Season 3: Strengthening our Support Systems
Renowned allergist Dr. David Stukus joins Dr. Whitehouse to discuss the evolving landscape of allergy treatment and what it means for those living with food allergies. We discuss promising new therapies, advancements on the horizon, and what patients should know about emerging treatment options. Beyond the science, we also examine the importance of a strong doctor-patient relationship—what Dr. Stukus sees as the barriers to this and how open communication, trust, and collaboration can improve both medical outcomes and quality of life.
Photo credit: Nationwide Children’s Hospital
Special thanks to Kyle Dine for permission to use his song The Doghouse for the podcast theme!
www.kyledine.com
Find Dr. Whitehouse:
-thefoodallergypsychologist.com
-Instagram: @thefoodallergypsychologist
-Facebook: Dr. Amanda Whitehouse, Food Allergy Anxiety Psychologist
-welcome@dramandawhitehouse.com
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. David Stukus (00:00):
there's more and more treatment options being
(00:01):
investigated.
So hold on to your hats.
I mean, if we had thisconversation once a year for the
next five years, it's going tochange.
there are other treatmentoptions that approach different
pathways, We're learning moreand more about, long term
treatment?
The future is very bright.
Speaker (00:17):
Welcome to the Don't Feed the Fear podcast, where we
dive into the complex world offood allergy anxiety.
I'm your host, Dr.
Amanda Whitehouse, food allergyanxiety psychologist and food
allergy mom.
Whether you're dealing withallergies yourself or supporting
someone who is, join us for anempathetic and informative
journey toward food allergy calmand confidence..
(00:39):
This season on Don't Feed TheFear.
We are talking aboutstrengthening and expanding our
support systems.
And what this has actuallyturned into for me has been, the
opportunity to talk with a lotof the people who've been
influential On our own allergyjourney here in my house, and to
thank them for the help and thesupport that they provided to
me, At times, I have mentioned,and my guests have mentioned
some of our discouraging andfrustrating experiences with the
(01:02):
allergists that we have workedwith, but I also wanna make sure
that I acknowledge how hardallergists are working.
I've had some that were not agreat fit for us,.
But overwhelmingly, theexperience has been wonderful
with those that were a good fitfor us, who were supportive and
who guided us through differenttreatments to get my son into a
(01:22):
good spot.
So thank you to them.
Thank you to all of the doctorsout there working hard to keep
us educated and safe.
And in that spirit, I'm excitedto share this conversation with
Dr.
David Skuas.
DRAs or Dr.
Dave as his patients call him,has devoted his career as an
allergist to communicatingevidence-based practices and
best clinical practices tocolleagues, medical
(01:43):
professionals of allbackgrounds, patients and the
general public.
You probably are familiar withhim.
He's active on social media.
He uses his popular Twitter andInstagram accounts at Allergy
Kids Doc to dispel myths andcombat misinformation.
DRAs is an academic allergistwho holds multiple leadership
positions in the AmericanAcademy of Allergy, asthma and
(02:04):
Immunology, and the AmericanCollege of Allergy, asthma and
Immunology, he has been named atop doctor in pediatric allergy
every year since 2015.
Dr Amanda Whitehouse (02:15):
I'm really glad to finally meet you.
I've been following all of yourcontent for a while.
and it's nice to.
Put a face to the name.
Dr. David Stukus (02:22):
Yeah.
Well, thank you.
And I appreciate you reachingout.
Dr Amanda Whitehouse (02:25):
You just stepped down from your podcast,
right?
And was it in December?
So in here, I roped you backinto,
Dr. David Stukus (02:31):
Oh no, if I could somehow find a way to
like, Sustain a living being apodcast guest.
I would love that.
I love this.
Dr Amanda Whitehouse (02:37):
I think most of our listeners are
listening to the content that'sout there and they're probably
familiar with you, but I don'tthink a lot of us know fully all
of the hats that you've worn andthe roles that you have played
because there are quite a few.
Would you mind telling us just alittle bit more about all of the
projects you've done andpositions you've explored?
Dr. David Stukus (02:57):
Yeah.
So, um, I am an academicpediatric allergist, uh, through
and through, which means I workat a, at a major Children's
Hospital, Nationwide Children'sHospital in Columbus, Ohio.
And at my institution, I haveseveral roles.
My most prominent role is as thedirector of our food allergy
treatment center, which means itis my job to make sure that our
clinical operations are up andrunning and that we're always
(03:19):
adjusting towards the latestevidence based.
Practices.
I do a lot of teaching in myrole with different trainees at
different levels.
Um, I participate in clinicalresearch.
I like to write and publish aswell.
You know, over 100 peer reviewedpublications out there, a dozen
book chapters.
I've written a couple textbooksand I love teaching.
I mean, medical education iswhat I love.
(03:39):
So every opportunity I get toeither, you know, give grand
rounds or give presentations atregional national meetings that
I love that.
Now that's just my day job.
In addition to that, I've beeninvolved with our national
organizations.
Uh, I'm currently the vicepresident of the American
College of Allergy, Asthma, andImmunology, which means I'll be
president in two years.
(03:59):
Uh, I served as a social mediaeditor and host the podcast for
the American Academy of Allergy,Asthma, and Immunology for six
years.
And I'm, I'm on the executivecommittee for the American
Academy of Pediatrics.
So what this allows me to do isreally help just learn how the
organizations work, learn howthey can help our patients, how
they can help members andpracticing allergists and
physicians, uh, and contributein various ways with committee
(04:22):
work and things like that.
And then I love working withadvocacy organizations as well.
So I, I try to do what I can,uh, but you know, it can spread
you thin at certain times.
Dr Amanda Whitehouse (04:32):
It sure sounds like it.
Is that why you stepped downfrom the podcast?
Dr. David Stukus (04:36):
That, yeah, it was time.
I, you know, that was a greatrole.
I cherished it.
Um, it really changed my careerin a great way, but I thought it
was time for a new voice aswell.
I typically step down from majorthings.
Once a year, uh, because I do areassessment of my personal and
career goals, my one, three andfive year goals.
And I realized that, you know,for that position I'd have to
(04:58):
commit to another three years.
I don't think that lined up withwhat I want to do three years
from now.
So it's time for a new voice andwe found a great replacement.
Dr Amanda Whitehouse (05:05):
Yeah, it seems like you're always up for
a new challenge and a new
Dr. David Stukus (05:09):
Uh, I love building things and creating
things.
I realize that that's what getsme motivated.
Um, I don't want to just go inand punch a clock every day that
won't satisfy me career wise.
So yeah, that's that's I guess Iseek out opportunities.
You were also a member of thepanel of Allergists who did the
most recent round of updates forbest practices and allergy
(05:31):
practice parameters.
I am sure I fumbled the namethere.
Yeah.
You can't keep all the acronymsstraight yet, right?
So I was the, it's called theJoint Task Force on Practice
Parameters for AllergyImmunology.
So it's 12 allergists invited tojoin this amazing group where,
we're tasked with basicallygoing through all of the
evidence and doing a metaanalysis and systematic reviews
(05:53):
and then coming up with, they'renot quite guidelines, they're
more here's best practices.
and I was a member of that forfive years, and that was one of
those roles.
I loved it.
I voluntarily didn't re up formy second five year term because
it, I was just busy with, stuffgoing on with their kids lives.
And I, you know, the conferencecalls were interfering and it
took a lot of time, but I wouldlove to go back and rejoin that
group in the future.
(06:13):
But yeah, I was able to helpwrite, um, some of the, the most
recent parameters, uh, inregards to anaphylaxis and, uh,
food allergy and, um, drugallergy and things like that.
Dr Amanda Whitehouse (06:23):
I'd love to hear what you think is most
important for us to know aboutthat.
Dr. David Stukus (06:27):
Where do we begin?
Like no seriously theconversations I have with
families in the office today.
I wouldn't have had two yearsago five years ago It's a bit
much to say everything haschanged with food allergy, but a
lot has changed in regards tojust our understanding of
diagnosis, prognosis, individualrisk, treatment, prevention.
(06:47):
I think the biggest paradigmshift, there's a couple.
One was when we startedrecommending that we introduce
allergenic foods like milk, egg,wheat, soy, peanuts, tree nuts.
Um, seafood to babies aroundfour to six months of age and
keep those foods in their dietconsistently.
That's our best path towardspreventing food allergy.
The advice before that, which isway outdated, was to avoid those
(07:08):
foods.
Uh, that was based on get best,you know, opinion at the time.
But the evidence has evolvedtremendously.
Um, you know, with the pivotalleap trial that was published a
decade ago that really showed usif we get the peanut in the
baby's diet, it can help.
promote tolerance and protectthem.
So that's a huge shift and thatreally still causes a lot of
confusion with families and withpediatricians lately.
(07:32):
The most updated evidence.
And again, it's important forpeople listening to understand,
you know, evidence changes andaccumulates over time.
And science is really messy.
We rarely have definitiveanswers.
Oftentimes, new researchcontradicts prior research.
There's levels of evidence.
Some research studies are reallywell done, and they can show
things like cause and effect.
(07:52):
Other studies really just showus a peek at what may be
associated with each other.
So the evidence surroundingeczema, as well as anaphylaxis r
Um, in the last decade an reallyhelp families under to manage
both of those
Dr Amanda Whitehouse (08:09):
It's interesting us out because there
is s so much new information adoctor who's out there on social
media myth busting and tellingus like this isn't true.
This isn't true.
Here's the truth, but really itseems like Allergy and
immunology is a field wherethere's so much gray area.
As a psychologist I'm helpingpeople all day long.
(08:29):
You're you're in black and whitethinking let's find the gray
area so I was wondering if youcould comment on what that's
like trying to Give clearparameters when there is still
so much in between.
Dr. David Stukus (08:40):
Yeah, I, I love that you brought that up.
So I think we can reallyestablish the diagnosis.
So that's, that's the mostimportant part of what we do in
allergy immunology.
Like what is your actualdiagnosis?
All of the symptoms that occurfor allergic conditions, whether
it's allergic rhinitis and youget itchy, sneezing in the
spring, food allergy, causinghives and vomiting.
All of the symptoms that occurdue to allergies can occur for
(09:02):
non allergic reasons.
So there's a ton of overlap.
I probably undiagnosed suspectedfood allergy in half of the
families I meet at the firstencounter.
Everybody comes to me thinkingtheir child has a food allergy,
but 50 percent of the time weclarify.
No, no, this is actually whattheir diagnosis is.
which really impacts management.
So we have to have a gooddiagnosis up at the forefront
because that changes your entirelife.
(09:23):
And then with the gray area,it's actually a good thing
because there's so much nuanceinvolved and there's such
individual variation.
We don't want to be treatingeverybody the exact same way.
That is such a disservice toeverybody out there.
Um, so it's hard because if yougo on social media or the
internet, you may, read peopleor meet people that are doing
things one way.
That may be completely differentfrom the way that you should be
(09:44):
managing yourself or your child.
And that's okay.
Uh, that's the message we wantto send.
It really is, should not be onesize fits all it, whether it's
asthma, allergic rhinitis,eczema, food allergy, everybody
should have their own individualplan.
Dr Amanda Whitehouse (09:58):
Of those, 50 percent that you're
dispelling, the suspecteddiagnosis, what's going on with
them and how are you ruling itout?
I understand, the basics thatjust a positive test can be a
false positive But give us alittle more detail on who might
fall into that false positivecategory and why
Dr. David Stukus (10:13):
yeah two big buckets And parents are so good
at you know, seeing whensomething's going on with their
child So one it's natural forparents to associate symptoms
with their child eating a foodKids eat all day every day,
right?
So if they start getting rashesor they start having symptoms,
it's natural for them to think,Oh, well, they ate this that day
or you know, they've been eatingthis and they're having these
(10:34):
symptoms.
So oftentimes that's morecorrelation and not causation.
The second big bucket is, no,your child is having symptoms
that we think are clearly linkedwith that food, but it's not due
to an allergic mechanism.
Sometimes it's more difficultydigestion, like intolerance.
We see a lot of kids that getcontact rashes on their face,
uh, to things that don't causeallergic reactions, like berries
(10:55):
and citrus and tomato sauce.
Um, so yes, I hear you andbelieve you.
You see these symptoms, and youassociate with your child eating
that food, but it's reallyimportant for me to figure out,
are they allergic or not.
Because if they're allergic, weneed to know that because it
puts them at risk to have moresevere reactions potentially,
but if they're not allergic,that means we don't, we probably
don't have to avoid that foodand we don't need to worry about
things like carrying epinephrineand anaphylaxis and stuff like
(11:17):
that.
Dr Amanda Whitehouse (11:18):
That's good to know.
So how do people find a greatallergist who can help them
distinguish this?
I know there are a lot of greatdoctors.
There are also some of us whohave gotten not the best
information from some of ourdoctors.
So how do we know?
Dr. David Stukus (11:32):
A large part of what I do is is I try my best
to translate evidence intoclinical practice, and that's I
have that privilege when I speakat our national meetings, my
colleagues and things like that.
