February 13, 2024 • 37 mins
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Alice Hoyt, MD (00:11):
Hello and welcome to Food Allergy and your
kiddo.
I am your host, dr Alice Hoyt,along with my amazing co-host,
ms Pam Lestage.
Hello, pam, how are you?
Pam Lestage, MBA (00:22):
Hello, I'm good.
How are you?
I'm excited.
This is my first video cast.
Alice Hoyt, MD (00:27):
I know it's going to be awesome.
Pam Lestage, MBA (00:28):
I know.
Alice Hoyt, MD (00:29):
I'm excited.
It's a good episode today.
I think so too Our illustrious,very creative title Real
Questions posted on social media.
Pam Lestage, MBA (00:40):
Yes, Dun dun dun.
So many people go to socialmedia to ask questions because
they don't know where else toask.
They leave their allergistoffice and they don't know.
They think of all of thesequestions afterwards and instead
of making that call or maybethey don't feel comfortable
making that call they just go tosocial media to ask other
(01:00):
parents who have lived it, whichcan be good, but sometimes it's
not the best place to getespecially medical advice.
And also, I think sometimes newparents who maybe aren't in
need of a food allergist yetwill ask some questions.
So we're just going to I'mgoing to throw some questions at
(01:20):
you today and see how you, anMD board certified, will answer.
Alice Hoyt, MD (01:26):
Oh right, great, yes, and I think so.
I know some of the questions,but I don't know all of the
questions.
And, like as Pam said, there'sdefinitely value in hearing the
lived experiences of others.
That is definitely a value, andhaving community, that is
definitely a value.
But what is really important tokeep in mind whenever you're on
(01:48):
social media is, of course,what is evidence based, what is
factual, what is not and,honestly like, what really
applies to your kiddo.
So when Pam throws thesequestions at me, I'm going to
answer them, but I'll alsoprobably go down a few rabbit
holes, go on a few tangents.
I'm sure Pam will reel me in.
Pam Lestage, MBA (02:10):
It's what we do, so it makes the podcast fun.
There you go.
All right, you ready, I'm ready.
Okay, I'm going to start withwhat I think is maybe a little
easy one for you.
This is actually from someonethat I was on my friends list
and it says starting baby ledweaning.
(02:30):
In two weeks because my babywill be six months old, we're
introducing peanut butter.
Then what was your favorite wayto do this?
And she sort of asked all ofher friends list and so I
thought it was a great questionwhat is your favorite way to
recommend?
A?
Maybe weaning their kiddo frommilk or breast milk, but also
(02:52):
introducing those allergensearly.
Alice Hoyt, MD (02:54):
Yeah, no, that's a really good question, and
what I want all families to keepin mind is that this is
different, really, for everychild.
Now, if your kiddo has severeeczema or an egg allergy, then
we know that they're at higherrisk for having a peanut allergy
.
That's pretty solid data atthis point.
That being said, there is alsoresearch that suggests that if
(03:18):
we just mask it everybody tointroduce allergens early
meaning around four or sixmonths, something along those
lines instead of waiting untilthey're one or two years old
then we can have significantlyless food allergies, especially
a significantly less peanutallergy.
So then, what really is myfavorite way to introduce peanut
?
It's the way that the familywill do it most regularly,
(03:41):
because sometimes families think, oh well, I just need to
introduce it once, make surethey're not allergic and then go
about my merry way.
That is really poor marketingon the part of the allergist.
That is not what earlyintroduction is all about.
Early introduction reallyshould be called early
incorporation of the food, andthe purpose of incorporating
(04:05):
foods into the diet early is toteach the immune system to
tolerate the foods.
We're talking specificallyabout foods that are commonly
allergens peanuts, tree nuts,like milk, wheat, soy, thin fish
, shellfish, within reason, andthen also now sesame.
So those are the ones that wewant to start feeding kiddos
early.
And specifically for peanut, thespecific question of what's the
(04:28):
favorite way to introduce it,it really does come back to how
will the family not justintroduce it but keep it in the
diet.
So, of course, thinking aboutwell, we already have some
peanut butter in the pantry, solet's just mix some peanut
butter with breast milk, make ita nice consistency that's a
appropriate for a kiddo who isaround six months old.
If you have a kiddo youngerthan that, who you've talked
(04:52):
with your allergist or you'vetalked with your pediatrician
and they're definitelyrecommending introducing peanut
at four months to help preventthe development of peanut
allergy, then you can also lookat some of the products that are
little packets to mix in with abottle, or if you have a little
baby who is exclusively nursing, doesn't take a bottle at all.
(05:14):
Then you can also think aboutthings about putting a little
bit of peanut butter on thenipple.
There's lots of different waysto do it.
But it comes back to how is thefamily going to do it, and do it
regularly, Because when we'retalking about incorporation,
we're talking about at leastthree times per week.
So this is where other products, especially as kiddos get older
(05:34):
, can become super fun.
And when I say older, I meanthere's just such a big
difference between afour-month-old and an
eight-month-old and a12-month-old.
And so Puffs.
I've been a spokesperson forMission Mighty Me Puffs.
I think they're a great company.
They were developed in part byGideon Lack, who is the primary
author of the LEAP study, and sothat study was really the
(05:59):
landmark study that showed thatearly introduction and
incorporation of peanut helpsprevent the development of
peanut allergy.
So you can do Puffs with mykiddo, my little guy.
I do a lot of the Puffs becauseit's easy.
It's easy and it's not as messyas the peanut butter, even
though, like I'll do sometimes,the peanut butter diluted to a
(06:19):
nice texture to mix it up.
But really it just comes backto what is the family going to
do regularly?
Pam Lestage, MBA (06:27):
So one of the questions which you kind of hit
on, or one of the comments onher post, was that another
parent did it on their fingerevery day for two weeks but then
stopped after two weeks becauseshe had heard that and this is
straight from her.
She heard that allergies getworse with more exposure after
(06:48):
two weeks.
So basically, that's I know theanswer to this, but you alluded
to it that that's not true,that you need to.
It's not introducing it onetime or a couple of days, it's
incorporating it in the diet,and so that is a prime example
of, yes, you can go to socialmedia to to get some help.
(07:10):
But remember, these are humansthat have never been to med
school sometimes.
So it's definitely important tosee your allergist, or to ask
your pediatrician in that case,if you don't have an allergist
yet.
Alice Hoyt, MD (07:24):
No, that's exactly right.
Yeah, there's no evidence thatshows that.
Do it for two weeks, becausethen you stop, because then
they're at higher risk.
No, no, no, no, no, no, no.
Introduce, incorporate, keep itthere.
It's just like going to the gym, it's just like eating
healthier to have that that body, that wellness that you want,
you do it, you do it.
You can't just cold turkey,stop and expect the same results
(07:47):
, right.
And so you want to introduceand incorporate.
Pam Lestage, MBA (07:51):
Awesome.
Okay, here is one about anolder kiddo and I found this on
a food allergy page for parentsand it says my freshman is
learning about EpiPen use inhealth class.
I'm keeping a close, opencommunication about this to make
sure he's learning correct infoand not what is against our
action plan.
