping and vomiting, not vomiting necessarily, but like diarrhea or you'll get constipated and you just don't feel great.

24:24.961 --> 24:27.102
[SPEAKER_02]: And those are all valid symptoms, right?

24:27.142 --> 24:33.665
[SPEAKER_02]: But the testing that we have within the world of food allergy, the skin testing or the lab work that people traditionally think about.

24:34.205 --> 24:39.251
[SPEAKER_02]: It's only good for the first type of thing that we talked about that IG mediated reaction.

24:39.331 --> 24:47.962
[SPEAKER_02]: So it's useless if you come in and you tell me I'm having all these symptoms when I eat a bunch of gluten or I have a bunch of dairy and I think I have a lactose intolerance.

24:48.322 --> 24:49.864
[SPEAKER_02]: Like yes, your symptoms are valid.

24:50.144 --> 24:51.906
[SPEAKER_02]: My testing is not going to be helpful.

24:53.308 --> 24:54.589
[SPEAKER_01]: That makes perfect sense.

24:54.669 --> 24:55.609
[SPEAKER_01]: That makes perfect sense.

24:56.070 --> 24:59.552
[SPEAKER_01]: And my grand daughter has F pies.

24:59.732 --> 25:01.454
[SPEAKER_01]: Will you break that down?

25:02.194 --> 25:10.941
[SPEAKER_01]: What F pies is and how it actually differences differentiates from a food allergy and a food intolerance.

25:11.510 --> 25:11.891
[SPEAKER_01]: Yes.

25:11.991 --> 25:13.853
[SPEAKER_01]: So I have to, I'm sorry.

25:13.873 --> 25:24.126
[SPEAKER_01]: I have to tell you that I, as a pediatrician, I never heard of it until one day my son came home and said, my, my daughter has f pies against egg.

25:24.266 --> 25:26.389
[SPEAKER_01]: And I was like, look it up.

25:26.629 --> 25:28.631
[SPEAKER_01]: So let's, yeah, what is that?

25:29.232 --> 25:30.652
[SPEAKER_02]: So it's interesting that it's egg.

25:30.732 --> 25:41.876
[SPEAKER_02]: Traditionally, we think about it with like oat and like fruit, banana and sweet potato and avocado, things that don't necessarily cause like the lib and tongue swelling and the hives and stuff.

25:41.916 --> 25:46.177
[SPEAKER_02]: So F pies, stands for food, protein, induced, and to a kaleidos syndrome.

25:46.257 --> 25:46.877
[SPEAKER_02]: It's a mouthful.

25:47.357 --> 25:48.578
[SPEAKER_02]: But honestly, it's like...

25:49.478 --> 25:58.708
[SPEAKER_02]: We don't even understand the exact mechanism of what's happening, but the way that I explain it to parents and families is that there is an immaturity in the gut where it has this delayed reaction.

25:59.208 --> 26:03.853
[SPEAKER_02]: So typically with the traditional allergies, it starts within fifteen, twenty minutes an hour.

26:04.594 --> 26:24.970
[SPEAKER_02]: but oftentimes F pies reactions because it's involved in the gut and your gut sort of has to like break down the food and then it realizes like nope I'm not having this and then it causes the vomiting the vomiting can be very very pronounced and sometimes it starts two or three hours after the food and so the first time that your kid has a reaction

26:25.450 --> 26:29.932
[SPEAKER_02]: You don't even know, and most of the time people will be like, I think baby they caught a G-I-Bug.

26:29.972 --> 26:38.416
[SPEAKER_02]: I don't know, there was a lot of puking, and he seemed really out of it, a motharject, and then he sort of perked up after I gave him a bottle, and he was able to nurse again.

26:38.936 --> 26:45.499
[SPEAKER_02]: And then they do the eggs again, where the avocado again, not realizing that maybe this delayed reaction was the thing.

26:47.019 --> 26:47.539
[SPEAKER_01]: That did.

26:47.899 --> 26:48.580
[SPEAKER_02]: That did it.

26:48.620 --> 26:50.500
[SPEAKER_02]: That was leading to the App Pies diagnosis.

26:50.820 --> 26:57.582
[SPEAKER_02]: So sometimes it does take two or three exposures before you start to put it together because the vomiting can be delayed.

26:58.202 --> 27:01.142
[SPEAKER_02]: I will say that even F pies is changing.

27:01.182 --> 27:05.363
[SPEAKER_02]: So sometimes these kids will start to have lots of vomiting like an hour after they be eaten.

27:05.383 --> 27:11.965
[SPEAKER_02]: They're out the trigger and then you're sort of left with like was it a traditional allergy or was it the F pies?

27:12.025 --> 27:16.146
[SPEAKER_02]: And that's where the allergistum and the office visit should help to clarify.