There's a huge lag.
Um, so not all allergists aresort of up to date with evidence
based practices.
Not all medical professionalsare up to date with medicine,
you know, best practices.
(11:53):
If you come to me with concernsabout primary immune deficiency,
I cannot help you.
I've been so deep in the foodallergy world for the last five
years.
I am not up to speed with thatliterature and that, that, that
way to practice.
So I'm not a good person forthat sort of thing.
Um, it can be difficult to teasethat out through websites.
Um, a lot of times you have tomeet with them and see their
approach.
(12:13):
Um, In general, especially withthings like food allergy and
children, major academic centersare typically have more
opportunities to offer thingslike oral food challenges and
spend more time with people tokind of tease things out.
That being said, a lot ofcommunity allergists are
fantastic at diagnosing andtreating this.
Unfortunately, there's no easyway.
(12:34):
One thing I can say is it'sreally important that you,
making a point with a boardcertified allergist,
immunologist, that boardcertification really makes a
huge difference in regards totheir level of expertise and
understanding.
Um, we live in a, in a societywhere anybody can hang a shingle
that says they're an allergist,including folks that aren't even
like qualified medicalprofessionals.
Um, so really vetting and makingsure you know who you're seeing.
(12:56):
And both of our professionalorganizations in the United
States, the American Academy andAmerican College of Allergy and
Immunology.
have a listing of boardcertified allergists in your
area.
So that's a good place to start.
Dr Amanda Whitehouse (13:07):
Okay, I'll make sure I link those in the
notes for people who are lookingand maybe want to consider,
looking for somebody new.
we're talking this season on thepodcast about building your
support system.
And obviously I wanted you hereto help us make the most of our
relationships with ourallergists.
How do, how do we do that?
How do we walk into the officewith all these questions and all
this information that may or notbe correct and make the most of
(13:27):
our time and our relationshipwith you?
Dr. David Stukus (13:29):
Yeah, um, so a couple of thoughts.
One is have an open mind,because as I mentioned, half of
the people that I meet come inconvinced their child has an
allergy and it's my job toclarify and, and, you know,
educate them and, and as long,you know, most of them are open
to that.
Sometimes people get reallyupset because, you know, it's
really These cognitive biases wehave and they have this
confirmation bias and they don'tbelieve me and I do my absolute
(13:52):
best to explain to them anddemonstrate to them.
And, um, and every once in awhile, they're just, you know,
that's their identity and whothey are.
So if you can have an open mindgoing in thinking, okay, here,
here are my concerns.
Um, so being able to clearlydemonstrate that the history is
extremely important.
So we need to hear from you,like what's going on with you or
your child?
Um, you know, what are youassociating it with?
(14:14):
What's the timing of onset forany symptoms that are occurring?
What are the symptoms?
How long are they lasting for?
Have you tried any treatment sofar?
Um, have you taken anything outof the diet, you know, things
like that.
Um, and then, you know, from aparent family standpoint, if
you're meeting with an allergistand they're.
They have their back turned toyou, and they're just clicking
boxes during that encounter, andthey're not, you know, listening
(14:36):
to you and answering yourquestions.
I mean that, that you're allowedto seek a second opinion.
Um, not everybody has the samesort of bedside manner and
approach.
So you really need to have atrusting relationship with
whoever you work with.
And I tell families all thetime, I say, listen, here,
you've, this is the approachI've spent time discussing this
with you.
If what I have to offer youdoesn't quite gel with what
you're looking for, there's nohard feelings.
There's other allergists intown.
(14:56):
Uh, so please meet with them andsee if they can offer you
something that you feel muchbetter with.
Dr Amanda Whitehouse (15:01):
Another thing that I tell a lot of the
patients that I work with,obviously, I'm not giving them
any medical advice, butsometimes they're having
confusion or questions aboutthings.
And I will often tell them,You're allowed to call your
allergist and ask to come backin and have an appointment.
Some people think, Oh, but wedon't go back in for our checkup
until next year.
So I was hoping maybe you couldconfirm that because I think we
feel a little intimidated.
Dr. David Stukus (15:22):
Oh, absolutely.
All right, here's the, let's,let's get into it, shall we?
So here's the dark side ofmedicine is all of us are under
pressure to see more patients domore.
We're getting paid less for whatwe do.
Uh, the health insurance in theUnited States is a mess.
So, um, it's natural.
People want to be reimbursed fortheir time.
Uh, I chose academics for areason.
(15:44):
I just have a salary regardlessof how many patients I see or
what I do and things like that.
But if you're in community basedpractice, like you have to be
able to support your business.
Um, so for some allergists, ifyou are going to send them
messages, um, it's a chance thatthey may actually bill for that
time.
They should tell you that upfront and they should say, if
we're going to have a 15 minutetelephone conversation, this is
what I charge for it.
Uh, so that you can have alonger conversation and that you
(16:09):
can, you know, they canactually, you know, get
reimbursed appropriately forthat time that they're giving
you and their expert opinion.
And that's okay, but they shouldbe willing to do that.
So you should feel comfortableto reach out to them and say, I
have follow up questions.
What's the best way to do this?
Sometimes it's through theelectronic health record.
Sometimes it's through atelephone call.
Sometimes it's through a followup visit.
I get people reaching out to meall the time on social media.
(16:32):
Asking me specific questions oreven more general questions, and
I would love to help them, but Ican't I'm not there I'm not
their physician.
Um, I don't know anything aboutthem and it's it's Unethical for
me to provide any advicewhatsoever on social media, but
I tell all of them the samething Please reach out to your
personal allergist with thesequestions and you know more
often than not they say wellThey're not they're not willing
to answer them and I said wellthen seek a second opinion like
(16:55):
it It stinks that you have to dothat and it's really unsettling
But if that's the point thatyou're at to you're reaching out
to some stranger on InstagramLike maybe you should rethink
that relationship you have withyour own allergist
Dr Amanda Whitehouse (17:06):
I agree.
I think it's a tough balancebecause obviously none of us are
experts and know better thanyou, but we also have to have
that trust.
And if it's not there, thenobviously any, any advice that's
coming or, or recommendationsare going to, be regarded
differently if we aren't feelingreally comfortable with that
connection and relationship.
Dr. David Stukus (17:23):
Absolutely.
Yeah.
So I encourage you and for yourlisteners like, yes, you are
allowed to ask questions.
You're allowed to reach backout.
You don't have to wait for thatnext scheduled visit.
Um, and if you're not gettingthat support that you need as
much as you can find somebodyelse.
Dr Amanda Whitehouse (17:37):
Thank you.
That's good to hear.
you mentioned some of thechallenges and restrictions
don't apply to you because ofthe nature of your position.
But what is for you the hardestpart of working with patients?
Dr. David Stukus (17:48):
That's a great question.
I think access to care, itbreaks my heart, especially
with, infants that have concernwith food allergy because we, we
now have an opportunity to offertreatment and we can really, you
know, guide their management.
But when I meet families thatwait 2 months to see an
allergist or 3 months, and theywere given terrible advice and
they've been living in constantfear.
(18:08):
and their lives have been ruinedand they stopped all their
social engagements and stoppedgoing to restaurants.
That just breaks my heart.
Um, so that, that limited accessto care is really frustrating.
Uh, I'm in a position where Ican work on, on fixing that.
And lately we've been able tosee families within one, within
a week, basically.
A lot of times I can see themthe next day.
Um, so that is an idealscenario.
(18:29):
Um, but yeah, that's, that'sbeen one of the hardest parts, I
think.
Dr Amanda Whitehouse (18:32):
I do see that challenge a lot of times
and I'm in a, not a big city,but a somewhat bigger area and
people are waiting a long timeand in the meantime, I think
that's where we are on Googleand we're on social media and I
think then that's where themisinformation can come in.
Would you agree?
Dr. David Stukus (18:49):
100%.
Um, we also see it from actualboard certified allergist.
So this is where it gets reallytricky is and you know, we in
our specialty, you're going toget a range of opinions.
Um, there's still a lot ofallergists that are doing
unnecessary panel testing.
Uh, so you go in thinking thatyour child has a reaction to
egg.
and you walk out being diagnosedwith 12 different food allergies
that they don't actually have.
(19:09):
Uh, we often see them as asecond, third opinion and can
clarify that diagnosis overtime.
But these families are livingwith this for months and months.
Uh, or sometimes we miss awindow of opportunity where we
could have introduced the foodand maybe prevent that allergy
from developing.
So that's the other reallyfrustrating part is not only the
misinformation online, but justthe bad advice people are
getting from their own medicalprofessionals.
Dr Amanda Whitehouse (19:31):
I've heard a lot of people ask you, what's
the most common myth that youhear?
But I want to ask you, what doyou think is the most dangerous
or the most concerningmisconception or myth that's out
there about allergies?
Dr. David Stukus (19:43):
Oh, I think the most concerning one is,
strict avoidance is mandatory.
Even trace amounts can kill you.
Um, so this is where all thisstarted like 15 years ago when
we didn't have a goodunderstanding of actual risk
from reactions.
This is why we have peanut freeschools.
Uh, this is why we have peanutfree playgrounds and sections of
baseball games from a medicalstandpoint.
(20:05):
These are vastly not necessary.
Um, there are Children andpeople out there that are
exquisitely sensitive to verysmall amounts, but they are the
exception and not the rule.
And we now have ways that we canactually protect those
individuals through treatmentoptions.
Uh, so sending that message tofamilies now, especially when,
you know, we're doing thresholdchallenges and identifying, you
know, many Children aren't evengonna react at all until they
(20:27):
eat a certain amount.
Um, that's just a really badmisconception that continues to
sort of get parlayed and in thefood allergy space, you know,
this better than anybody fearcells.
Right?
So all the fear based messages,even from some advocacy
organizations, that's what gainspeople's attention.
That's how you get clicks andthings like that.
I mean, I don't, I've never senta fear based message when it
(20:48):
comes to food allergy in myentire career.
There's no need.
Um, it should be positive basedmessaging like we can help you.
Uh, so yeah, I think that's theone that stands out.
Yeah.
Dr Amanda Whitehouse (20:57):
I love that, and I agree about being
careful what you're consuming,I've been careful about how do I
even approach this on socialmedia, and you've done it well,
but I don't want to do that, anyof those techniques where you're
trying to gain followers, and,and that's what people are drawn
to, is that, that fear basedapproach, and alarmist,
messages, and so that's what wesee the most of, and that's what
gets passed along, and the, andthe soothing, calming, great
(21:18):
grounding information, like whatyou're sharing.
Although people are listening toyou.
So you're doing something,right?
Dr. David Stukus (21:24):
Well, so I've and I've learned lessons along
the way.
Um, I I tried addressing.
This is a really tricky subjectSo when we talk about food
allergy fatalities, you know,thankfully they are very rare
They're tragic every time theyoccur and we need to be aware of
them But it's also wellestablished though.
That's not the reality for thevast majority of people that's
Not something that's going tobe, you know, part of their
(21:44):
life.
Um, and when you try to addressthat on a platform like social
media, it's really hard to getin the nuance.
And, uh, I, I personally upset alot of people because it's a
very emotionally charged subjectin my effort to provide
reassurance.
A lot of people weren't ready tohear that.
Um, and that's okay.
And that was a lesson learned onmy end of like, this is not the
medium for me to do it.
So I stopped doing that.
(22:04):
If that's fine, I can do it whenI'm in a room with people and I
can read the room and answerquestions.
Um, I can do it one on oneconversations, but, um, yeah,
it.
It's a tricky space out there.
Dr Amanda Whitehouse (22:15):
It is.
I talk a lot to my patients andon the podcast too about, what's
going on with our nervoussystems and how when we're in a
fear state, the blood flow isrestricted to the areas of the
brain that can receive thatinformation.
And so, I try to remind people,like, literally some of that
information is not going to beabsorbed by your brain if you're
in this constant fear state andseeking out this scary
information.
I think people have to begrounded first before they're
(22:37):
able to receive.
The message that you're tryingto send, right?
We're not in that state whenwe're on social media.
Dr. David Stukus (22:43):
I, I, I love that, how you put that.
You're right.
So I, I, so I recognized yearsago of people are just dumping
their anxiety on me.
And that's their emotionalresponse to it.
And I don't get upset with that.
I, I feel bad for them.
There's nothing I can offer.
And I can just say I'm reallysorry you're going through this.
I hope you find the guidancethat you deserve.
Um, but oh my gosh, that's a,more often than ever I'm seeing
that on social media.
(23:04):
They're just using it as theirdiary or their psychologist.
And then you get in the echochamber because other people
then climb onto it.
And this is where I, you know, Ilike, I've been personally
attacked by people in the foodallergy community.
Um, I've had to block peoplebecause then they come after me
and now all of a sudden I'm thebad guy.
Uh, when I'm really just, I'mjust a conduit for the evidence.
So this isn't Dave's opinion outhere.
This is, you know, this is thereality of it.
(23:25):
But anyway, that's a differentstory for a different time.
Dr Amanda Whitehouse (23:28):
It's tricky though.