I'm calling the allergist toconfirm later, but he was taught
(08:14):
yesterday that if your heartrate is up during a run, for
example, you have it and youhave a reaction that you should
not use your EpiPen because itcould kill you.
Is this fact myth?
Please help.
Alice Hoyt, MD (08:27):
Oh, my gosh.
No, no, what is that?
What is that?
Pam Lestage, MBA (08:32):
And I know who posted that, who posted that,
but you know I'm glad she postedit because she knew that was
wrong.
And no, that's absolutely wrong, you know well, it's like she
knew it was wrong, because shewas like let me ask my allergist
.
But she also posted it tryingto get other people's comment,
so I thought it was a greatquestion for you.
(08:52):
I knew you were gonna have thatreaction.
Alice Hoyt, MD (08:57):
That like way.
Emotional reaction like oh mygosh, okay.
So no, that's very inaccurate.
Exercise increases the heartrate, increases the body temp.
Both of those things Decreaseor lower the threshold to have
(09:18):
an allergic reaction, meaningyou're at increased likelihood
of having an allergic reactionif you accidentally ingest your
allergen and then you go for arun.
There is also an entity calledfood dependent exercise induced
anaphylaxis.
One of the most common allergensassociated with that condition
is wheat.
These patients, they can eatwheat products, sandwiches,
(09:39):
whatever they want, anytime, butif they then exercise within a
window of when they eatsomething that contains wheat,
then they can have anaphylaxis.
So the treatment foranaphylaxis is epinephrine.
Epinephrine coming from an autoinjector is incredibly safe.
It doesn't matter if your heartrate is already up.
Chances are your heart rate isalready up if you're having
(10:02):
anaphylaxis, because when you'rehaving anaphylaxis your body is
already secreting increasedamounts of epinephrine,
hopefully to help combat thereaction.
And it's really the epinephrinefrom the auto injector that's
sort of like a supplement tohelp make sure that you've got
enough epinephrine on board toshut down that allergic reaction
(10:22):
.
So no, if your heart rate isalready up, it's not surprising.
Your heart rate is already upin an allergic reaction.
It doesn't matter if you'rerunning or not.
Anaphylaxis is.
Epinephrine is the treatmentfor anaphylaxis.
Pam Lestage, MBA (10:37):
So it was a myth.
Alice Hoyt, MD (10:40):
True statement.
Wow, they're teaching that in ahealth class, I know so.
I think if you're listening tothis podcast you've probably
heard me talk about stockepinephrine.
I'm very engaged in this space.
I'm a huge advocate for stockepinephrine meaning epinephrine
in schools, non-school entitiesto be used in case of
(11:01):
anaphylaxis for somebody whodoesn't necessarily have an
epinephrine auto injector, andthat has never been something
that we teach in a stockepinephrine sort of education.
Meaning stock epinephrine is epithat's prescribed really for
anybody to use when the symptomsand signs of anaphylaxis are
(11:22):
recognized, and so that's goingto be a little bit different.
Sometimes when you're usingstock epi, it can be a little
bit different than when anallergist has told their patient
to use epinephrine.
And let me give an example ofthat.
If my patient, if I know mypatient, little Allie let's say
little Allie I know she has avery sensitive peanut allergy.
(11:44):
Even low amounts of cause veryserious reactions in her.
I know that if she eats even alittle bit of it and she starts
having any symptoms, myrecommendation for her is to use
epinephrine promptly, even ifshe's only having a few hives.
If I know she has had a seriousreaction in the past and she
injected her and she ingestedher allergen and she is now
(12:07):
having symptoms of a reaction.
I'm telling her promptly useyour epinephrine, because we
want to stop that reactionbefore it gets big.
In the case of stockepinephrine, we don't
necessarily have that luxury ofknowing someone's past medical
history, so we're definitelyleaning into the definitions of
anaphylaxis, the most commonbeing the two systems involved.
(12:29):
Right.
Pam Lestage, MBA (12:32):
It's a great question.
I'm glad we were able todiscuss it.
Thanks for asking it Pam.
You're welcome.
Here's another one, and it wasactually asked to you online
what is the difference betweenskin patch testing versus skin
prick testing?
I believe I have actually hadskin prick testing because they
(12:53):
poked me with needles.
Alice Hoyt, MD (12:56):
Yes, so that was that was a really good question
.
This, this post, was.
I can't remember the origin ofthe post, but it had to do with
she thought she was allergic tosomething and she wouldn't have
patch testing and lots of thingscame up positive and it was
something like that, somethinglike that and and she was asking
(13:18):
like what to do, I think, andso I said, well, any, what do
you mean?
You had patch testing, becausepatch testing is testing that we
as allergists and alsodermatologists, use to help
identify different types ofallergens, not anaphylactic
allergens, allergens like nickelallergy, you know, like if you
(13:39):
wear costume jewelry and you getlike a really bad rash and
stuff.
That's a delayedhypersensitivity.
It's a very differentimmunologic process.
And so then anaphylactic foodallergies, and so we use
different testing for evaluationof that.
And that's what patch testingis, which is little patches that
are impregnated with nickel,with fragrance, which, with all
(14:01):
these different things.
Little patches actually getapplied to the back and they
stay on for a couple of days,you don't shower, and then you
go back in to the doctor'soffice, they remove them, they
look and see if there's littlered marks that would suggest
that there is a hypersensitivityor a delayed allergic response
occurring.
And then you actually go back afew, a few more times if you're
being super thorough with thepatch testing, because it can
(14:23):
take a few days for some ofthese allergens to induce that
delayed allergic inflammation.
So that's patch testing, skinprick testing, and it's not
needles that we use.
We use a lot, of a lot of timesit's a little plastic skin pick
device.
There are a few different typesof devices on the market.
Yes, in the old days and I'mtaking back to my residency when
(14:48):
I was first being exposed toallergy like, yes, there there
is a method where you can use aneedle.
So maybe someone is still usinga needle, but you're not like
injecting anything.
It's just very tiny, just likebricks in the skin, really just
exposing that type top layer ofout top layer of the immune
system to the allergen.
And you, you read that test.
(15:08):
After you put the little brickson either the arm or on the
back, then you, you look for thelittle red, raised, itchy wheel
like a little.
It looks like a little mosquitobite that wheel to appear
within about 15 minutes.
And so skin prick testing isused to determine whether or not
allergic antibodies,specifically IgE are on those
(15:30):
mast cells, on on those allergycells in that top layer of the
skin, and that that test isright about 15 minutes, whereas
the patch testing is used for adelayed hypersensitivity, like I
said, like the costume, jewelry, stuff, and that's read a few
days later.
So that's the big difference.
(15:50):
And so why I chimed in?
Because I don't?
I I try to be very engaged inwhat's going on in the food
allergy social media world sothat I can bring the best
evidence and best information toour listeners and our viewers.
So why I really like engaged inthis post is because it was
(16:14):
very concerning to me that hereis a woman who is experiencing
allergic symptoms andpotentially had a completely
incorrect evaluation.