27:16.826 --> 27:17.587
[SPEAKER_01]: to clarify that.

27:17.727 --> 27:37.516
[SPEAKER_01]: Thanks for, thanks for clarifying that because I know it does get very confusing and also clarifying what a food intolerance is and also specifying that that is still significant and that when we say it's a food intolerance it doesn't mean that we don't think that it's still bothersome for the child and the family.

27:38.076 --> 27:45.060
[SPEAKER_01]: Now I know a lot of people also have skin issues when it comes to allergies

27:45.860 --> 27:48.604
[SPEAKER_01]: And many people know the term Exima.

27:49.004 --> 27:53.890
[SPEAKER_01]: And let's talk about Exima and food allergies or food intolerances.

27:54.170 --> 27:55.472
[SPEAKER_01]: What's the relationship there?

27:55.492 --> 27:57.975
[SPEAKER_01]: Because I know there's some myths, right?

27:58.415 --> 27:59.757
[SPEAKER_02]: Yes, there's a lot of myths.

28:00.197 --> 28:03.762
[SPEAKER_02]: And I'm going to tell you that the science behind this is still evolving.

28:04.262 --> 28:13.670
[SPEAKER_02]: So, Exima is sort of this broad category of a skit where your skin has this inflammatory condition, which can come out as dry, itchy, and flame skin.

28:14.070 --> 28:21.276
[SPEAKER_02]: When we think about food allergies, the more specific term is atopic dermatitis, but it's just easier to say Exima, so it's sort of like a garbage can.

28:21.857 --> 28:22.077
[SPEAKER_02]: Yes.

28:23.098 --> 28:23.879
[SPEAKER_02]: That's what I call it.

28:25.520 --> 28:27.141
[SPEAKER_02]: So, what do we think?

28:28.002 --> 28:44.277
[SPEAKER_02]: are working theory in two thousand and twenty five is that if you have eczema you have a broken skin barrier your skin barrier supposed to look like this nice and tight nothing leaves nothing gains access to it but in eczema kind of looks like this you have a ton of holes all of the moisture leaves which is why

28:44.857 --> 28:46.398
[SPEAKER_02]: Exemptive skin is very dry.

28:46.438 --> 28:50.622
[SPEAKER_02]: Dry skin is very itchy and then you're itching and then you're it's getting inflamed and then you're stuck in a cycle.

28:50.982 --> 29:00.889
[SPEAKER_02]: But then all of the stuff in our environment also gains access to our immune system and teaches it the wrong thing before you even had a chance to feed the eggs in the dairy and the peanut.

29:01.410 --> 29:08.916
[SPEAKER_02]: And because your immune system has to learn that it's allergic to something before it has an allergic reaction, that's what we think is the first step.

29:09.156 --> 29:11.438
[SPEAKER_02]: The eggs are potentially

29:12.158 --> 29:14.399
[SPEAKER_02]: puts you at a higher risk of developing a food allergy.

29:14.439 --> 29:27.525
[SPEAKER_02]: So it's the teaching of the immune system, the wrong thing through the skin, which then leads to, well, I gave them scrambled eggs for the first time, and then they broke out in hives and had the vomiting.

29:27.585 --> 29:30.426
[SPEAKER_02]: And I think that's the connection that sometimes people will miss.

29:32.427 --> 29:33.728
[SPEAKER_02]: That's one thing to keep in mind.

29:33.968 --> 29:36.509
[SPEAKER_02]: The other controversial thing that I'm going to sort of just

29:38.179 --> 29:44.764
[SPEAKER_02]: A dress is that oftentimes people will think that certain foods are triggering and causing the eggsima.

29:45.325 --> 29:47.246
[SPEAKER_02]: Okay, okay.

29:47.847 --> 29:55.332
[SPEAKER_02]: And I'm going to tell you that the root cause of eggsima is genetics, and you can have two not allergic parents.

29:55.373 --> 29:57.814
[SPEAKER_02]: So they don't have any seasonal allergies or eggsma or asthma.

29:58.355 --> 30:07.282
[SPEAKER_02]: You can have new mutations when you were in utero and you're a fetus that predisposes you to having eggsima and food allergies, seasonal allergies.

30:09.044 --> 30:17.354
[SPEAKER_02]: So food can potentially be a trigger, but honestly, again, we don't understand the mechanism, and I want to make sure that we're balancing everything, right?

30:17.414 --> 30:22.360
[SPEAKER_02]: So if you take away dairy or take away egg or take away wheat or soy,

30:23.441 --> 30:26.382
[SPEAKER_02]: You don't want to be in a position where you're trading one problem for another.

30:26.502 --> 30:29.862
[SPEAKER_02]: So think that the dairy is going to make the eczema better.

30:30.362 --> 30:34.343
[SPEAKER_02]: There are some cases where parents will swear by that was the only thing that helped.