I think, you know, from whatI've seen and followed, you've
done a good job balancing it.
But for those who are wanting tohear that information and
listening, I would love if youwould share with us what you
want to get across about thoseunfortunate, very obviously
tragic and rare.
Those those deaths that we'reall afraid of every food allergy
parent.
That's our worst nightmare.
Dr. David Stukus (23:50):
Yeah, a couple of thoughts.
One is, um, these aren'thappening in young Children.
So, you know, all the parents Imeet that are scared to death to
send their kids to school, thosearen't the ones that are
experiencing these sorts ofoutcomes.
Um, it's almost unheard of ininfants, toddlers and school age
kids.
Um, when you look at the datasurrounding it, it's almost
always going to be young adults,adolescents and, um, more often
(24:11):
than not, they either don't havetheir epinephrine with them or
they don't use it in a timelyfashion.
there's really, really scaryscenarios where people get
multiple outcomes.
You know, treatment treatmentswith epinephrine, and they still
have a fatality, but thosereally are extremely rare.
So we can learn from that,right?
So we can really help ouradolescents and young adults
know that, hey, let's let'scontinue to be mindful of this.
Let's make sure that we're, youknow, double checking things.
(24:33):
We're going to restaurants.
Let's make sure you have yourepinephrine with you.
Let's make sure you communicatewith your social, your peer
network and the people thatyou're dating and hanging out
with.
Like, do they know you actuallyhave food allergies?
Do they know that you haveepinephrine in case you're in a
situation?
You know, um, These are suchrare occurrences that it's hard
to be prepared for it 24 7, butif we can establish good basic
(24:54):
sort of, you know, habits thatmake sure we have these things
with us, then that's how theseget prevented.
Um, so that's sort of themessaging is, you know, that we
we know enough to know thatthere's
Dr Amanda Whitehouse (25:07):
and I get what you're saying.
It's hard to be prepared.
We can't anticipate and controleverything.
But at the same time, it's, it'spretty simple to be prepared,
right?
Just to always have yourepinephrine and always have the
people who know you know thatyou have an allergy and to use
it right away.
Is that, is that really thebottom line?
As far as if we control that,we're pretty much going to be
okay.
Dr. David Stukus (25:25):
I mean, for the most part, there's really
scary stories of, uh, undeclaredallergens from certain
restaurants and stuff like that.
There's nothing we can ever doto control for that, um, but you
can have your epinephrine withyou and use it if that situation
arises.
and now we have treatmentoptions available.
So that's the other thing is Ireally want people to
understand, like, especially ifyou're exquisitely sensitive,
(25:45):
like, we can help you.
Um, there, there's no need tolive in fear.
Um, there are so many optionsavailable now.
Dr Amanda Whitehouse (25:52):
I agree, and I would love for you to talk
about that because this iscommon in social media and our
food allergy circles.
Oh, my child is too sensitivefor these treatment options.
Right.
And I felt the opposite.
I have to do something for thiskiddo So I was wondering if you
could talk about that, how,these treatment options have
gone from the gray area to nowvery widely used and well
established.
Right.
Dr. David Stukus (26:12):
Right.
Yeah.
So the two main treatments areone is being exposed to what
you're allergic to and really,really small amounts.
You have to do this undersupervision.
So there's oral immunotherapy.
There's something, you know,therapy where you're actually
getting very small amounts ofthe allergen increasing this
over time.
This is a daily therapy foryears and years and years.
is desensitizes your immunesystem.
(26:32):
So you become more tolerant tosmaller amounts.
So this really is is veryhelpful for accidental ingestion
of small amounts.
It can increase your thresholdand decrease your risk to have a
severe reaction.
Um, it's unlikely this is goingto cure most people with their
food allergy.
That's really important,especially when we have well
established immune systems andteenagers and young adults.
If we start this early in lifein the first couple of years,
(26:55):
maybe we have an opportunity tohelp that.
you know, usher that out andmake it go away.
But that's still, you know,being investigated.
The second option is amedication called, um,
Omalizumab Rezolair.
And this is a biologic thatwe've used for over 20 years.
And what this does is it targetsthe IgE antibody that causes
reactions, So you don't have toeat the food, uh, because with
OIT and SLIT, you actually havea risk of causing reactions
(27:17):
every time you take a dose.
We have ways of lowering thatrisk and making it more
manageable.
But with Xolair, you don't eatthe food.
And with Xolair, it's reallycool because it doesn't care
what you're allergic to.
It's ideal for people withmultiple food allergies.
Oh, by the way, it's a greattreatment if you happen to have
asthma and environmentalallergies as well.
So now we're treating the wholeperson with one treatment.
The downside is you have to getit by injection either every two
(27:38):
weeks or every four weeks.
And every treatment is roughlytwo to 3, 000.
You want to make sure insurancecovers it.
yes, we can help you.
We can protect you and you don'thave to worry about those
things.
Are we going to get you to eatwhere you're allergic to?
No, that's not what this isdesigned to do, but we can help
navigate the world and make itmuch safer for you.
Dr Amanda Whitehouse (27:53):
Obviously a lot has changed.
change since we were trying tonavigate that.
I had doctors kick me out oftheir office just for asking.
Like I read about this thingcalled OIT How terrifying for me
to be that scared.
And then, and then for them tobe shoving me along, just
because I wanted information,you know?
Dr. David Stukus (28:08):
Yeah.
Dr Amanda Whitehouse (28:08):
So for those of us who are nerdy like
me, can you give us It's aboiled down explanation of
what's the mechanism, how doesZolair work on the body to
prevent the reactions andaddress the allergies.
Dr. David Stukus (28:20):
Yeah, so Zola is a very specific treatment
that binds to the IgE antibodythat's in our body.
So if you have IgE against afood, let's say just peanut, uh,
then when you're exposed topeanut, the peanut actually
binds to that IgE antibody,which is then attached to the
allergy cells and it opens themup and releases all the
chemicals that cause allergicreactions.
Histamine is one of the majorones that can cause itching and
(28:42):
swelling and vomiting anddifficulty breathing and things
like that.
There's more, a little more toit than that.
But what this, what thismedicine Zolaire does is when
you block up that I.
G.
E.
Um, you need to be exposed tohigher amounts of peanut in
order to trigger the allergicreaction.
Um, so that's how sort of itworks.
Uh, and it doesn't let you starteating peanut.
(29:02):
Although when combined withsmall levels of oral
immunotherapy, this is newresearch.
Uh, part of the big trial thatgot Zolaire approved.
Zolaire will make O.
I.
T.
Safer.
Uh, which makes sense becauseyou're, you're sort of blocking
that, that IgE antibody.
when you stop treatment, you goback to being allergic.
Um, that's just the way itworks.
So it's, uh, it's a long termtreatment.
even with OIT, if you stoptreatment, the vast majority of
(29:24):
people are still allergic andthey can't, you know, they go
back to having reactions.
So that's important tounderstand as well.
Dr Amanda Whitehouse (29:29):
a lot of people have fears about the side
effects they're hearing withZolair.
What would you say about that?
Dr. David Stukus (29:33):
Yeah, I don't know where this is coming from
because, you know, it's, it'sone of the few medications that
we've had for 20 years.
Like the safety track record isunbelievable.
Um, there's a boxed warning onthere that it can cause
anaphylaxis, which we don'tunderstand.
How does a treatment forallergies cause anaphylaxis?
We don't know.
There's, there's, it's very rareand almost always it occurs in
the first three injections,which is why we give those first
(29:55):
three in the office.
Uh, and then we can transitionyou to add at home dosing if you
want.
Some allergists prefer to giveevery dose in their office,
which is fine as well.
Um, yeah.
Initially, like when I was doingmy training to be an allergist
20 years ago, there was someconcern that maybe Zolaire was
associated with cancer.
It turns out after studying itin thousands of patients, that
was a statistical anomaly and itdidn't pan out.
(30:15):
Um, but other than that, I don'tknow where all these fears are
coming from other than, um, youknow, the zeitgeist.
Fear
Dr Amanda Whitehouse (30:22):
of the unknown.
I think, you know, that's alwayssuch a powerful thing with
allergy life because so much ofit's the unknown.
Dr. David Stukus (30:28):
Yeah, and and that's why we try our best to
extract and be like, you know,no, I've been prescribing this
treatment for literally twodecades.
Uh, it just has a newindication.
Just we didn't have the goodstudies like we do now to show
that it works for food allergy.
And that's why the FDA didn'tapprove it for that.
But it has indications forchronic hives for chronic
rhinosinusitis and nasal polyps.
Um, yeah, it's amazing.
(30:49):
Hopefully people understand.
Well, just because it gotapproved a year ago, it doesn't
mean that it's only been aroundfor a year.
Um, and I, I think, you know,with the, the world we live in
now, and all the confusionsurrounding all the covert
vaccines, and there's just a lotof, you know, anti pharma, anti
medication, all this otherstuff.
But, you know, hopefully peoplecan just have that honest
conversation with their ownallergist and really understand.
(31:09):
Is this a good option for mychild?
And, and what does that looklike?
Dr Amanda Whitehouse (31:13):
Yeah.
Could you in the same waycomment on some of the fears
that people have about thedifferent immunotherapy options,
OIT and SLIT?
You mentioned briefly, butwhat's your take on those if
people aren't interested inZolaire and they are looking
just at that path withoutmedication added in?
Dr. David Stukus (31:29):
Yeah, we also want to make sure people
understand really risks,benefits, expected outcomes and
the regimen involved.
So this is not an easy decisionto make.
Uh, it's one that should berevisited we call it the concept
of shared decision making whereevery family, you should really
say, here's what is mostimportant to me.
I want to make sure that mychild never has a reaction.
Ever, ever.
Well, OIT is not a good optionfor you because side effects do
(31:49):
occur.
Most of them are pretty mild andwe can manage them, but yeah,
okay, fine.
That's fine.
Um, oh, by the way, avoidancewithout treatment is a great
option for many people.
I think that a lot of folks outthere, they get pressured.
why would you not put your childon this treatment?
My child did great with it.
That's great.
That's your story.
You have no idea what my child'sstory is.
avoidance is great.
I have so many families.
(32:09):
My son is a teenager.
He's 15 pistachio allergy.
He doesn't want to treat.
He doesn't want to do OIT.
He's like, I'm pretty sure I canmake this successfully work for
him.
He's like, I'm just not going toeat it.
And he's traveled to Europe withhis school and he's doing great.
He just, that's his choice andthat's fine.
So avoidance is an absolutelygreat option with OIT and SLID.
(32:29):
It really is understanding.
Okay.
This is you taking proactivecontrol of your child's allergy,
and you're treating them everysingle day at home, hopefully
under a lot of supervision, andyou have, um, you know, the room
to ask questions and stuff likethat.
Um, but just really thinkingthrough what does this look like
in your daily life?
If you have a seven year old,he's playing three sports, um,
and there are practice all thetime.
(32:50):
I don't know if these are goingto fit into your daily life
because we want to have periodswithout exercise for about two
hours after the dosing.
Uh, so those are things toconsider.
Dr Amanda Whitehouse (32:58):
You make such a good point because I
think the more information thereis out there, the more pressure
there is to do something rightand to take action.
But I work with a lot offamilies who are doing fine,
avoiding, and then they'rehearing all these things and
feeling this pressure.
Oh, I should be, I should becalling every manufacturer of
every label know, have you hadany problems with the food?
You know, oh, we're not supposedto be eating out.
Well, no, if you're doing fineand things are going along fine,
(33:21):
many people, like you're saying,can be safe by being careful and
avoiding.
Dr. David Stukus (33:26):
Oh my gosh, I have families.
This is probably once a month.
They say, I feel like such a badfood allergy parent because I'm
not calling manufacturers.
We go to restaurants, we travel,they do, you know, play dates
and social activities.
Um, we read labels and we havetheir epinephrine.
And I was like, why?
I was like, you're doing a greatjob.
I was like, that is successful.
It's food allergy management.
(33:46):
I said, you're, you're livingyour best life.
Uh, you're taking necessaryprecautions.
You're not letting it defineyou.
And by the way, when was thelast time your child had a
reaction?
Yeah.
It's been years, or you know,just their initial reaction
oftentimes.
I say, no, you, this is, this isthe epitome of management.
You're doing an amazing job.
Dr Amanda Whitehouse (34:03):
thank you for saying that.
Because I think there are a lotof people out there who are, you
know, struggling with that.
The more and more they'rehearing, and the more people are
talking about all those excitingthings that are coming up.
Dr. David Stukus (34:13):
Yeah, there's, there's just so many opinions
these days.
Um, and it's really hard to sortthrough and, but these are very
powerful influences in our dailylives, especially relatives and
friends and family members.
I hear that more than anythingof like, you know, my, my cousin
or my, my sister told me this.
Um, and she's really pressuringme to do this.
What do you think about it?
I'm like, well, it's, that's thesame as if you're on a social
(34:34):
media group and you know, theecho chamber pushing you into a
certain direction or another.