Right, and I'm going to put aplug in right now for board
certified allergists, which, ifyou have an allergy or you
(16:34):
suspect you or your child has anallergy, then you want to see a
board certified allergist,pediatricians, e&ts, gi docs.
They can provide some reallygreat information about food
allergies.
Sometimes they are not asinformed and I will say if
you're a board certifiedallergist, you have done
(16:55):
fellowship, you have donesignificant training, you are
going to the conferences, youare the most engaged.
You are the expert, so that iswho people who have allergies
should be seeing if they havesuspicion of allergic disorders.
So if you have a kiddo with afood allergy and you've not seen
a board certified allergist,get in with a board certified
allergist that's well.
Pam Lestage, MBA (17:17):
I say that's awesome because that's my go-to
phrase, but it's I.
I knew that some people confuseskin patch testing with skin
prick testing but I have to becompletely honest, had no idea
what skin patch testing was.
I just sort of like but that'svery interesting, because I
don't.
I think most people probablyare like me and this woman, who
(17:37):
really don't understand thedifference until it happens and
maybe like they still don't havethe answers.
And again, that's why it's niceto go to social media to maybe
have community, but it's justthe best to speak to a board
certified allergist.
Alice Hoyt, MD (17:54):
Absolutely, and I think in one of these cases
too and I'm wondering if it wasthis particular person they were
evaluated for their foodallergy by an ENT.
Look, I love a good ENT, don'tget me wrong ENTs are incredibly
valuable, but when it comes tofood allergies, you want to be
evaluated by a board certifiedallergist.
Pam Lestage, MBA (18:16):
Right, right, that's a great question, great
answer.
Okay, here's a little bit of alonger one.
It was also posted on a foodallergy group.
It said I would love tounderstand better the
correlation between OIT andoutgrowing an allergy.
I was under the impression thatthey are mutually exclusive.
Example if you are doing OIT,then you're still considered
(18:40):
allergic and have to takemaintenance doses for the rest
of your life, which willpreclude the possibility of the
allergy going away on its own.
Is this wrong?
And my reading?
I am reading a lot of commentson other posts that talk about
how people started OIT early fortheir children to maximize the
chances of outgrowing theallergy and I would love to
understand this more accurately.
(19:01):
Thank you.
Alice Hoyt, MD (19:03):
Yeah, this is a really good question, and so I
don't like to use the termoutgrow when we're talking about
a kiddo who had an egg allergyat eight months and then, by the
time they're five, doesn't havean egg allergy.
I prefer to use the term theallergy self-resolved or
tolerance spontaneouslydeveloped.
(19:23):
The reason I use those terms isbecause when we're thinking
about the immune system and I'veprobably said this before on
this podcast when I was a fellowin training I used to think
well, why are these kidsdeveloping food allergies?
And that's really not the wayto think about it.
What we need to think about iswhy aren't kids developing
(19:43):
tolerance to certain foods?
And what we know is that allallergens are not created equal.
So what studies show is thatmaybe 20 to 30% of kids with a
peanut or tree nut allergy, theallergy will self-resolve or
they'll outgrow it, whateverterminology you want to use, by
the time they're five, seven,something like that.
(20:05):
It'll resolve 20 to 30% of kidswith a peanut or tree nut
allergy.
So that means we're saying 70to 80% of kids.
It's going to stick around fora while.
And let's think back.
We first noticed the uptick inpeanut allergy in the 1990s, so
it's not like we're dealing withsome disorder that's been
(20:25):
around since Job, right, no,right.
So then, when we think aboutegg or even milk, to some extent
a lot of times those kiddos itis self-resolving, or this is
where we need to tease out thedata more.
Is it that it's self-resolvingor is it that a lot of these
(20:46):
kiddos are able to tolerate eggmilk when it's baked, and so
they have that in the diet andit sort of is a form of
immunotherapy, where the bakedegg, baked milk, is teaching
their immune system to toleratethe protein and then by the time
they're five, six, seven,whatever starting school, then
(21:06):
the allergy has resolved.
And is it really that it wasoutgrown, that their immune
system outgrew it, or was itthat it was in the diet?
Well, we know that evidencetells us that if it's in the
diet, it can help in many casesdevelop tolerance.
There was a study that comparedegg OIT with eating baked egg
(21:29):
and who develops more tolerance,and egg OIT was more powerful,
meaning more kids weredeveloping better tolerance.
However you want to interpretthe study, but there were still
kids that were tolerating eggafter they were eating baked egg
.
So that's where that's a verylong-winded answer to this
(21:51):
question.
That really is such a goodquestion and one that I talk
with my patients a lot,especially our littles, because
I am a big advocate of oralimmunotherapy in the right
setting.
So if it's a kiddo who has apeanut allergy say it's a
one-year-old has a peanutallergy pretty legit peanut
(22:13):
component testing results has apretty legit history.
We're not just dealing with akiddo who was skin tested
because they have eczema andthen they're being referred to
my practice.
It sounds like a pretty robusthistory.
So in that kiddo we look atwhat the reaction history has
(22:33):
been and what is the likelihoodof itself resolving.
That is going to be a verydifferent case than when we have
a kiddo who had hives at eightmonths with scrambled egg, has a
negative ingestion challenge tobaked egg and that's the only
allergy they're dealing with.
(22:53):
In that case very rarely do Iencourage, if ever, oit for egg.
If the only allergen they'redealing with is egg and they can
tolerate baked egg, it's justvery rare.
Now if they're already doingOIT for peanut and they have
this egg allergy, then will wedo OIT for egg too?
(23:14):
Yeah, we typically will.
So that's where it can be veryallergen specific, very patient,
specific, but ultimately, atthe end of the day, we don't
know whose allergy is going toself-resolve.
That's where I'm hoping thatthe research will continue to
(23:35):
catch up to us, because we'reliving this every day.
But that's exactly theconversation to be having with
your allergist.
Pam Lestage, MBA (23:43):
And we actually have had a few people
ask us about should I start OIT?
Because what if they outgrow it?
But, like you said, there's noanswer.
I think, a lot of times we, asparents of allergic kids or of
kids who have allergies, want toknow the definitive.
(24:06):
I think we all do as parents ashumans.
We want to know, we want to seethe outcome and, especially as
parents with kiddos who havefood allergies, we're trying to
juggle what are my best options.
If I don't do this, then willthis happen?
Or if I do this, but thishappens.
And so, like there's a lot ofwhat ifs, and I find, as a
(24:30):
person who speaks with parents,as the care navigator for your
practice, sometimes theystruggle with OIT or slit before
they come see you because theyjust want to know the answers
and I often have to tell them.
Sometimes we just don't knowand what Dr Hoyt will recommend
(24:50):
is the best next steps, becausewe can't see into the future.
We can't.
We hope that little Joe isgoing to outgrow his allergy at
whatever time, or resolve See, Iuse the wrong terms too.
His allergy will resolve, butwe just don't know that.
And so if we don't know thatbut we want it to resolve, then
(25:15):
OIT is your answer.