30:34.403 --> 30:39.864
[SPEAKER_02]: But I always tell them and encourage them to revisit that elimination diet plan frequently.

30:40.324 --> 30:44.065
[SPEAKER_02]: Frequently, don't just like do it and then go a year without exposing your kid, right?

30:44.105 --> 30:49.926
[SPEAKER_02]: Because that lack of exposure could potentially set your kid up for having that traditional allergy.

30:49.986 --> 30:51.806
[SPEAKER_02]: We don't want to trade one problem for another.

30:52.743 --> 30:54.905
[SPEAKER_01]: Yeah, so well said, I appreciate that.

30:55.525 --> 31:06.374
[SPEAKER_01]: And I know I'm shifting for a minute, but I feel like I would be remiss if we didn't talk about the financial burden that these allergies also have.

31:07.135 --> 31:13.460
[SPEAKER_01]: And I know every pens are expensive and sometimes aren't covered by insurance.

31:14.141 --> 31:21.687
[SPEAKER_01]: I know that let's talk about the financial burden and what you've experienced in your clinic and what parents are asking about.

31:23.122 --> 31:37.871
[SPEAKER_02]: Uh, yeah, I think somebody just message me on Instagram and said, I had made some comment about Hyville Aller-Donic Formula and how one can is like near eighty dollars compared to like thirty five bucks were like, and the can is like supposed to last you a week to feed your baby.

31:37.911 --> 31:39.051
[SPEAKER_02]: I mean, it's insane.

31:39.412 --> 31:44.795
[SPEAKER_02]: The the the comment was like food allergy taxes real and it's true.

31:44.815 --> 31:47.656
[SPEAKER_02]: And it's true because

31:48.717 --> 31:52.100
[SPEAKER_02]: Alternative ingredients are more expensive, right?

31:52.200 --> 31:57.985
[SPEAKER_02]: If your kid is allergic to dairy and you can't have the three dollar, how much, how much is milk right now?

31:58.025 --> 31:58.485
[SPEAKER_02]: Three dollars?

31:58.505 --> 32:00.206
[SPEAKER_01]: Three dollars of milk.

32:00.447 --> 32:06.031
[SPEAKER_01]: I'm going to tell you, at my, I've gone back to my grandbaby and this is just real life experiences.

32:06.111 --> 32:14.138
[SPEAKER_01]: My daughter allowed to tell me yesterday, she drinks goat milk and it's twelve dollars a carton for the goat milk.

32:14.732 --> 32:19.296
[SPEAKER_02]: Right, or if you're doing oat milk or pea protein milk, those are way more expensive.

32:19.656 --> 32:22.418
[SPEAKER_02]: And this is the thing, like this is your grocery bill.

32:22.498 --> 32:24.120
[SPEAKER_02]: And we go groceries every week.

32:24.180 --> 32:25.060
[SPEAKER_02]: I mean, it's insane.

32:25.300 --> 32:25.981
[SPEAKER_02]: It's insane.

32:26.061 --> 32:28.243
[SPEAKER_02]: Alternative ingredients are way more expensive.

32:28.663 --> 32:39.232
[SPEAKER_02]: And they cause more financial stress than most people realize, which is also why my goal is always to keep people allergic for the least amount of time as powerful.

32:39.972 --> 32:42.956
[SPEAKER_02]: And the other thing is like how you go through a shop, right?

32:42.977 --> 32:48.224
[SPEAKER_02]: Like unless you're a vegan avoiding dairy and egg, it's very hard.

32:48.384 --> 32:52.410
[SPEAKER_02]: It's very hard, especially if the entire family is not also avoiding those things.

32:52.490 --> 32:52.630
[SPEAKER_02]: So

32:53.653 --> 33:01.298
[SPEAKER_01]: Yeah, we're constantly reading labels and it's okay, we do it and except it because of course we don't want her to have a reaction.

33:01.658 --> 33:12.986
[SPEAKER_01]: But then this gets into my next question and that is how do allergies, these intolerances, eggs, and all these things really impact the emotional well-being of the family and the child.

33:13.406 --> 33:13.606
[SPEAKER_02]: Yeah.

33:14.287 --> 33:21.652
[SPEAKER_02]: My favorite thing to say to patients and families is you are not just your diagnosis, you are a whole person, right?

33:21.732 --> 33:28.417
[SPEAKER_02]: So even though people can't see your food allergy or even if they can see your ex-email flaring, you're still more than that, right?

33:28.457 --> 33:28.977
[SPEAKER_02]: You're still

33:30.158 --> 33:37.725
[SPEAKER_02]: impacted by the chronicity of the decisions that you're having to make around the food allergies or the X amount because they are chronic conditions.