So, you know, Really, reallythinking through what's best for
your family.
Dr Amanda Whitehouse (34:41):
that's sometimes where I come in, in
terms of families weighing allthese decisions, obviously I
can't make medicalrecommendations to them, but I
will help them consider whattheir, family life is like, what
their child's personality and,and mental health is like, and
theirs, and what kind of supportsystem they have, and I think
that plays a big factor in whatyou decide to.
Like you said, OIT is not foreverybody,
Dr. David Stukus (35:00):
Well, absolutely.
And you can change your mind atany point.
So for some families, maybe it'snot the right decision now, but
it's that option will exist.
It's not going away.
Same thing was all there.
Um, a lot of families, they say,well, let's see if if their
allergy persists when they're anadolescent or teenager.
And maybe we'll considersomething like that before they
go off to college to give themsome protection, which for
everybody listening, if you'renot, uh, You know, we should be
(35:22):
following, um, typically withlabs at least once a year, uh,
for, you know, because a lot ofkids outgrow their food allergy,
and I've met people that theywere diagnosed a decade ago and
never had follow up testing, andthey probably lost their allergy
five years ago, and, uh, yeah,so hopefully your allergist is
also talking about prognosiswith you as well.
Dr Amanda Whitehouse (35:40):
Good to know.
speaking of all these newthings, talk to us about the new
options for epinephrine.
I think that's what a lot of usare the most excited about.
I just ordered my son's firstnephi.
Dr. David Stukus (35:48):
Oh, yeah.
Yeah.
Yeah.
So the first, um, intranasalepinephrine device is the trade
name is nephi was approved inSeptember.
I believe it's a two milligramdose.
So that one is only if you weigh66 pounds or above.
Um, there are one milligram doseI just learned is going to be
available sometime in the nextfew months, and that's gonna be
down to, um, 30 pounds.
(36:10):
Eso very exciting.
There are two other epinephrinenasal sprays I'm aware of that
may come to market in the next 1to 2 years.
There's also a sublingualepinephrine strip.
It's kind of like a list.
Rene strip that we should haveavailable by the beginning of
2026.
Eso these are all needle free.
When you, when you look at a lotof families tell me, well, does
(36:31):
it work?
So no, uh, to IRBs,Institutional Review Boards are
what we use to help govern.
Are we doing safe and ethicalresearch?
No IRB in the world is going toapprove a study where we
intentionally cause anaphylaxisand then randomize them to
either get nasal epinephrine orno treatment at all.
It's not going to work.
So the way they study this, it'sthe same exact way that they
(36:52):
studied the auto injectors inthe first place.
Is, you give the medicine tohealthy volunteers, and then you
look at parameters inside theirbloodstream.
How fast does the epinephrinereach a certain concentration,
how high does it go, how longdoes it last for, and then what
effect does it have.
on parts of the body where it,where it impacts us, such as
blood pressure and heart rateand stuff like that.
So the nasal epinephrine wasnear, I mean, it was essentially
(37:14):
the same as giving it through aninjection.
Uh, they also studied the nasalepinephrine in people with
allergic rhinitis, environmentalallergies, uh, because that's a
big concern, right?
Is it going to absorb?
It actually absorbed a littlebit better.
Um, so yeah, so that's how thesethings are studied.
We're going to be part of, um,multiple sites that are going
to, um, be part of a clinicaltrial where we enroll people
during oral food challenges thatif they require epinephrine, we
(37:37):
will randomize them to eitherget the nasal spray or the
injection.
So we'll actually have some reallife advocacy data in the next
year or two.
Dr Amanda Whitehouse (37:44):
I think that will be helpful for people,
to hear.
You understand this is the sameway that the injectors we're
tested and verified.
Dr. David Stukus (37:49):
It's like, um, you know, we'll never have a
study demonstrating thatparachutes work for people
jumping out of airplanes.
Dr Amanda Whitehouse (37:55):
good comparison.
you mentioned something thatreminded me of something earlier
in the conversation.
The difference between,threshold testing and food
challenges.
Could you talk about that?
I don't think a lot of peopleunderstand.
Dr. David Stukus (38:07):
No, this is kind of another paradigm shift.
I told you in the beginning,everything's changed.
Um, so not, there's not a lot offolks doing this.
We've been doing these thresholdchallenges for a couple of
years.
Um, so there's, you know, oralfood challenges are the gold
standard.
Um, this is the best way.
So if you're allergic tosomething When when you eat it,
you should have reactions.
If you eat a certain amount, youknow, a serving size or 4 to 5
(38:28):
grams without symptoms, it'svery unlikely that you're
allergic.
So when either the diagnosis isin question or people with known
food allergies, we think it maybe going away.
The oral food challenge is themost valuable part of what we
do.
It's an extremely empoweringexperience.
I know there's a ton of fearmongering surrounding them.
Uh, it's been suggested thatthey're inhumane.
Um, that is, you know, we do athousand food challenges a year
(38:50):
at our center.
And yeah, I mean, I can tell youthis is the most helpful thing
that we do.
The threshold challenge is, it'svery similar where we give a
very small amount of the food.
We observe if nothing happensafter 10 or 15 minutes, we give
a little bit more, a little bitmore, a little bit more.
Instead of trying to get them toeat an entire serving, we'll go
for a very small amount that wemeasure out.
So, like, if we do a peanutthreshold challenge, the single
(39:11):
highest dose is one peanut.
So we're not proving whetheryou're allergic or not, because
these are people we typicallythink you're probably allergic.
And if you were to eat enough,you'll have a reaction.
But these are people that haveextreme restrictions because
they, they thought maybe.
if they're exquisitely sensitiveor severely allergic, or they're
not quite sure if they shouldpursue treatment.
And often, oftentimes we candemonstrate like, wow, your
child ate two peanuts andnothing happened.
(39:33):
I'm not saying go eat peanutwhenever you want, but I am
saying you don't need to worryabout trace amounts, cross
contact.
I still want you to communicateand read labels, but you know,
your child's threshold is higherthan they'd ever received
through that sort of exposure.
And if you want to start oralimmunotherapy, we can start them
at a higher dose and maybe aimfor a higher goal dose as well.
So that's sort of how we usethose challenges.
Dr Amanda Whitehouse (39:53):
So that would be an individualized
decision then, once you do that,do we just avoid it, or do we
move into?
OIT from here.
Would they start the dose at thethreshold that you had
established then if they movedinto OIT from there?
Dr. David Stukus (40:06):
Yeah, so it all depends.
So we also wanna identify arethey somebody who is exquisitely
sensitive?
So we have children react tosmall amounts and that's
important information to know aswell.
Uh,'cause that means either weneed to adjust the protocol for
OIT and go to a much slowerpace, or we may consider
something Xolair.
Um, so it, it's just a valuableexperience regardless.
Dr Amanda Whitehouse (40:24):
Thanks for explaining that.
it sounds like you're saying alot of places are not offering
that specifically, right?
Dr. David Stukus (40:29):
Not that I'm aware of.
this is sort of new, even in theliterature, just like, like in
the last year is when we startedseeing a lot of folks talk about
this sort of thing, but it justgoes back to it's such a great
time for food allergy managementbecause it is so highly
individualized.
And if I haven't impressed thismessage enough upon your great
listeners, it's, it's okay.
Everybody else's story is theirstory.
(40:49):
That's not your story.
Um, so we need to figure outwhat your story is and then it
can help guide your management.
Dr Amanda Whitehouse (40:54):
The impression I'm getting from you
describing all this and you tellme if this is wrong, but it
sounds like the, with so muchhappening, the field is moving
from these broad recommendationsto more and more individualized
Is it just becoming so specificto each person when it used to
be just a broad, avoid and carryepinephrine?
Dr. David Stukus (41:12):
That's the way it should be.
Uh, again, as I mentionedbefore, it's gonna take a while
for everybody to kind of catchup.
Um, but that's where we are.
I mean, we're, we're in thatspace.
That's why, that's why I shiftedgears in my career and fell in
love with food allergy seven,eight years ago.
I knew that we were on the cuspof individualized management,
just like we were with asthma15, 20 years ago.
It's not one size fits all withasthma either.
Dr Amanda Whitehouse (41:34):
Is there anything else that's on the
horizon, even if it's just anidea, theory stage that you
think will be a big change?
Dr. David Stukus (41:40):
I mean, there's more and more treatment
options being investigated.
So hold on to your hats.
I mean, if we had thisconversation once a year for the
next five years, it's going tochange.
Um, so there's the, it's calledepicutaneous, um, immunotherapy.
So the peanut patch, um, youknow, that was, it's That was
shown to be effective years ago.
The FDA didn't approve itbecause the sticky part of the
patch wasn't quite stickyenough.
(42:01):
So we're going to have thoseresults sometime in the fall.
Uh, so we may have that andthat's, that might be a no
brainer.
Just put the patch on your skinand kind of set it and forget
it.
And any side effects arelocalized to the skin.
Um, there are other treatmentoptions that approach different
pathways, including potentialoral treatment options.
So we can get away from theneedle with biologics, which can
(42:22):
be really fascinating.
Uh, and just we're learning moreand more about, long term
treatment?
Can we sort of space?
Oh, I see doses out as kids getfurther along.
Uh, can we combine therapies toreally make them better
tolerated and safer and moreeffective?
The future is very bright.
Dr Amanda Whitehouse (42:38):
That was a lot packed in to, the
conversation, but a lot ofinformation in there.
So thank you.
Will you tell everybody wherethey can find you on social
media if they don't alreadyknow?
Dr. David Stukus (42:47):
Yeah, so I mostly live on Instagram these
days.
Um, my handle's atAllergyKidsDoc.
so I've gone through my ownpersonal journey.
Along with my academic side toeverything else I do, I've taken
a truly academic view of socialmedia and I've taken a deep dive
into learning how it's impactingall of our lives, especially our
medical decision making andthings like that.
And as I've learned more andmore about this, I've learned
(43:09):
how the algorithms have hijackedour brains.
So I try my best not to be on myphone.
so I'm not posting as much as Iused to in the past, but I'm
still out there.
I can never give individualmedical advice, but I love
interacting with folks and Ilearned from all of you.
And I take that back to mypatients and I take what I
learned from my patients andoffer it to all of you as well.
Dr Amanda Whitehouse (43:28):
Great.
So the last question that I liketo ask everybody on the show
again, let's get out of the fearmongering.
Tell me something good aboutallergies.
Dr. David Stukus (43:39):
it's a hidden superpower actually.
Then people don't talk aboutthis enough, but, uh, in
general, Children who have foodallergies, they tend to eat
healthier.
Um, they tend to have moreconfidence as does anybody with
chronic medical conditions thatthey have to manage on a regular
basis.
Uh, families learn to cook,which is often a great sort of,
um, family event where, you'relearning these skills and trying
(44:00):
new recipes.
Um, so I think that, in manyways it can be empowering, and
these kids actually do verywell.
Um, and I know there's a lot ofscary stuff in the world
especially in the food allergycommunity, they talk about how
people are insensitive, butchildren aren't.
I can tell you that, you know,school aged kids and teenagers,
like, they have such supportfrom their classmates and their
(44:21):
friends.
So yeah, I know there's, youknow, jokes being made about it
and commercials and stuff thatmake everybody mad, but like
your, your child's going to beokay.
It's all going to be okay.
Dr Amanda Whitehouse (44:32):
thank you so much for joining me here on
the show.
You have so much goodinformation to share.
I love conversations that reallydive in like this.
Dr. David Stukus (44:39):
It was my pleasure.
Thank you for inviting me.
And now here are your threeideas for action steps to help
you follow through on ourconversation today.
Number one, if you don't alreadyfollow Dr.
Skuas on Instagram and Twitterat allergy kids.
Doc Number two, if listening totoday's chat has made you
realize that your allergistmight not be the best fit for
(45:01):
you, or if maybe you're someonewho just gotten epinephrine from
your primary care doctor andnever saw a specialist, you can
find the College and the Academyof Allergy, asthma and
Immunology easily online.
And there are also links in theshow notes for you on both of
their websites.
You can search for a boardcertified allergist near you.
(45:21):
And number three, whether you'reconsidering meeting with a new
allergist, haven't seen your ownallergist in a while, or
considering treatment options,or maybe have questions about
your own health, take a momentto jot down some notes about
your thoughts, observations, andquestions.
Remember that Dr.
Skuas explained to us that ithelps our doctors provide the
best care when we come preparedwith good notes and careful
(45:43):
observations about the timingand onset of our symptoms, how
frequent they are and how longthey last foods we've eaten,
foods we've eliminated, anytreatments we've attempted, and
anything else that might behelpful for them in providing us
with good medical care.
Thanks again so much to Dr.
DUIs and thank you for listeningtoday.
I.
the content of this podcast isfor informational and
(46:04):
educational purposes only, andis not a substitute for
professional medical or mentalhealth advice, diagnosis, or
treatment.
If you have any questions aboutyour own medical experience or
mental health needs, pleaseconsult a professional.
I'm Dr.
Amanda White house.