Alice Hoyt, MD (25:16):
And I'll go back to the question, because I
think the question about well,if we start doing OIT, then
we'll never know if they weregonna outgrow it, right, if you
start doing OIT, you do OIT, youdo a full-dose challenge, they
tolerate a full-dose challengeand then they just start eating
it.
They start when the case of eggmilk you incorporate that into
(25:40):
the diet.
It's a staple food and you kindof just make sure you have it
in the diet a few times per week.
A lot of those patients, theyleave the allergy in the rear
view mirror.
Now, allergists are not gonnacommit to this word cure that we
cured your food allergy.
We're not there yet, right, butin a lot of these cases egg
(26:03):
milk, these staple foods once wecan get it into the diet and it
stays in the diet, then it kindof fades into the background.
So it's the whole.
Well, if we start OIT, we'llnever know if it was gonna be
outgrown.
You're right, you won't.
The other thing to considerhere is the goal of
(26:27):
immunotherapy and this is a bigconversation that I have with my
families, that we have with ourfamilies.
Is your goal to free eat Likeyou want your kiddo to be able
to sit at the lunch table andeat the same peanut butter and
jelly sandwich as his or herfriends.
Or is your goal to bebite-proof, Meaning if they
(26:51):
accidentally ate a bite ofsomething to which they were
allergic, they're not gonna havea severe allergic reaction
Either way.
By the way, tangent lunch tablediscussion we don't like
alienating children based ontheir food allergy.
Oh no, we do not.
I have a whole other podcast,Woo.
But what really is your goalwith oral immunotherapy and so
(27:16):
many families?
They want their kid to havethat level of protection that,
whether they're four and theyaccidentally eat their friend's
cookie, or they're 14 andthey're out ordering food and
somebody accidentally servesthem something that has their
allergen in it, they just wantthat level of safety and that's
(27:37):
what OIT can do.
So, even if you don't know ifthe kiddo is going to develop
tolerance, some families stillwant that level of protection
that you can get withimmunotherapy.
Pam Lestage, MBA (27:50):
And I think it's important too, especially
to our listeners, that in whatwe tell patients is that, as
with allergies, oralimmunotherapy is very
individualized as well.
Just because XYZ reach acertain level does not mean that
you will.
It all is so dependent on thatchild's body or their history
(28:16):
and all of that.
And so if you're listening, ifyou're listening with a kiddo
with food allergy and you'reteetering on the line, or you're
just here because you want tolearn more information, just
know that Just because it worksreally well for one, we're not
saying it's not gonna workreally well for you as well.
But you have to remember thatthe timelines can often change,
Cause I think that's whatparents sometimes struggle with
(28:37):
the most is that they feel likethey need to hit certain
milestones at certain times, andthat's not.
You always like to say slow andsteady, and it's so true with
all of that that we never wantsomeone to come to our podcast
and think well, Dr Hoyt and Pamsaid this, but it's not
happening to us, it may not.
It may not happen the same waythat we're telling you.
(28:59):
So, just as a parent and as aperson who sometimes speaks to
parents who are struggling, knowthat that we'll get there.
We'll get there it just it maylook a little different than it
does for other people.
Yep.
Alice Hoyt, MD (29:13):
That's exactly right, pam, I know.
Pam Lestage, MBA (29:16):
Okay, I have a question that is actually Last
question.
Last question Okay, this blewmy mind.
I saw it on Instagram.
Alice Hoyt, MD (29:26):
Oh gosh.
Pam Lestage, MBA (29:27):
And it was.
It blew my mind.
I immediately was like ah, Iwish I could just like be a
keyboard warrior and likerespond to this person.
A person who claims to have agluten allergy and a wheat
allergy and these are words thatcame out of their mouths cannot
(29:48):
eat them in the States went toEurope and posted a story about
how in Europe, because there'sno preservatives or they farm
their wheat differently, he wasable to eat all of the wheat and
all of the gluten withouthaving any problems at all and
(30:12):
no rashes and no allergyreactions.
And I just thought, ah, ah, soDr Hoyt, yes, if he can eat
wheat and gluten in Italy, he'snot allergic in the States
correct.
Alice Hoyt, MD (30:33):
So you're hitting the nail on the head.
Pam Lestage, MBA (30:36):
And look, and I'm not to say there's not maybe
an intolerance there and maybehe he reacts to something and
that's fine and I can understandthat, but we're not talking.
He didn't use the termintolerant, I'm intolerant.
He used the term I am allergic.
Alice Hoyt, MD (30:51):
Right, and so this is where the term allergic
has been commandeered to reallykind of mean anything, right,
right, so you can have the wayyou can have adverse reactions
to wheat.
Wheat is with with IGE, meaningyou can have anaphylactic wheat
allergy.
You can have non-celiac glutensensitivity, which is some sort
(31:16):
of inflammation in the gut.
We don't know a whole lot aboutit.
Some people don't believe in it, I do believe in it.
And then there's celiac disease, which is an autoimmune
condition.
So those are the three wheatslash, gluten associated adverse
reactions to foods In a wheatallergy.
What a wheat allergy means isthat you eat wheat and that
(31:41):
wheat protein binds to wheat IGEon the person's mast cells
because they have a wheatallergy, so they have wheat IGE
on their mast cells and thenthey have an allergic reaction
high swelling, trouble,breathing.
This typically occurs within,starts to occur within 30
minutes.
Pretty much definitely isoccurring by two, maybe three
(32:01):
hours.
So that is what a wheat allergyis.
Who's thought of the?
Pam Lestage, MBA (32:07):
epinephrine.
Alice Hoyt, MD (32:09):
Yes, treatment is epinephrine for wheat induced
anaphylaxis, and I talkedearlier in this episode about
food dependent exercise inducedanaphylaxis.
That's also wheat, but is thereweird stuff that we see wheat
doing?
Yes, or that we see glutendoing which is different than
wheat yes.
So in this case, this isdefinitely something that I
(32:33):
would encourage that person tosee a board certified allergist
about, because it's awesome thatthis person had improvement of
whatever symptoms they werehaving with wheat here in the
States.
But I would also look at firsttry to give this person a
diagnosis.
What really is their diagnosis?
Why are they having anysymptoms anytime here in the US
(32:55):
or wherever they are?
And what they might also begetting at is some of the
changes that have been made towheat plants and all of these
things.
Right, genetic modification offoods, blah, blah, blah, blah,
blah.
I'm not going to go down thatrabbit hole, but of course, if
we're having geneticmodifications of foods, could
(33:18):
that impact the way the immunesystem recognizes them?
Just like if we process foodsdifferently, can that affect the
way the immune systemrecognizes them, interacts with
them?
Sure, but really this personneeds to have a diagnosis from a
board certified allergist sothat they really can live their
best life.
Figure out what's safe, what'snot safe for them and in what
context?
Pam Lestage, MBA (33:39):
Yeah, and the reason that I really wanted to
bring it up was mostly becausethose are the types of things
that we can sometimes see onsocial media that if you're not
well informed, then you maybehave celiac or you have a wheat
allergy and you think toyourself oh well, joe Blow said
that he went to Europe and heate all of these things.