33:37.785 --> 33:50.976
[SPEAKER_02]: So it doesn't matter that it's just food out like you're still a whole person and all of the stress and anxiety that goes into like I'm going to a new school or my kid is now a teenager and going away.

33:51.797 --> 33:59.419
[SPEAKER_02]: to travel by themselves, you know, like it's all of the stress that kind of goes into that and takes a different band with to be able to navigate.

33:59.839 --> 34:05.441
[SPEAKER_02]: So I started addressing that stuff early, right, especially if it's something like a dairy or an egg allergy work.

34:06.141 --> 34:12.003
[SPEAKER_02]: I mean, like as you guys experience probably, like, is totally very different to even go up to eat.

34:13.195 --> 34:13.976
[SPEAKER_01]: It's in everything.

34:14.617 --> 34:15.238
[SPEAKER_01]: Everything.

34:15.599 --> 34:26.154
[SPEAKER_01]: So what safety steps should parents take when they are at school or with friends or restaurants, as you mentioned, birthday parties all all the above?

34:27.055 --> 34:27.836
[SPEAKER_02]: I think we have come

34:28.457 --> 34:46.600
[SPEAKER_02]: a long way as a community and a society with food allergies and intolerances, that it's much easier to have those conversations, but there are still people that are like shamed or shunned because they are managing those things, which kind of is in pirating, but I think normalizing it, right?

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[SPEAKER_02]: And then sometimes, like the message that I always share with parents and patients and families and friends, even, is like, let's say you're having somebody over for a gathering.

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[SPEAKER_02]: The easiest thing that you can do is just to ask them a question, hey, are there any food restrictions or dietary preferences that I need to be aware of, right?

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[SPEAKER_02]: Normalize it.

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[SPEAKER_02]: And if you start early enough, I think people are more likely to engage in that.

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[SPEAKER_02]: And then you don't have to feel like as the parent who's managing the food allergies that you're carrying all of this on your own and your own burden and on your own shoulders.

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[SPEAKER_02]: Your friend, you can tap into your friends in your community and I think people are way more supportive when you're just like, hey, this is just what we do.

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[SPEAKER_02]: Our kid is allergic to shellfish or whatever it is.

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[SPEAKER_02]: And then normalizing that, I think, is the biggest thing that you can do.

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[SPEAKER_02]: And then working, and then giving them some options, would you feel more comfortable bringing your own alternative or is it okay if I have a dairy-free menu and would you guys feel comfortable with that, right?

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[SPEAKER_02]: So just normalizing it.

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[SPEAKER_01]: Yeah, that is awesome.

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[SPEAKER_01]: I know that sometimes I'll recommend that to parents that are especially going to birthday parties if they can't have the birthday cake and to bring, you know, there may be a cupcake with ingredients that they can have and just so that the child doesn't feel left out.

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[SPEAKER_01]: But I love that you added that element to it, just talking to

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[SPEAKER_01]: the people that are having the party, for example, in this situation so that they're all on the same page and normalizing that.

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[SPEAKER_01]: I love that.

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[SPEAKER_01]: So as we start to wrap up, I want to know what really gives you hope in this field.

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[SPEAKER_02]: I love our specialty because it has changed so much.

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[SPEAKER_02]: You know, like we have the bread and butter conditions, but it's all of the stuff that's evolving, especially in the food allergy space, like compared to where we were even ten years ago or fifteen years ago, so much has changed and you can individualize and personalize the treatment option to that person and to that family and it can change over time.

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[SPEAKER_02]: I think that's what I love the most is that like,

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[SPEAKER_02]: Yes, right now, this is where we are.

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[SPEAKER_02]: But in six months, we're in a year or two years, things may be totally different.

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[SPEAKER_02]: And to keep that conversation evolving, I think is the probably the favorite part of my job, and then to be able to give that hope back to parents and families like, yes, right now, we're navigating a milk and egg allergy, but it's not going to be like this, hopefully it's not going to be like this forever.

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[SPEAKER_01]: Dr. Kahn, you really help families understand and manage these real risks and the realities of food allergies with compassion and science.

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[SPEAKER_01]: And I really appreciate you being on the show for breaking down this complex and often misunderstood topic.

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[SPEAKER_01]: Food allergies are so frightening, but with the right guidance, families can feel prepared and supported and safer.

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[SPEAKER_01]: Thank you for being a guest on the show.

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[SPEAKER_01]: Thank you so much for having me, Sarah.

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[SPEAKER_01]: And if you would like more resources, visit a-a-a-i.org or check out nationwide children's hospital allergy and immunology page.

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[SPEAKER_01]: And to our listeners, thank you for tuning in.

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[SPEAKER_01]: Don't forget to subscribe and share this episode with someone who could use this information.

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[SPEAKER_01]: Until next time, keep growing up with me.

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[SPEAKER_01]: And let's grow up to