Thanks for joining me.
And until we chat again,remember don't feed the fear.
there's more and more treatment options being
(00:01):
investigated.
So hold on to your hats.
I mean, if we had thisconversation once a year for the
next five years, it's going tochange.
there are other treatmentoptions that approach different
pathways, We're learning moreand more about, long term
treatment?
The future is very bright.
Speaker (00:17):
Welcome to the Don't Feed the Fear podcast, where we
dive into the complex world offood allergy anxiety.
I'm your host, Dr.
Amanda Whitehouse, food allergyanxiety psychologist and food
allergy mom.
Whether you're dealing withallergies yourself or supporting
someone who is, join us for anempathetic and informative
journey toward food allergy calmand confidence..
(00:39):
This season on Don't Feed TheFear.
We are talking aboutstrengthening and expanding our
support systems.
And what this has actuallyturned into for me has been, the
opportunity to talk with a lotof the people who've been
influential On our own allergyjourney here in my house, and to
thank them for the help and thesupport that they provided to
me, At times, I have mentioned,and my guests have mentioned
some of our discouraging andfrustrating experiences with the
(01:02):
allergists that we have workedwith, but I also wanna make sure
that I acknowledge how hardallergists are working.
I've had some that were not agreat fit for us,.
But overwhelmingly, theexperience has been wonderful
with those that were a good fitfor us, who were supportive and
who guided us through differenttreatments to get my son into a
(01:22):
good spot.
So thank you to them.
Thank you to all of the doctorsout there working hard to keep
us educated and safe.
And in that spirit, I'm excitedto share this conversation with
Dr.
David Skuas.
DRAs or Dr.
Dave as his patients call him,has devoted his career as an
allergist to communicatingevidence-based practices and
best clinical practices tocolleagues, medical
(01:43):
professionals of allbackgrounds, patients and the
general public.
You probably are familiar withhim.
He's active on social media.
He uses his popular Twitter andInstagram accounts at Allergy
Kids Doc to dispel myths andcombat misinformation.
DRAs is an academic allergistwho holds multiple leadership
positions in the AmericanAcademy of Allergy, asthma and
(02:04):
Immunology, and the AmericanCollege of Allergy, asthma and
Immunology, he has been named atop doctor in pediatric allergy
every year since 2015.
Dr Amanda Whitehouse (02:15):
I'm really glad to finally meet you.
I've been following all of yourcontent for a while.
and it's nice to.
Put a face to the name.
Dr. David Stukus (02:22):
Yeah.
Well, thank you.
And I appreciate you reachingout.
Dr Amanda Whitehouse (02:25):
You just stepped down from your podcast,
right?
And was it in December?
So in here, I roped you backinto,
Dr. David Stukus (02:31):
Oh no, if I could somehow find a way to
like, Sustain a living being apodcast guest.
I would love that.
I love this.
Dr Amanda Whitehouse (02:37):
I think most of our listeners are
listening to the content that'sout there and they're probably
familiar with you, but I don'tthink a lot of us know fully all
of the hats that you've worn andthe roles that you have played
because there are quite a few.
Would you mind telling us just alittle bit more about all of the
projects you've done andpositions you've explored?
Dr. David Stukus (02:57):
Yeah.
So, um, I am an academicpediatric allergist, uh, through
and through, which means I workat a, at a major Children's
Hospital, Nationwide Children'sHospital in Columbus, Ohio.
And at my institution, I haveseveral roles.
My most prominent role is as thedirector of our food allergy
treatment center, which means itis my job to make sure that our
clinical operations are up andrunning and that we're always
(03:19):
adjusting towards the latestevidence based.
Practices.
I do a lot of teaching in myrole with different trainees at
different levels.
Um, I participate in clinicalresearch.
I like to write and publish aswell.
You know, over 100 peer reviewedpublications out there, a dozen
book chapters.
I've written a couple textbooksand I love teaching.
I mean, medical education iswhat I love.
(03:39):
So every opportunity I get toeither, you know, give grand
rounds or give presentations atregional national meetings that
I love that.
Now that's just my day job.
In addition to that, I've beeninvolved with our national
organizations.
Uh, I'm currently the vicepresident of the American
College of Allergy, Asthma, andImmunology, which means I'll be
president in two years.
(03:59):
Uh, I served as a social mediaeditor and host the podcast for
the American Academy of Allergy,Asthma, and Immunology for six
years.
And I'm, I'm on the executivecommittee for the American
Academy of Pediatrics.
So what this allows me to do isreally help just learn how the
organizations work, learn howthey can help our patients, how
they can help members andpracticing allergists and
physicians, uh, and contributein various ways with committee
(04:22):
work and things like that.
And then I love working withadvocacy organizations as well.
So I, I try to do what I can,uh, but you know, it can spread
you thin at certain times.
Dr Amanda Whitehouse (04:32):
It sure sounds like it.
Is that why you stepped downfrom the podcast?
Dr. David Stukus (04:36):
That, yeah, it was time.
I, you know, that was a greatrole.
I cherished it.
Um, it really changed my careerin a great way, but I thought it
was time for a new voice aswell.
I typically step down from majorthings.
Once a year, uh, because I do areassessment of my personal and
career goals, my one, three andfive year goals.
And I realized that, you know,for that position I'd have to
(04:58):
commit to another three years.
I don't think that lined up withwhat I want to do three years
from now.
So it's time for a new voice andwe found a great replacement.
Dr Amanda Whitehouse (05:05):
Yeah, it seems like you're always up for
a new challenge and a new
Dr. David Stukus (05:09):
Uh, I love building things and creating
things.
I realize that that's what getsme motivated.
Um, I don't want to just go inand punch a clock every day that
won't satisfy me career wise.
So yeah, that's that's I guess Iseek out opportunities.
You were also a member of thepanel of Allergists who did the
most recent round of updates forbest practices and allergy
(05:31):
practice parameters.
I am sure I fumbled the namethere.
Yeah.
You can't keep all the acronymsstraight yet, right?
So I was the, it's called theJoint Task Force on Practice
Parameters for AllergyImmunology.
So it's 12 allergists invited tojoin this amazing group where,
we're tasked with basicallygoing through all of the
evidence and doing a metaanalysis and systematic reviews
(05:53):
and then coming up with, they'renot quite guidelines, they're
more here's best practices.
and I was a member of that forfive years, and that was one of
those roles.
I loved it.
I voluntarily didn't re up formy second five year term because
it, I was just busy with, stuffgoing on with their kids lives.
And I, you know, the conferencecalls were interfering and it
took a lot of time, but I wouldlove to go back and rejoin that
group in the future.
(06:13):
But yeah, I was able to helpwrite, um, some of the, the most
recent parameters, uh, inregards to anaphylaxis and, uh,
food allergy and, um, drugallergy and things like that.
Dr Amanda Whitehouse (06:23):
I'd love to hear what you think is most
important for us to know aboutthat.
Dr. David Stukus (06:27):
Where do we begin?
Like no seriously theconversations I have with
families in the office today.
I wouldn't have had two yearsago five years ago It's a bit
much to say everything haschanged with food allergy, but a
lot has changed in regards tojust our understanding of
diagnosis, prognosis, individualrisk, treatment, prevention.
(06:47):
I think the biggest paradigmshift, there's a couple.
One was when we startedrecommending that we introduce
allergenic foods like milk, egg,wheat, soy, peanuts, tree nuts.
Um, seafood to babies aroundfour to six months of age and
keep those foods in their dietconsistently.
That's our best path towardspreventing food allergy.
The advice before that, which isway outdated, was to avoid those
(07:08):
foods.
Uh, that was based on get best,you know, opinion at the time.
But the evidence has evolvedtremendously.
Um, you know, with the pivotalleap trial that was published a
decade ago that really showed usif we get the peanut in the
baby's diet, it can help.
promote tolerance and protectthem.
So that's a huge shift and thatreally still causes a lot of
confusion with families and withpediatricians lately.
(07:32):
The most updated evidence.
And again, it's important forpeople listening to understand,
you know, evidence changes andaccumulates over time.
And science is really messy.
We rarely have definitiveanswers.
Oftentimes, new researchcontradicts prior research.
There's levels of evidence.
Some research studies are reallywell done, and they can show
things like cause and effect.
(07:52):
Other studies really just showus a peek at what may be
associated with each other.
So the evidence surroundingeczema, as well as anaphylaxis r
Um, in the last decade an reallyhelp families under to manage
both of those
Dr Amanda Whitehouse (08:09):
It's interesting us out because there
is s so much new information adoctor who's out there on social
media myth busting and tellingus like this isn't true.
This isn't true.
Here's the truth, but really itseems like Allergy and
immunology is a field wherethere's so much gray area.
As a psychologist I'm helpingpeople all day long.
(08:29):
You're you're in black and whitethinking let's find the gray
area so I was wondering if youcould comment on what that's
like trying to Give clearparameters when there is still
so much in between.
Dr. David Stukus (08:40):
Yeah, I, I love that you brought that up.
So I think we can reallyestablish the diagnosis.
So that's, that's the mostimportant part of what we do in
allergy immunology.
Like what is your actualdiagnosis?
All of the symptoms that occurfor allergic conditions, whether
it's allergic rhinitis and youget itchy, sneezing in the
spring, food allergy, causinghives and vomiting.
All of the symptoms that occurdue to allergies can occur for
(09:02):
non allergic reasons.
So there's a ton of overlap.
I probably undiagnosed suspectedfood allergy in half of the
families I meet at the firstencounter.
Everybody comes to me thinkingtheir child has a food allergy,
but 50 percent of the time weclarify.
No, no, this is actually whattheir diagnosis is.
which really impacts management.
So we have to have a gooddiagnosis up at the forefront
because that changes your entirelife.
(09:23):
And then with the gray area,it's actually a good thing
because there's so much nuanceinvolved and there's such
individual variation.
We don't want to be treatingeverybody the exact same way.
That is such a disservice toeverybody out there.
Um, so it's hard because if yougo on social media or the
internet, you may, read peopleor meet people that are doing
things one way.
That may be completely differentfrom the way that you should be
(09:44):
managing yourself or your child.
And that's okay.
Uh, that's the message we wantto send.
It really is, should not be onesize fits all it, whether it's
asthma, allergic rhinitis,eczema, food allergy, everybody
should have their own individualplan.
Dr Amanda Whitehouse (09:58):
Of those, 50 percent that you're
dispelling, the suspecteddiagnosis, what's going on with
them and how are you ruling itout?
I understand, the basics thatjust a positive test can be a
false positive But give us alittle more detail on who might
fall into that false positivecategory and why
Dr. David Stukus (10:13):
yeah two big buckets And parents are so good
at you know, seeing whensomething's going on with their
child So one it's natural forparents to associate symptoms
with their child eating a foodKids eat all day every day,
right?
So if they start getting rashesor they start having symptoms,
it's natural for them to think,Oh, well, they ate this that day
or you know, they've been eatingthis and they're having these
(10:34):
symptoms.
So oftentimes that's morecorrelation and not causation.
The second big bucket is, no,your child is having symptoms
that we think are clearly linkedwith that food, but it's not due
to an allergic mechanism.
Sometimes it's more difficultydigestion, like intolerance.
We see a lot of kids that getcontact rashes on their face,
uh, to things that don't causeallergic reactions, like berries
(10:55):
and citrus and tomato sauce.
Um, so yes, I hear you andbelieve you.
You see these symptoms, and youassociate with your child eating
that food, but it's reallyimportant for me to figure out,
are they allergic or not.
Because if they're allergic, weneed to know that because it
puts them at risk to have moresevere reactions potentially,
but if they're not allergic,that means we don't, we probably
don't have to avoid that foodand we don't need to worry about
things like carrying epinephrineand anaphylaxis and stuff like
(11:17):
that.
Dr Amanda Whitehouse (11:18):
That's good to know.
So how do people find a greatallergist who can help them
distinguish this?
I know there are a lot of greatdoctors.
There are also some of us whohave gotten not the best
information from some of ourdoctors.
So how do we know?
Dr. David Stukus (11:32):
A large part of what I do is is I try my best
to translate evidence intoclinical practice, and that's I
have that privilege when I speakat our national meetings, my
colleagues and things like that.
There's a huge lag.
Um, so not all allergists aresort of up to date with evidence
based practices.
Not all medical professionalsare up to date with medicine,
you know, best practices.
(11:53):
If you come to me with concernsabout primary immune deficiency,
I cannot help you.
I've been so deep in the foodallergy world for the last five
years.
I am not up to speed with thatliterature and that, that, that
way to practice.
So I'm not a good person forthat sort of thing.
Um, it can be difficult to teasethat out through websites.
Um, a lot of times you have tomeet with them and see their
approach.
(12:13):
Um, In general, especially withthings like food allergy and
children, major academic centersare typically have more
opportunities to offer thingslike oral food challenges and
spend more time with people tokind of tease things out.
That being said, a lot ofcommunity allergists are
fantastic at diagnosing andtreating this.
Unfortunately, there's no easyway.