(33:59):
And if you take that informationand without asking an allergist
or a doctor, and you go toEurope and you eat it and you
have a reaction, I just thinkthings like that are so
dangerous, and so that's why wewanted to ask some questions and
why we've had, in the past,podcast about the dangers of
social media, because while, yes, it is good and it is good for
(34:22):
someone to share their story,but you have to remember that
people sharing their stories onsocial media are just people for
the most part, and they mayincorrectly use terms that make
other people think, oh well, ifyou were able to do that, then
that means I can do it, becausein no world I would imagine that
(34:42):
a celiac person would.
I mean, you're still a celiac inEurope and so it's just such
wrong information and you don'twant to be a person who maybe is
following these people andthink, oh well, they had such a
great experience, I'm going todo it too.
And then you have adversereactions.
(35:03):
And so just remember that, that, yes, good community, but
remember who the source is and,as always, go see a board
certified allergist.
This was fun.
Yeah yeah, I think it was fun.
It was fun.
I have more questions, but youknow we're on a time limit, so
we'll have to do this again Nexttime.
(35:25):
Next time, Part two.
This was a lot of fun, Thankyou, and I think we'll have to
do this again.
For families who well, all ofour families but who sometimes
go to social media to ask things, I think it'll be helpful for
them to understand that.
Okay, well, I can maybe startgetting formulating an idea from
there, but I need to bring thatback to my MD.
Alice Hoyt, MD (35:47):
And this is also I'm going to plug our office
hours, because this is where wehelp families navigate.
It's not a medical appointment,but we help families, we guide
them and what questions theyshould be asking to their
allergist to get really goodanswers.
Yeah, sure Love it.
Thanks so much, Pam.
(36:08):
Thank you, I enjoyed this.
Thanks so much for tuning in.
Remember I'm an allergist, butI'm not your allergist.
So talk with your allergistabout what you learned today,
Like subscribe, share this withyour friends and go to
foodallergyandyourkiddoscomwhere you can join our
newsletter.
God bless you and God blessyour family.
Hello and welcome to Food Allergy and your
kiddo.
I am your host, dr Alice Hoyt,along with my amazing co-host,
ms Pam Lestage.
Hello, pam, how are you?
Pam Lestage, MBA (00:22):
Hello, I'm good.
How are you?
I'm excited.
This is my first video cast.
Alice Hoyt, MD (00:27):
I know it's going to be awesome.
Pam Lestage, MBA (00:28):
I know.
Alice Hoyt, MD (00:29):
I'm excited.
It's a good episode today.
I think so too Our illustrious,very creative title Real
Questions posted on social media.
Pam Lestage, MBA (00:40):
Yes, Dun dun dun.
So many people go to socialmedia to ask questions because
they don't know where else toask.
They leave their allergistoffice and they don't know.
They think of all of thesequestions afterwards and instead
of making that call or maybethey don't feel comfortable
making that call they just go tosocial media to ask other
(01:00):
parents who have lived it, whichcan be good, but sometimes it's
not the best place to getespecially medical advice.
And also, I think sometimes newparents who maybe aren't in
need of a food allergist yetwill ask some questions.
So we're just going to I'mgoing to throw some questions at
(01:20):
you today and see how you, anMD board certified, will answer.
Alice Hoyt, MD (01:26):
Oh right, great, yes, and I think so.
I know some of the questions,but I don't know all of the
questions.
And, like as Pam said, there'sdefinitely value in hearing the
lived experiences of others.
That is definitely a value, andhaving community, that is
definitely a value.
But what is really important tokeep in mind whenever you're on
(01:48):
social media is, of course,what is evidence based, what is
factual, what is not and,honestly like, what really
applies to your kiddo.
So when Pam throws thesequestions at me, I'm going to
answer them, but I'll alsoprobably go down a few rabbit
holes, go on a few tangents.
I'm sure Pam will reel me in.
Pam Lestage, MBA (02:10):
It's what we do, so it makes the podcast fun.
There you go.
All right, you ready, I'm ready.
Okay, I'm going to start withwhat I think is maybe a little
easy one for you.
This is actually from someonethat I was on my friends list
and it says starting baby ledweaning.
(02:30):
In two weeks because my babywill be six months old, we're
introducing peanut butter.
Then what was your favorite wayto do this?
And she sort of asked all ofher friends list and so I
thought it was a great questionwhat is your favorite way to
recommend?
A?
Maybe weaning their kiddo frommilk or breast milk, but also
(02:52):
introducing those allergensearly.
Alice Hoyt, MD (02:54):
Yeah, no, that's a really good question, and
what I want all families to keepin mind is that this is
different, really, for everychild.
Now, if your kiddo has severeeczema or an egg allergy, then
we know that they're at higherrisk for having a peanut allergy
.
That's pretty solid data atthis point.
That being said, there is alsoresearch that suggests that if
(03:18):
we just mask it everybody tointroduce allergens early
meaning around four or sixmonths, something along those
lines instead of waiting untilthey're one or two years old
then we can have significantlyless food allergies, especially
a significantly less peanutallergy.
So then, what really is myfavorite way to introduce peanut
?
It's the way that the familywill do it most regularly,
(03:41):
because sometimes families think, oh well, I just need to
introduce it once, make surethey're not allergic and then go
about my merry way.
That is really poor marketingon the part of the allergist.
That is not what earlyintroduction is all about.
Early introduction reallyshould be called early
incorporation of the food, andthe purpose of incorporating
(04:05):
foods into the diet early is toteach the immune system to
tolerate the foods.
We're talking specificallyabout foods that are commonly
allergens peanuts, tree nuts,like milk, wheat, soy, thin fish
, shellfish, within reason, andthen also now sesame.
So those are the ones that wewant to start feeding kiddos
early.
And specifically for peanut, thespecific question of what's the
(04:28):
favorite way to introduce it,it really does come back to how
will the family not justintroduce it but keep it in the
diet.
So, of course, thinking aboutwell, we already have some
peanut butter in the pantry, solet's just mix some peanut
butter with breast milk, make ita nice consistency that's a
appropriate for a kiddo who isaround six months old.
If you have a kiddo youngerthan that, who you've talked
(04:52):
with your allergist or you'vetalked with your pediatrician
and they're definitelyrecommending introducing peanut
at four months to help preventthe development of peanut
allergy, then you can also lookat some of the products that are
little packets to mix in with abottle, or if you have a little
baby who is exclusively nursing, doesn't take a bottle at all.
(05:14):
Then you can also think aboutthings about putting a little
bit of peanut butter on thenipple.
There's lots of different waysto do it.
But it comes back to how is thefamily going to do it, and do it
regularly, Because when we'retalking about incorporation,
we're talking about at leastthree times per week.
So this is where other products, especially as kiddos get older
(05:34):
, can become super fun.
And when I say older, I meanthere's just such a big
difference between afour-month-old and an
eight-month-old and a12-month-old.
And so Puffs.
I've been a spokesperson forMission Mighty Me Puffs.
I think they're a great company.