(12:34):
One thing I can say is it'sreally important that you,
making a point with a boardcertified allergist,
immunologist, that boardcertification really makes a
huge difference in regards totheir level of expertise and
understanding.
Um, we live in a, in a societywhere anybody can hang a shingle
that says they're an allergist,including folks that aren't even
like qualified medicalprofessionals.
Um, so really vetting and makingsure you know who you're seeing.
(12:56):
And both of our professionalorganizations in the United
States, the American Academy andAmerican College of Allergy and
Immunology.
have a listing of boardcertified allergists in your
area.
So that's a good place to start.
Dr Amanda Whitehouse (13:07):
Okay, I'll make sure I link those in the
notes for people who are lookingand maybe want to consider,
looking for somebody new.
we're talking this season on thepodcast about building your
support system.
And obviously I wanted you hereto help us make the most of our
relationships with ourallergists.
How do, how do we do that?
How do we walk into the officewith all these questions and all
this information that may or notbe correct and make the most of
(13:27):
our time and our relationshipwith you?
Dr. David Stukus (13:29):
Yeah, um, so a couple of thoughts.
One is have an open mind,because as I mentioned, half of
the people that I meet come inconvinced their child has an
allergy and it's my job toclarify and, and, you know,
educate them and, and as long,you know, most of them are open
to that.
Sometimes people get reallyupset because, you know, it's
really These cognitive biases wehave and they have this
confirmation bias and they don'tbelieve me and I do my absolute
(13:52):
best to explain to them anddemonstrate to them.
And, um, and every once in awhile, they're just, you know,
that's their identity and whothey are.
So if you can have an open mindgoing in thinking, okay, here,
here are my concerns.
Um, so being able to clearlydemonstrate that the history is
extremely important.
So we need to hear from you,like what's going on with you or
your child?
Um, you know, what are youassociating it with?
(14:14):
What's the timing of onset forany symptoms that are occurring?
What are the symptoms?
How long are they lasting for?
Have you tried any treatment sofar?
Um, have you taken anything outof the diet, you know, things
like that.
Um, and then, you know, from aparent family standpoint, if
you're meeting with an allergistand they're.
They have their back turned toyou, and they're just clicking
boxes during that encounter, andthey're not, you know, listening
(14:36):
to you and answering yourquestions.
I mean that, that you're allowedto seek a second opinion.
Um, not everybody has the samesort of bedside manner and
approach.
So you really need to have atrusting relationship with
whoever you work with.
And I tell families all thetime, I say, listen, here,
you've, this is the approachI've spent time discussing this
with you.
If what I have to offer youdoesn't quite gel with what
you're looking for, there's nohard feelings.
There's other allergists intown.
(14:56):
Uh, so please meet with them andsee if they can offer you
something that you feel muchbetter with.
Dr Amanda Whitehouse (15:01):
Another thing that I tell a lot of the
patients that I work with,obviously, I'm not giving them
any medical advice, butsometimes they're having
confusion or questions aboutthings.
And I will often tell them,You're allowed to call your
allergist and ask to come backin and have an appointment.
Some people think, Oh, but wedon't go back in for our checkup
until next year.
So I was hoping maybe you couldconfirm that because I think we
feel a little intimidated.
Dr. David Stukus (15:22):
Oh, absolutely.
All right, here's the, let's,let's get into it, shall we?
So here's the dark side ofmedicine is all of us are under
pressure to see more patients domore.
We're getting paid less for whatwe do.
Uh, the health insurance in theUnited States is a mess.
So, um, it's natural.
People want to be reimbursed fortheir time.
Uh, I chose academics for areason.
(15:44):
I just have a salary regardlessof how many patients I see or
what I do and things like that.
But if you're in community basedpractice, like you have to be
able to support your business.
Um, so for some allergists, ifyou are going to send them
messages, um, it's a chance thatthey may actually bill for that
time.
They should tell you that upfront and they should say, if
we're going to have a 15 minutetelephone conversation, this is
what I charge for it.
Uh, so that you can have alonger conversation and that you
(16:09):
can, you know, they canactually, you know, get
reimbursed appropriately forthat time that they're giving
you and their expert opinion.
And that's okay, but they shouldbe willing to do that.
So you should feel comfortableto reach out to them and say, I
have follow up questions.
What's the best way to do this?
Sometimes it's through theelectronic health record.
Sometimes it's through atelephone call.
Sometimes it's through a followup visit.
I get people reaching out to meall the time on social media.
(16:32):
Asking me specific questions oreven more general questions, and
I would love to help them, but Ican't I'm not there I'm not
their physician.
Um, I don't know anything aboutthem and it's it's Unethical for
me to provide any advicewhatsoever on social media, but
I tell all of them the samething Please reach out to your
personal allergist with thesequestions and you know more
often than not they say wellThey're not they're not willing
to answer them and I said wellthen seek a second opinion like
(16:55):
it It stinks that you have to dothat and it's really unsettling
But if that's the point thatyou're at to you're reaching out
to some stranger on InstagramLike maybe you should rethink
that relationship you have withyour own allergist
Dr Amanda Whitehouse (17:06):
I agree.
I think it's a tough balancebecause obviously none of us are
experts and know better thanyou, but we also have to have
that trust.
And if it's not there, thenobviously any, any advice that's
coming or, or recommendationsare going to, be regarded
differently if we aren't feelingreally comfortable with that
connection and relationship.
Dr. David Stukus (17:23):
Absolutely.
Yeah.
So I encourage you and for yourlisteners like, yes, you are
allowed to ask questions.
You're allowed to reach backout.
You don't have to wait for thatnext scheduled visit.
Um, and if you're not gettingthat support that you need as
much as you can find somebodyelse.
Dr Amanda Whitehouse (17:37):
Thank you.
That's good to hear.
you mentioned some of thechallenges and restrictions
don't apply to you because ofthe nature of your position.
But what is for you the hardestpart of working with patients?
Dr. David Stukus (17:48):
That's a great question.
I think access to care, itbreaks my heart, especially
with, infants that have concernwith food allergy because we, we
now have an opportunity to offertreatment and we can really, you
know, guide their management.
But when I meet families thatwait 2 months to see an
allergist or 3 months, and theywere given terrible advice and
they've been living in constantfear.
(18:08):
and their lives have been ruinedand they stopped all their
social engagements and stoppedgoing to restaurants.
That just breaks my heart.
Um, so that, that limited accessto care is really frustrating.
Uh, I'm in a position where Ican work on, on fixing that.
And lately we've been able tosee families within one, within
a week, basically.
A lot of times I can see themthe next day.
Um, so that is an idealscenario.
(18:29):
Um, but yeah, that's, that'sbeen one of the hardest parts, I
think.
Dr Amanda Whitehouse (18:32):
I do see that challenge a lot of times
and I'm in a, not a big city,but a somewhat bigger area and
people are waiting a long timeand in the meantime, I think
that's where we are on Googleand we're on social media and I
think then that's where themisinformation can come in.
Would you agree?
Dr. David Stukus (18:49):
100%.
Um, we also see it from actualboard certified allergist.
So this is where it gets reallytricky is and you know, we in
our specialty, you're going toget a range of opinions.
Um, there's still a lot ofallergists that are doing
unnecessary panel testing.
Uh, so you go in thinking thatyour child has a reaction to
egg.
and you walk out being diagnosedwith 12 different food allergies
that they don't actually have.
(19:09):
Uh, we often see them as asecond, third opinion and can
clarify that diagnosis overtime.
But these families are livingwith this for months and months.
Uh, or sometimes we miss awindow of opportunity where we
could have introduced the foodand maybe prevent that allergy
from developing.
So that's the other reallyfrustrating part is not only the
misinformation online, but justthe bad advice people are
getting from their own medicalprofessionals.
Dr Amanda Whitehouse (19:31):
I've heard a lot of people ask you, what's
the most common myth that youhear?
But I want to ask you, what doyou think is the most dangerous
or the most concerningmisconception or myth that's out
there about allergies?
Dr. David Stukus (19:43):
Oh, I think the most concerning one is,
strict avoidance is mandatory.
Even trace amounts can kill you.
Um, so this is where all thisstarted like 15 years ago when
we didn't have a goodunderstanding of actual risk
from reactions.
This is why we have peanut freeschools.
Uh, this is why we have peanutfree playgrounds and sections of
baseball games from a medicalstandpoint.
(20:05):
These are vastly not necessary.
Um, there are Children andpeople out there that are
exquisitely sensitive to verysmall amounts, but they are the
exception and not the rule.
And we now have ways that we canactually protect those
individuals through treatmentoptions.
Uh, so sending that message tofamilies now, especially when,
you know, we're doing thresholdchallenges and identifying, you
know, many Children aren't evengonna react at all until they
(20:27):
eat a certain amount.
Um, that's just a really badmisconception that continues to
sort of get parlayed and in thefood allergy space, you know,
this better than anybody fearcells.
Right?
So all the fear based messages,even from some advocacy
organizations, that's what gainspeople's attention.
That's how you get clicks andthings like that.
I mean, I don't, I've never senta fear based message when it
(20:48):
comes to food allergy in myentire career.
There's no need.
Um, it should be positive basedmessaging like we can help you.
Uh, so yeah, I think that's theone that stands out.
Yeah.
Dr Amanda Whitehouse (20:57):
I love that, and I agree about being
careful what you're consuming,I've been careful about how do I
even approach this on socialmedia, and you've done it well,
but I don't want to do that, anyof those techniques where you're
trying to gain followers, and,and that's what people are drawn
to, is that, that fear basedapproach, and alarmist,
messages, and so that's what wesee the most of, and that's what
gets passed along, and the, andthe soothing, calming, great
(21:18):
grounding information, like whatyou're sharing.
Although people are listening toyou.
So you're doing something,right?
Dr. David Stukus (21:24):
Well, so I've and I've learned lessons along
the way.
Um, I I tried addressing.
This is a really tricky subjectSo when we talk about food
allergy fatalities, you know,thankfully they are very rare
They're tragic every time theyoccur and we need to be aware of
them But it's also wellestablished though.
That's not the reality for thevast majority of people that's
Not something that's going tobe, you know, part of their
(21:44):
life.
Um, and when you try to addressthat on a platform like social
media, it's really hard to getin the nuance.
And, uh, I, I personally upset alot of people because it's a
very emotionally charged subjectin my effort to provide
reassurance.
A lot of people weren't ready tohear that.
Um, and that's okay.
And that was a lesson learned onmy end of like, this is not the
medium for me to do it.
So I stopped doing that.
(22:04):
If that's fine, I can do it whenI'm in a room with people and I
can read the room and answerquestions.
Um, I can do it one on oneconversations, but, um, yeah,
it.
It's a tricky space out there.
Dr Amanda Whitehouse (22:15):
It is.
I talk a lot to my patients andon the podcast too about, what's
going on with our nervoussystems and how when we're in a
fear state, the blood flow isrestricted to the areas of the
brain that can receive thatinformation.
And so, I try to remind people,like, literally some of that
information is not going to beabsorbed by your brain if you're
in this constant fear state andseeking out this scary
information.
I think people have to begrounded first before they're
(22:37):
able to receive.
The message that you're tryingto send, right?
We're not in that state whenwe're on social media.
Dr. David Stukus (22:43):
I, I, I love that, how you put that.
You're right.
So I, I, so I recognized yearsago of people are just dumping
their anxiety on me.
And that's their emotionalresponse to it.
And I don't get upset with that.
I, I feel bad for them.
There's nothing I can offer.
And I can just say I'm reallysorry you're going through this.
I hope you find the guidancethat you deserve.
Um, but oh my gosh, that's a,more often than ever I'm seeing
that on social media.
(23:04):
They're just using it as theirdiary or their psychologist.
And then you get in the echochamber because other people
then climb onto it.
And this is where I, you know, Ilike, I've been personally
attacked by people in the foodallergy community.
Um, I've had to block peoplebecause then they come after me
and now all of a sudden I'm thebad guy.
Uh, when I'm really just, I'mjust a conduit for the evidence.
So this isn't Dave's opinion outhere.
This is, you know, this is thereality of it.
(23:25):
But anyway, that's a differentstory for a different time.
Dr Amanda Whitehouse (23:28):
It's tricky though.
I think, you know, from whatI've seen and followed, you've
done a good job balancing it.
But for those who are wanting tohear that information and
listening, I would love if youwould share with us what you
want to get across about thoseunfortunate, very obviously
tragic and rare.
Those those deaths that we'reall afraid of every food allergy
parent.
That's our worst nightmare.
Dr. David Stukus (23:50):
Yeah, a couple of thoughts.
One is, um, these aren'thappening in young Children.
So, you know, all the parents Imeet that are scared to death to
send their kids to school, thosearen't the ones that are
experiencing these sorts ofoutcomes.
Um, it's almost unheard of ininfants, toddlers and school age
kids.
Um, when you look at the datasurrounding it, it's almost
always going to be young adults,adolescents and, um, more often
(24:11):
than not, they either don't havetheir epinephrine with them or
they don't use it in a timelyfashion.
there's really, really scaryscenarios where people get
multiple outcomes.
You know, treatment treatmentswith epinephrine, and they still
have a fatality, but thosereally are extremely rare.
So we can learn from that,right?
So we can really help ouradolescents and young adults
know that, hey, let's let'scontinue to be mindful of this.
Let's make sure that we're, youknow, double checking things.
(24:33):
We're going to restaurants.
Let's make sure you have yourepinephrine with you.
Let's make sure you communicatewith your social, your peer
network and the people thatyou're dating and hanging out
with.
Like, do they know you actuallyhave food allergies?
Do they know that you haveepinephrine in case you're in a
situation?
You know, um, These are suchrare occurrences that it's hard
to be prepared for it 24 7, butif we can establish good basic
(24:54):
sort of, you know, habits thatmake sure we have these things
with us, then that's how theseget prevented.
Um, so that's sort of themessaging is, you know, that we
we know enough to know thatthere's
Dr Amanda Whitehouse (25:07):
and I get what you're saying.
It's hard to be prepared.
We can't anticipate and controleverything.
But at the same time, it's, it'spretty simple to be prepared,
right?
Just to always have yourepinephrine and always have the
people who know you know thatyou have an allergy and to use
it right away.
Is that, is that really thebottom line?
As far as if we control that,we're pretty much going to be
okay.
Dr. David Stukus (25:25):
I mean, for the most part, there's really
scary stories of, uh, undeclaredallergens from certain
restaurants and stuff like that.
There's nothing we can ever doto control for that, um, but you
can have your epinephrine withyou and use it if that situation
arises.
and now we have treatmentoptions available.
So that's the other thing is Ireally want people to
understand, like, especially ifyou're exquisitely sensitive,
(25:45):
like, we can help you.
Um, there, there's no need tolive in fear.
Um, there are so many optionsavailable now.
Dr Amanda Whitehouse (25:52):
I agree, and I would love for you to talk
about that because this iscommon in social media and our
food allergy circles.
Oh, my child is too sensitivefor these treatment options.
Right.
And I felt the opposite.
I have to do something for thiskiddo So I was wondering if you
could talk about that, how,these treatment options have
gone from the gray area to nowvery widely used and well
established.
Right.
Dr. David Stukus (26:12):
Right.
Yeah.
So the two main treatments areone is being exposed to what
you're allergic to and really,really small amounts.
You have to do this undersupervision.
So there's oral immunotherapy.
There's something, you know,therapy where you're actually
getting very small amounts ofthe allergen increasing this
over time.
This is a daily therapy foryears and years and years.
is desensitizes your immunesystem.
(26:32):
So you become more tolerant tosmaller amounts.
So this really is is veryhelpful for accidental ingestion
of small amounts.
It can increase your thresholdand decrease your risk to have a
severe reaction.
Um, it's unlikely this is goingto cure most people with their
food allergy.
That's really important,especially when we have well
established immune systems andteenagers and young adults.
If we start this early in lifein the first couple of years,
(26:55):
maybe we have an opportunity tohelp that.
you know, usher that out andmake it go away.
But that's still, you know,being investigated.
The second option is amedication called, um,
Omalizumab Rezolair.
And this is a biologic thatwe've used for over 20 years.
And what this does is it targetsthe IgE antibody that causes
reactions, So you don't have toeat the food, uh, because with
OIT and SLIT, you actually havea risk of causing reactions
(27:17):
every time you take a dose.
We have ways of lowering thatrisk and making it more
manageable.
But with Xolair, you don't eatthe food.
And with Xolair, it's reallycool because it doesn't care
what you're allergic to.
It's ideal for people withmultiple food allergies.
Oh, by the way, it's a greattreatment if you happen to have
asthma and environmentalallergies as well.
So now we're treating the wholeperson with one treatment.
The downside is you have to getit by injection either every two
(27:38):
weeks or every four weeks.
And every treatment is roughlytwo to 3, 000.
You want to make sure insurancecovers it.
yes, we can help you.
We can protect you and you don'thave to worry about those
things.
Are we going to get you to eatwhere you're allergic to?
No, that's not what this isdesigned to do, but we can help
navigate the world and make itmuch safer for you.
Dr Amanda Whitehouse (27:53):
Obviously a lot has changed.
change since we were trying tonavigate that.
I had doctors kick me out oftheir office just for asking.
Like I read about this thingcalled OIT How terrifying for me
to be that scared.
And then, and then for them tobe shoving me along, just
because I wanted information,you know?
Dr. David Stukus (28:08):
Yeah.
Dr Amanda Whitehouse (28:08):
So for those of us who are nerdy like
me, can you give us It's aboiled down explanation of
what's the mechanism, how doesZolair work on the body to
prevent the reactions andaddress the allergies.
Dr. David Stukus (28:20):
Yeah, so Zola is a very specific treatment
that binds to the IgE antibodythat's in our body.
So if you have IgE against afood, let's say just peanut, uh,
then when you're exposed topeanut, the peanut actually
binds to that IgE antibody,which is then attached to the
allergy cells and it opens themup and releases all the
chemicals that cause allergicreactions.
Histamine is one of the majorones that can cause itching and
(28:42):
swelling and vomiting anddifficulty breathing and things
like that.
There's more, a little more toit than that.
But what this, what thismedicine Zolaire does is when
you block up that I.
G.
E.
Um, you need to be exposed tohigher amounts of peanut in
order to trigger the allergicreaction.
Um, so that's how sort of itworks.
Uh, and it doesn't let you starteating peanut.
(29:02):
Although when combined withsmall levels of oral
immunotherapy, this is newresearch.
Uh, part of the big trial thatgot Zolaire approved.
Zolaire will make O.
I.
T.
Safer.
Uh, which makes sense becauseyou're, you're sort of blocking
that, that IgE antibody.
when you stop treatment, you goback to being allergic.
Um, that's just the way itworks.
So it's, uh, it's a long termtreatment.
even with OIT, if you stoptreatment, the vast majority of
(29:24):
people are still allergic andthey can't, you know, they go
back to having reactions.
So that's important tounderstand as well.
Dr Amanda Whitehouse (29:29):
a lot of people have fears about the side
effects they're hearing withZolair.
What would you say about that?
Dr. David Stukus (29:33):
Yeah, I don't know where this is coming from
because, you know, it's, it'sone of the few medications that
we've had for 20 years.
Like the safety track record isunbelievable.
Um, there's a boxed warning onthere that it can cause
anaphylaxis, which we don'tunderstand.
How does a treatment forallergies cause anaphylaxis?
We don't know.
There's, there's, it's very rareand almost always it occurs in
the first three injections,which is why we give those first
(29:55):
three in the office.
Uh, and then we can transitionyou to add at home dosing if you
want.
Some allergists prefer to giveevery dose in their office,
which is fine as well.
Um, yeah.
Initially, like when I was doingmy training to be an allergist
20 years ago, there was someconcern that maybe Zolaire was
associated with cancer.
It turns out after studying itin thousands of patients, that
was a statistical anomaly and itdidn't pan out.
(30:15):
Um, but other than that, I don'tknow where all these fears are
coming from other than, um, youknow, the zeitgeist.
Fear
Dr Amanda Whitehouse (30:22):
of the unknown.
I think, you know, that's alwayssuch a powerful thing with
allergy life because so much ofit's the unknown.
Dr. David Stukus (30:28):
Yeah, and and that's why we try our best to
extract and be like, you know,no, I've been prescribing this
treatment for literally twodecades.
Uh, it just has a newindication.
Just we didn't have the goodstudies like we do now to show
that it works for food allergy.
And that's why the FDA didn'tapprove it for that.
But it has indications forchronic hives for chronic
rhinosinusitis and nasal polyps.
Um, yeah, it's amazing.
(30:49):
Hopefully people understand.
Well, just because it gotapproved a year ago, it doesn't
mean that it's only been aroundfor a year.
Um, and I, I think, you know,with the, the world we live in
now, and all the confusionsurrounding all the covert
vaccines, and there's just a lotof, you know, anti pharma, anti
medication, all this otherstuff.
But, you know, hopefully peoplecan just have that honest
conversation with their ownallergist and really understand.
(31:09):
Is this a good option for mychild?
And, and what does that looklike?
Dr Amanda Whitehouse (31:13):
Yeah.
Could you in the same waycomment on some of the fears
that people have about thedifferent immunotherapy options,
OIT and SLIT?
You mentioned briefly, butwhat's your take on those if
people aren't interested inZolaire and they are looking
just at that path withoutmedication added in?
Dr. David Stukus (31:29):
Yeah, we also want to make sure people
understand really risks,benefits, expected outcomes and
the regimen involved.
So this is not an easy decisionto make.
Uh, it's one that should berevisited we call it the concept
of shared decision making whereevery family, you should really
say, here's what is mostimportant to me.
I want to make sure that mychild never has a reaction.
Ever, ever.
Well, OIT is not a good optionfor you because side effects do
(31:49):
occur.
Most of them are pretty mild andwe can manage them, but yeah,
okay, fine.
That's fine.
Um, oh, by the way, avoidancewithout treatment is a great
option for many people.
I think that a lot of folks outthere, they get pressured.
why would you not put your childon this treatment?
My child did great with it.
That's great.
That's your story.
You have no idea what my child'sstory is.
avoidance is great.
I have so many families.
(32:09):
My son is a teenager.
He's 15 pistachio allergy.
He doesn't want to treat.
He doesn't want to do OIT.
He's like, I'm pretty sure I canmake this successfully work for
him.
He's like, I'm just not going toeat it.
And he's traveled to Europe withhis school and he's doing great.
He just, that's his choice andthat's fine.
So avoidance is an absolutelygreat option with OIT and SLID.
(32:29):
It really is understanding.
Okay.
This is you taking proactivecontrol of your child's allergy,
and you're treating them everysingle day at home, hopefully
under a lot of supervision, andyou have, um, you know, the room
to ask questions and stuff likethat.
Um, but just really thinkingthrough what does this look like
in your daily life?
If you have a seven year old,he's playing three sports, um,
and there are practice all thetime.
(32:50):
I don't know if these are goingto fit into your daily life
because we want to have periodswithout exercise for about two
hours after the dosing.
Uh, so those are things toconsider.
Dr Amanda Whitehouse (32:58):
You make such a good point because I
think the more information thereis out there, the more pressure
there is to do something rightand to take action.
But I work with a lot offamilies who are doing fine,
avoiding, and then they'rehearing all these things and
feeling this pressure.
Oh, I should be, I should becalling every manufacturer of
every label know, have you hadany problems with the food?
You know, oh, we're not supposedto be eating out.
Well, no, if you're doing fineand things are going along fine,
(33:21):
many people, like you're saying,can be safe by being careful and
avoiding.
Dr. David Stukus (33:26):
Oh my gosh, I have families.
This is probably once a month.
They say, I feel like such a badfood allergy parent because I'm
not calling manufacturers.
We go to restaurants, we travel,they do, you know, play dates
and social activities.
Um, we read labels and we havetheir epinephrine.
And I was like, why?
I was like, you're doing a greatjob.
I was like, that is successful.
It's food allergy management.
(33:46):
I said, you're, you're livingyour best life.
Uh, you're taking necessaryprecautions.
You're not letting it defineyou.
And by the way, when was thelast time your child had a
reaction?
Yeah.
It's been years, or you know,just their initial reaction
oftentimes.
I say, no, you, this is, this isthe epitome of management.
You're doing an amazing job.
Dr Amanda Whitehouse (34:03):
thank you for saying that.
Because I think there are a lotof people out there who are, you
know, struggling with that.
The more and more they'rehearing, and the more people are
talking about all those excitingthings that are coming up.
Dr. David Stukus (34:13):
Yeah, there's, there's just so many opinions
these days.
Um, and it's really hard to sortthrough and, but these are very
powerful influences in our dailylives, especially relatives and
friends and family members.
I hear that more than anythingof like, you know, my, my cousin
or my, my sister told me this.
Um, and she's really pressuringme to do this.
What do you think about it?
I'm like, well, it's, that's thesame as if you're on a social
(34:34):
media group and you know, theecho chamber pushing you into a
certain direction or another.
So, you know, Really, reallythinking through what's best for
your family.
Dr Amanda Whitehouse (34:41):
that's sometimes where I come in, in
terms of families weighing allthese decisions, obviously I
can't make medicalrecommendations to them, but I
will help them consider whattheir, family life is like, what
their child's personality and,and mental health is like, and
theirs, and what kind of supportsystem they have, and I think
that plays a big factor in whatyou decide to.
Like you said, OIT is not foreverybody,
Dr. David Stukus (35:00):
Well, absolutely.
And you can change your mind atany point.
So for some families, maybe it'snot the right decision now, but
it's that option will exist.
It's not going away.
Same thing was all there.
Um, a lot of families, they say,well, let's see if if their
allergy persists when they're anadolescent or teenager.