They were developed in part byGideon Lack, who is the primary
author of the LEAP study, and sothat study was really the
(05:59):
landmark study that showed thatearly introduction and
incorporation of peanut helpsprevent the development of
peanut allergy.
So you can do Puffs with mykiddo, my little guy.
I do a lot of the Puffs becauseit's easy.
It's easy and it's not as messyas the peanut butter, even
though, like I'll do sometimes,the peanut butter diluted to a
(06:19):
nice texture to mix it up.
But really it just comes backto what is the family going to
do regularly?
Pam Lestage, MBA (06:27):
So one of the questions which you kind of hit
on, or one of the comments onher post, was that another
parent did it on their fingerevery day for two weeks but then
stopped after two weeks becauseshe had heard that and this is
straight from her.
She heard that allergies getworse with more exposure after
(06:48):
two weeks.
So basically, that's I know theanswer to this, but you alluded
to it that that's not true,that you need to.
It's not introducing it onetime or a couple of days, it's
incorporating it in the diet,and so that is a prime example
of, yes, you can go to socialmedia to to get some help.
(07:10):
But remember, these are humansthat have never been to med
school sometimes.
So it's definitely important tosee your allergist, or to ask
your pediatrician in that case,if you don't have an allergist
yet.
Alice Hoyt, MD (07:24):
No, that's exactly right.
Yeah, there's no evidence thatshows that.
Do it for two weeks, becausethen you stop, because then
they're at higher risk.
No, no, no, no, no, no, no.
Introduce, incorporate, keep itthere.
It's just like going to the gym, it's just like eating
healthier to have that that body, that wellness that you want,
you do it, you do it.
You can't just cold turkey,stop and expect the same results
(07:47):
, right.
And so you want to introduceand incorporate.
Pam Lestage, MBA (07:51):
Awesome.
Okay, here is one about anolder kiddo and I found this on
a food allergy page for parentsand it says my freshman is
learning about EpiPen use inhealth class.
I'm keeping a close, opencommunication about this to make
sure he's learning correct infoand not what is against our
action plan.
I'm calling the allergist toconfirm later, but he was taught
(08:14):
yesterday that if your heartrate is up during a run, for
example, you have it and youhave a reaction that you should
not use your EpiPen because itcould kill you.
Is this fact myth?
Please help.
Alice Hoyt, MD (08:27):
Oh, my gosh.
No, no, what is that?
What is that?
Pam Lestage, MBA (08:32):
And I know who posted that, who posted that,
but you know I'm glad she postedit because she knew that was
wrong.
And no, that's absolutely wrong, you know well, it's like she
knew it was wrong, because shewas like let me ask my allergist
.
But she also posted it tryingto get other people's comment,
so I thought it was a greatquestion for you.
(08:52):
I knew you were gonna have thatreaction.
Alice Hoyt, MD (08:57):
That like way.
Emotional reaction like oh mygosh, okay.
So no, that's very inaccurate.
Exercise increases the heartrate, increases the body temp.
Both of those things Decreaseor lower the threshold to have
(09:18):
an allergic reaction, meaningyou're at increased likelihood
of having an allergic reactionif you accidentally ingest your
allergen and then you go for arun.
There is also an entity calledfood dependent exercise induced
anaphylaxis.
One of the most common allergensassociated with that condition
is wheat.
These patients, they can eatwheat products, sandwiches,
(09:39):
whatever they want, anytime, butif they then exercise within a
window of when they eatsomething that contains wheat,
then they can have anaphylaxis.
So the treatment foranaphylaxis is epinephrine.
Epinephrine coming from an autoinjector is incredibly safe.
It doesn't matter if your heartrate is already up.
Chances are your heart rate isalready up if you're having
(10:02):
anaphylaxis, because when you'rehaving anaphylaxis your body is
already secreting increasedamounts of epinephrine,
hopefully to help combat thereaction.
And it's really the epinephrinefrom the auto injector that's
sort of like a supplement tohelp make sure that you've got
enough epinephrine on board toshut down that allergic reaction
(10:22):
.
So no, if your heart rate isalready up, it's not surprising.
Your heart rate is already upin an allergic reaction.
It doesn't matter if you'rerunning or not.
Anaphylaxis is.
Epinephrine is the treatmentfor anaphylaxis.
Pam Lestage, MBA (10:37):
So it was a myth.
Alice Hoyt, MD (10:40):
True statement.
Wow, they're teaching that in ahealth class, I know so.
I think if you're listening tothis podcast you've probably
heard me talk about stockepinephrine.
I'm very engaged in this space.
I'm a huge advocate for stockepinephrine meaning epinephrine
in schools, non-school entitiesto be used in case of
(11:01):
anaphylaxis for somebody whodoesn't necessarily have an
epinephrine auto injector, andthat has never been something
that we teach in a stockepinephrine sort of education.
Meaning stock epinephrine is epithat's prescribed really for
anybody to use when the symptomsand signs of anaphylaxis are
(11:22):
recognized, and so that's goingto be a little bit different.
Sometimes when you're usingstock epi, it can be a little
bit different than when anallergist has told their patient
to use epinephrine.
And let me give an example ofthat.
If my patient, if I know mypatient, little Allie let's say
little Allie I know she has avery sensitive peanut allergy.
(11:44):
Even low amounts of cause veryserious reactions in her.
I know that if she eats even alittle bit of it and she starts
having any symptoms, myrecommendation for her is to use
epinephrine promptly, even ifshe's only having a few hives.
If I know she has had a seriousreaction in the past and she
injected her and she ingestedher allergen and she is now
(12:07):
having symptoms of a reaction.
I'm telling her promptly useyour epinephrine, because we
want to stop that reactionbefore it gets big.
In the case of stockepinephrine, we don't
necessarily have that luxury ofknowing someone's past medical
history, so we're definitelyleaning into the definitions of
anaphylaxis, the most commonbeing the two systems involved.
(12:29):
Right.
Pam Lestage, MBA (12:32):
It's a great question.
I'm glad we were able todiscuss it.
Thanks for asking it Pam.
You're welcome.
Here's another one, and it wasactually asked to you online
what is the difference betweenskin patch testing versus skin
prick testing?
I believe I have actually hadskin prick testing because they
(12:53):
poked me with needles.
Alice Hoyt, MD (12:56):
Yes, so that was that was a really good question
.
This, this post, was.
I can't remember the origin ofthe post, but it had to do with
she thought she was allergic tosomething and she wouldn't have
patch testing and lots of thingscame up positive and it was
something like that, somethinglike that and and she was asking
(13:18):
like what to do, I think, andso I said, well, any, what do
you mean?
You had patch testing, becausepatch testing is testing that we
as allergists and alsodermatologists, use to help
identify different types ofallergens, not anaphylactic
allergens, allergens like nickelallergy, you know, like if you
(13:39):
wear costume jewelry and you getlike a really bad rash and
stuff.
That's a delayedhypersensitivity.
It's a very differentimmunologic process.
And so then anaphylactic foodallergies, and so we use
different testing for evaluationof that.
And that's what patch testingis, which is little patches that
are impregnated with nickel,with fragrance, which, with all
(14:01):
these different things.