And maybe we'll considersomething like that before they
go off to college to give themsome protection, which for
everybody listening, if you'renot, uh, You know, we should be
(35:22):
following, um, typically withlabs at least once a year, uh,
for, you know, because a lot ofkids outgrow their food allergy,
and I've met people that theywere diagnosed a decade ago and
never had follow up testing, andthey probably lost their allergy
five years ago, and, uh, yeah,so hopefully your allergist is
also talking about prognosiswith you as well.
Dr Amanda Whitehouse (35:40):
Good to know.
speaking of all these newthings, talk to us about the new
options for epinephrine.
I think that's what a lot of usare the most excited about.
I just ordered my son's firstnephi.
Dr. David Stukus (35:48):
Oh, yeah.
Yeah.
Yeah.
So the first, um, intranasalepinephrine device is the trade
name is nephi was approved inSeptember.
I believe it's a two milligramdose.
So that one is only if you weigh66 pounds or above.
Um, there are one milligram doseI just learned is going to be
available sometime in the nextfew months, and that's gonna be
down to, um, 30 pounds.
(36:10):
Eso very exciting.
There are two other epinephrinenasal sprays I'm aware of that
may come to market in the next 1to 2 years.
There's also a sublingualepinephrine strip.
It's kind of like a list.
Rene strip that we should haveavailable by the beginning of
2026.
Eso these are all needle free.
When you, when you look at a lotof families tell me, well, does
(36:31):
it work?
So no, uh, to IRBs,Institutional Review Boards are
what we use to help govern.
Are we doing safe and ethicalresearch?
No IRB in the world is going toapprove a study where we
intentionally cause anaphylaxisand then randomize them to
either get nasal epinephrine orno treatment at all.
It's not going to work.
So the way they study this, it'sthe same exact way that they
(36:52):
studied the auto injectors inthe first place.
Is, you give the medicine tohealthy volunteers, and then you
look at parameters inside theirbloodstream.
How fast does the epinephrinereach a certain concentration,
how high does it go, how longdoes it last for, and then what
effect does it have.
on parts of the body where it,where it impacts us, such as
blood pressure and heart rateand stuff like that.
So the nasal epinephrine wasnear, I mean, it was essentially
(37:14):
the same as giving it through aninjection.
Uh, they also studied the nasalepinephrine in people with
allergic rhinitis, environmentalallergies, uh, because that's a
big concern, right?
Is it going to absorb?
It actually absorbed a littlebit better.
Um, so yeah, so that's how thesethings are studied.
We're going to be part of, um,multiple sites that are going
to, um, be part of a clinicaltrial where we enroll people
during oral food challenges thatif they require epinephrine, we
(37:37):
will randomize them to eitherget the nasal spray or the
injection.
So we'll actually have some reallife advocacy data in the next
year or two.
Dr Amanda Whitehouse (37:44):
I think that will be helpful for people,
to hear.
You understand this is the sameway that the injectors we're
tested and verified.
Dr. David Stukus (37:49):
It's like, um, you know, we'll never have a
study demonstrating thatparachutes work for people
jumping out of airplanes.
Dr Amanda Whitehouse (37:55):
good comparison.
you mentioned something thatreminded me of something earlier
in the conversation.
The difference between,threshold testing and food
challenges.
Could you talk about that?
I don't think a lot of peopleunderstand.
Dr. David Stukus (38:07):
No, this is kind of another paradigm shift.
I told you in the beginning,everything's changed.
Um, so not, there's not a lot offolks doing this.
We've been doing these thresholdchallenges for a couple of
years.
Um, so there's, you know, oralfood challenges are the gold
standard.
Um, this is the best way.
So if you're allergic tosomething When when you eat it,
you should have reactions.
If you eat a certain amount, youknow, a serving size or 4 to 5
(38:28):
grams without symptoms, it'svery unlikely that you're
allergic.
So when either the diagnosis isin question or people with known
food allergies, we think it maybe going away.
The oral food challenge is themost valuable part of what we
do.
It's an extremely empoweringexperience.
I know there's a ton of fearmongering surrounding them.
Uh, it's been suggested thatthey're inhumane.
Um, that is, you know, we do athousand food challenges a year
(38:50):
at our center.
And yeah, I mean, I can tell youthis is the most helpful thing
that we do.
The threshold challenge is, it'svery similar where we give a
very small amount of the food.
We observe if nothing happensafter 10 or 15 minutes, we give
a little bit more, a little bitmore, a little bit more.
Instead of trying to get them toeat an entire serving, we'll go
for a very small amount that wemeasure out.
So, like, if we do a peanutthreshold challenge, the single
(39:11):
highest dose is one peanut.
So we're not proving whetheryou're allergic or not, because
these are people we typicallythink you're probably allergic.
And if you were to eat enough,you'll have a reaction.
But these are people that haveextreme restrictions because
they, they thought maybe.
if they're exquisitely sensitiveor severely allergic, or they're
not quite sure if they shouldpursue treatment.
And often, oftentimes we candemonstrate like, wow, your
child ate two peanuts andnothing happened.
(39:33):
I'm not saying go eat peanutwhenever you want, but I am
saying you don't need to worryabout trace amounts, cross
contact.
I still want you to communicateand read labels, but you know,
your child's threshold is higherthan they'd ever received
through that sort of exposure.
And if you want to start oralimmunotherapy, we can start them
at a higher dose and maybe aimfor a higher goal dose as well.
So that's sort of how we usethose challenges.
Dr Amanda Whitehouse (39:53):
So that would be an individualized
decision then, once you do that,do we just avoid it, or do we
move into?
OIT from here.
Would they start the dose at thethreshold that you had
established then if they movedinto OIT from there?
Dr. David Stukus (40:06):
Yeah, so it all depends.
So we also wanna identify arethey somebody who is exquisitely
sensitive?
So we have children react tosmall amounts and that's
important information to know aswell.
Uh,'cause that means either weneed to adjust the protocol for
OIT and go to a much slowerpace, or we may consider
something Xolair.
Um, so it, it's just a valuableexperience regardless.
Dr Amanda Whitehouse (40:24):
Thanks for explaining that.
it sounds like you're saying alot of places are not offering
that specifically, right?
Dr. David Stukus (40:29):
Not that I'm aware of.
this is sort of new, even in theliterature, just like, like in
the last year is when we startedseeing a lot of folks talk about
this sort of thing, but it justgoes back to it's such a great
time for food allergy managementbecause it is so highly
individualized.
And if I haven't impressed thismessage enough upon your great
listeners, it's, it's okay.
Everybody else's story is theirstory.
(40:49):
That's not your story.
Um, so we need to figure outwhat your story is and then it
can help guide your management.
Dr Amanda Whitehouse (40:54):
The impression I'm getting from you
describing all this and you tellme if this is wrong, but it
sounds like the, with so muchhappening, the field is moving
from these broad recommendationsto more and more individualized
Is it just becoming so specificto each person when it used to
be just a broad, avoid and carryepinephrine?
Dr. David Stukus (41:12):
That's the way it should be.
Uh, again, as I mentionedbefore, it's gonna take a while
for everybody to kind of catchup.
Um, but that's where we are.
I mean, we're, we're in thatspace.
That's why, that's why I shiftedgears in my career and fell in
love with food allergy seven,eight years ago.
I knew that we were on the cuspof individualized management,
just like we were with asthma15, 20 years ago.
It's not one size fits all withasthma either.
Dr Amanda Whitehouse (41:34):
Is there anything else that's on the
horizon, even if it's just anidea, theory stage that you
think will be a big change?
Dr. David Stukus (41:40):
I mean, there's more and more treatment
options being investigated.
So hold on to your hats.
I mean, if we had thisconversation once a year for the
next five years, it's going tochange.
Um, so there's the, it's calledepicutaneous, um, immunotherapy.
So the peanut patch, um, youknow, that was, it's That was
shown to be effective years ago.
The FDA didn't approve itbecause the sticky part of the
patch wasn't quite stickyenough.
(42:01):
So we're going to have thoseresults sometime in the fall.
Uh, so we may have that andthat's, that might be a no
brainer.
Just put the patch on your skinand kind of set it and forget
it.
And any side effects arelocalized to the skin.
Um, there are other treatmentoptions that approach different
pathways, including potentialoral treatment options.
So we can get away from theneedle with biologics, which can
(42:22):
be really fascinating.
Uh, and just we're learning moreand more about, long term
treatment?
Can we sort of space?
Oh, I see doses out as kids getfurther along.
Uh, can we combine therapies toreally make them better
tolerated and safer and moreeffective?
The future is very bright.
Dr Amanda Whitehouse (42:38):
That was a lot packed in to, the
conversation, but a lot ofinformation in there.
So thank you.
Will you tell everybody wherethey can find you on social
media if they don't alreadyknow?
Dr. David Stukus (42:47):
Yeah, so I mostly live on Instagram these
days.
Um, my handle's atAllergyKidsDoc.
so I've gone through my ownpersonal journey.
Along with my academic side toeverything else I do, I've taken
a truly academic view of socialmedia and I've taken a deep dive
into learning how it's impactingall of our lives, especially our
medical decision making andthings like that.
And as I've learned more andmore about this, I've learned
(43:09):
how the algorithms have hijackedour brains.
So I try my best not to be on myphone.
so I'm not posting as much as Iused to in the past, but I'm
still out there.
I can never give individualmedical advice, but I love
interacting with folks and Ilearned from all of you.
And I take that back to mypatients and I take what I
learned from my patients andoffer it to all of you as well.
Dr Amanda Whitehouse (43:28):
Great.
So the last question that I liketo ask everybody on the show
again, let's get out of the fearmongering.
Tell me something good aboutallergies.
Dr. David Stukus (43:39):
it's a hidden superpower actually.
Then people don't talk aboutthis enough, but, uh, in
general, Children who have foodallergies, they tend to eat
healthier.
Um, they tend to have moreconfidence as does anybody with
chronic medical conditions thatthey have to manage on a regular
basis.
Uh, families learn to cook,which is often a great sort of,
um, family event where, you'relearning these skills and trying
(44:00):
new recipes.
Um, so I think that, in manyways it can be empowering, and
these kids actually do verywell.
Um, and I know there's a lot ofscary stuff in the world
especially in the food allergycommunity, they talk about how
people are insensitive, butchildren aren't.
I can tell you that, you know,school aged kids and teenagers,
like, they have such supportfrom their classmates and their
(44:21):
friends.
So yeah, I know there's, youknow, jokes being made about it
and commercials and stuff thatmake everybody mad, but like
your, your child's going to beokay.
It's all going to be okay.
Dr Amanda Whitehouse (44:32):
thank you so much for joining me here on
the show.
You have so much goodinformation to share.
I love conversations that reallydive in like this.
Dr. David Stukus (44:39):
It was my pleasure.
Thank you for inviting me.
And now here are your threeideas for action steps to help
you follow through on ourconversation today.
Number one, if you don't alreadyfollow Dr.
Skuas on Instagram and Twitterat allergy kids.
Doc Number two, if listening totoday's chat has made you
realize that your allergistmight not be the best fit for
(45:01):
you, or if maybe you're someonewho just gotten epinephrine from
your primary care doctor andnever saw a specialist, you can
find the College and the Academyof Allergy, asthma and
Immunology easily online.
And there are also links in theshow notes for you on both of
their websites.
You can search for a boardcertified allergist near you.
(45:21):
And number three, whether you'reconsidering meeting with a new
allergist, haven't seen your ownallergist in a while, or
considering treatment options,or maybe have questions about
your own health, take a momentto jot down some notes about
your thoughts, observations, andquestions.
Remember that Dr.
Skuas explained to us that ithelps our doctors provide the
best care when we come preparedwith good notes and careful
(45:43):
observations about the timingand onset of our symptoms, how
frequent they are and how longthey last foods we've eaten,
foods we've eliminated, anytreatments we've attempted, and
anything else that might behelpful for them in providing us
with good medical care.
Thanks again so much to Dr.
DUIs and thank you for listeningtoday.
I.
the content of this podcast isfor informational and
(46:04):
educational purposes only, andis not a substitute for
professional medical or mentalhealth advice, diagnosis, or
treatment.
If you have any questions aboutyour own medical experience or
mental health needs, pleaseconsult a professional.
I'm Dr.
Amanda White house.
Thanks for joining me.
And until we chat again,remember don't feed the fear.
Popular Podcasts
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
True Crime Tonight
If you eat, sleep, and breathe true crime, TRUE CRIME TONIGHT is serving up your nightly fix. Five nights a week, KT STUDIOS & iHEART RADIO invite listeners to pull up a seat for an unfiltered look at the biggest cases making headlines, celebrity scandals, and the trials everyone is watching. With a mix of expert analysis, hot takes, and listener call-ins, TRUE CRIME TONIGHT goes beyond the headlines to uncover the twists, turns, and unanswered questions that keep us all obsessed—because, at TRUE CRIME TONIGHT, there’s a seat for everyone. Whether breaking down crime scene forensics, scrutinizing serial killers, or debating the most binge-worthy true crime docs, True Crime Tonight is the fresh, fast-paced, and slightly addictive home for true crime lovers.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com