Little patches actually getapplied to the back and they
stay on for a couple of days,you don't shower, and then you
go back in to the doctor'soffice, they remove them, they
look and see if there's littlered marks that would suggest
that there is a hypersensitivityor a delayed allergic response
occurring.
And then you actually go back afew, a few more times if you're
being super thorough with thepatch testing, because it can
(14:23):
take a few days for some ofthese allergens to induce that
delayed allergic inflammation.
So that's patch testing, skinprick testing, and it's not
needles that we use.
We use a lot, of a lot of timesit's a little plastic skin pick
device.
There are a few different typesof devices on the market.
Yes, in the old days and I'mtaking back to my residency when
(14:48):
I was first being exposed toallergy like, yes, there there
is a method where you can use aneedle.
So maybe someone is still usinga needle, but you're not like
injecting anything.
It's just very tiny, just likebricks in the skin, really just
exposing that type top layer ofout top layer of the immune
system to the allergen.
And you, you read that test.
(15:08):
After you put the little brickson either the arm or on the
back, then you, you look for thelittle red, raised, itchy wheel
like a little.
It looks like a little mosquitobite that wheel to appear
within about 15 minutes.
And so skin prick testing isused to determine whether or not
allergic antibodies,specifically IgE are on those
(15:30):
mast cells, on on those allergycells in that top layer of the
skin, and that that test isright about 15 minutes, whereas
the patch testing is used for adelayed hypersensitivity, like I
said, like the costume, jewelry, stuff, and that's read a few
days later.
So that's the big difference.
(15:50):
And so why I chimed in?
Because I don't?
I I try to be very engaged inwhat's going on in the food
allergy social media world sothat I can bring the best
evidence and best information toour listeners and our viewers.
So why I really like engaged inthis post is because it was
(16:14):
very concerning to me that hereis a woman who is experiencing
allergic symptoms andpotentially had a completely
incorrect evaluation.
Right, and I'm going to put aplug in right now for board
certified allergists, which, ifyou have an allergy or you
(16:34):
suspect you or your child has anallergy, then you want to see a
board certified allergist,pediatricians, e&ts, gi docs.
They can provide some reallygreat information about food
allergies.
Sometimes they are not asinformed and I will say if
you're a board certifiedallergist, you have done
(16:55):
fellowship, you have donesignificant training, you are
going to the conferences, youare the most engaged.
You are the expert, so that iswho people who have allergies
should be seeing if they havesuspicion of allergic disorders.
So if you have a kiddo with afood allergy and you've not seen
a board certified allergist,get in with a board certified
allergist that's well.
Pam Lestage, MBA (17:17):
I say that's awesome because that's my go-to
phrase, but it's I.
I knew that some people confuseskin patch testing with skin
prick testing but I have to becompletely honest, had no idea
what skin patch testing was.
I just sort of like but that'svery interesting, because I
don't.
I think most people probablyare like me and this woman, who
(17:37):
really don't understand thedifference until it happens and
maybe like they still don't havethe answers.
And again, that's why it's niceto go to social media to maybe
have community, but it's justthe best to speak to a board
certified allergist.
Alice Hoyt, MD (17:54):
Absolutely, and I think in one of these cases
too and I'm wondering if it wasthis particular person they were
evaluated for their foodallergy by an ENT.
Look, I love a good ENT, don'tget me wrong ENTs are incredibly
valuable, but when it comes tofood allergies, you want to be
evaluated by a board certifiedallergist.
Pam Lestage, MBA (18:16):
Right, right, that's a great question, great
answer.
Okay, here's a little bit of alonger one.
It was also posted on a foodallergy group.
It said I would love tounderstand better the
correlation between OIT andoutgrowing an allergy.
I was under the impression thatthey are mutually exclusive.
Example if you are doing OIT,then you're still considered
(18:40):
allergic and have to takemaintenance doses for the rest
of your life, which willpreclude the possibility of the
allergy going away on its own.
Is this wrong?
And my reading?
I am reading a lot of commentson other posts that talk about
how people started OIT early fortheir children to maximize the
chances of outgrowing theallergy and I would love to
understand this more accurately.
(19:01):
Thank you.
Alice Hoyt, MD (19:03):
Yeah, this is a really good question, and so I
don't like to use the termoutgrow when we're talking about
a kiddo who had an egg allergyat eight months and then, by the
time they're five, doesn't havean egg allergy.
I prefer to use the term theallergy self-resolved or
tolerance spontaneouslydeveloped.
(19:23):
The reason I use those terms isbecause when we're thinking
about the immune system and I'veprobably said this before on
this podcast when I was a fellowin training I used to think
well, why are these kidsdeveloping food allergies?
And that's really not the wayto think about it.
What we need to think about iswhy aren't kids developing
(19:43):
tolerance to certain foods?
And what we know is that allallergens are not created equal.
So what studies show is thatmaybe 20 to 30% of kids with a
peanut or tree nut allergy, theallergy will self-resolve or
they'll outgrow it, whateverterminology you want to use, by
the time they're five, seven,something like that.
(20:05):
It'll resolve 20 to 30% of kidswith a peanut or tree nut
allergy.
So that means we're saying 70to 80% of kids.
It's going to stick around fora while.
And let's think back.
We first noticed the uptick inpeanut allergy in the 1990s, so
it's not like we're dealing withsome disorder that's been
(20:25):
around since Job, right, no,right.
So then, when we think aboutegg or even milk, to some extent
a lot of times those kiddos itis self-resolving, or this is
where we need to tease out thedata more.
Is it that it's self-resolvingor is it that a lot of these
(20:46):
kiddos are able to tolerate eggmilk when it's baked, and so
they have that in the diet andit sort of is a form of
immunotherapy, where the bakedegg, baked milk, is teaching
their immune system to toleratethe protein and then by the time
they're five, six, seven,whatever starting school, then
(21:06):
the allergy has resolved.
And is it really that it wasoutgrown, that their immune
system outgrew it, or was itthat it was in the diet?
Well, we know that evidencetells us that if it's in the
diet, it can help in many casesdevelop tolerance.
There was a study that comparedegg OIT with eating baked egg
(21:29):
and who develops more tolerance,and egg OIT was more powerful,
meaning more kids weredeveloping better tolerance.
However you want to interpretthe study, but there were still
kids that were tolerating eggafter they were eating baked egg
.
So that's where that's a verylong-winded answer to this
(21:51):
question.
That really is such a goodquestion and one that I talk
with my patients a lot,especially our littles, because
I am a big advocate of oralimmunotherapy in the right
setting.
So if it's a kiddo who has apeanut allergy say it's a
one-year-old has a peanutallergy pretty legit peanut
(22:13):
component testing results has apretty legit history.
We're not just dealing with akiddo who was skin tested
because they have eczema andthen they're being referred to
my practice.
It sounds like a pretty robusthistory.
So in that kiddo we look atwhat the reaction history has
(22:33):
been and what is the likelihoodof itself resolving.
That is going to be a verydifferent case than when we have
a kiddo who had hives at eightmonths with scrambled egg, has a
negative ingestion challenge tobaked egg and that's the only
allergy they're dealing with.
(22:53):
In that case very rarely do Iencourage, if ever, oit for egg.
If the only allergen they'redealing with is egg and they can
tolerate baked egg, it's justvery rare.
Now if they're already doingOIT for peanut and they have
this egg allergy, then will wedo OIT for egg too?
(23:14):
Yeah, we typically will.
So that's where it can be veryallergen specific, very patient,
specific, but ultimately, atthe end of the day, we don't
know whose allergy is going toself-resolve.
That's where I'm hoping thatthe research will continue to
(23:35):
catch up to us, because we'reliving this every day.
But that's exactly theconversation to be having with
your allergist.
Pam Lestage, MBA (23:43):
And we actually have had a few people
ask us about should I start OIT?
Because what if they outgrow it?
But, like you said, there's noanswer.
I think, a lot of times we, asparents of allergic kids or of
kids who have allergies, want toknow the definitive.
(24:06):
I think we all do as parents ashumans.
We want to know, we want to seethe outcome and, especially as
parents with kiddos who havefood allergies, we're trying to
juggle what are my best options.
If I don't do this, then willthis happen?
Or if I do this, but thishappens.
And so, like there's a lot ofwhat ifs, and I find, as a
(24:30):
person who speaks with parents,as the care navigator for your
practice, sometimes theystruggle with OIT or slit before
they come see you because theyjust want to know the answers
and I often have to tell them.
Sometimes we just don't knowand what Dr Hoyt will recommend
(24:50):
is the best next steps, becausewe can't see into the future.
We can't.
We hope that little Joe isgoing to outgrow his allergy at
whatever time, or resolve See, Iuse the wrong terms too.
His allergy will resolve, butwe just don't know that.
And so if we don't know thatbut we want it to resolve, then
(25:15):
OIT is your answer.
Alice Hoyt, MD (25:16):
And I'll go back to the question, because I
think the question about well,if we start doing OIT, then
we'll never know if they weregonna outgrow it, right, if you
start doing OIT, you do OIT, youdo a full-dose challenge, they
tolerate a full-dose challengeand then they just start eating
it.
They start when the case of eggmilk you incorporate that into
(25:40):
the diet.
It's a staple food and you kindof just make sure you have it
in the diet a few times per week.
A lot of those patients, theyleave the allergy in the rear
view mirror.
Now, allergists are not gonnacommit to this word cure that we
cured your food allergy.
We're not there yet, right, butin a lot of these cases egg
(26:03):
milk, these staple foods once wecan get it into the diet and it
stays in the diet, then it kindof fades into the background.
So it's the whole.
Well, if we start OIT, we'llnever know if it was gonna be
outgrown.
You're right, you won't.
The other thing to considerhere is the goal of
(26:27):
immunotherapy and this is a bigconversation that I have with my
families, that we have with ourfamilies.
Is your goal to free eat Likeyou want your kiddo to be able
to sit at the lunch table andeat the same peanut butter and
jelly sandwich as his or herfriends.
Or is your goal to bebite-proof, Meaning if they
(26:51):
accidentally ate a bite ofsomething to which they were
allergic, they're not gonna havea severe allergic reaction
Either way.
By the way, tangent lunch tablediscussion we don't like
alienating children based ontheir food allergy.
Oh no, we do not.
I have a whole other podcast,Woo.
But what really is your goalwith oral immunotherapy and so
(27:16):
many families?
They want their kid to havethat level of protection that,
whether they're four and theyaccidentally eat their friend's
cookie, or they're 14 andthey're out ordering food and
somebody accidentally servesthem something that has their
allergen in it, they just wantthat level of safety and that's
(27:37):
what OIT can do.
So, even if you don't know ifthe kiddo is going to develop
tolerance, some families stillwant that level of protection
that you can get withimmunotherapy.
Pam Lestage, MBA (27:50):
And I think it's important too, especially
to our listeners, that in whatwe tell patients is that, as
with allergies, oralimmunotherapy is very
individualized as well.
Just because XYZ reach acertain level does not mean that
you will.
It all is so dependent on thatchild's body or their history
(28:16):
and all of that.
And so if you're listening, ifyou're listening with a kiddo
with food allergy and you'reteetering on the line, or you're
just here because you want tolearn more information, just
know that Just because it worksreally well for one, we're not
saying it's not gonna workreally well for you as well.
But you have to remember thatthe timelines can often change,
Cause I think that's whatparents sometimes struggle with
(28:37):
the most is that they feel likethey need to hit certain
milestones at certain times, andthat's not.
You always like to say slow andsteady, and it's so true with
all of that that we never wantsomeone to come to our podcast
and think well, Dr Hoyt and Pamsaid this, but it's not
happening to us, it may not.
It may not happen the same waythat we're telling you.
(28:59):
So, just as a parent and as aperson who sometimes speaks to
parents who are struggling, knowthat that we'll get there.
We'll get there it just it maylook a little different than it
does for other people.
Yep.
Alice Hoyt, MD (29:13):
That's exactly right, pam, I know.
Pam Lestage, MBA (29:16):
Okay, I have a question that is actually Last
question.
Last question Okay, this blewmy mind.
I saw it on Instagram.
Alice Hoyt, MD (29:26):
Oh gosh.
Pam Lestage, MBA (29:27):
And it was.
It blew my mind.
I immediately was like ah, Iwish I could just like be a
keyboard warrior and likerespond to this person.
A person who claims to have agluten allergy and a wheat
allergy and these are words thatcame out of their mouths cannot
(29:48):
eat them in the States went toEurope and posted a story about
how in Europe, because there'sno preservatives or they farm
their wheat differently, he wasable to eat all of the wheat and
all of the gluten withouthaving any problems at all and
(30:12):
no rashes and no allergyreactions.
And I just thought, ah, ah, soDr Hoyt, yes, if he can eat
wheat and gluten in Italy, he'snot allergic in the States
correct.
Alice Hoyt, MD (30:33):
So you're hitting the nail on the head.
Pam Lestage, MBA (30:36):
And look, and I'm not to say there's not maybe
an intolerance there and maybehe he reacts to something and
that's fine and I can understandthat, but we're not talking.
He didn't use the termintolerant, I'm intolerant.
He used the term I am allergic.
Alice Hoyt, MD (30:51):
Right, and so this is where the term allergic
has been commandeered to reallykind of mean anything, right,
right, so you can have the wayyou can have adverse reactions
to wheat.
Wheat is with with IGE, meaningyou can have anaphylactic wheat
allergy.
You can have non-celiac glutensensitivity, which is some sort
(31:16):
of inflammation in the gut.
We don't know a whole lot aboutit.
Some people don't believe in it, I do believe in it.
And then there's celiac disease, which is an autoimmune
condition.
So those are the three wheatslash, gluten associated adverse
reactions to foods In a wheatallergy.
What a wheat allergy means isthat you eat wheat and that
(31:41):
wheat protein binds to wheat IGEon the person's mast cells
because they have a wheatallergy, so they have wheat IGE
on their mast cells and thenthey have an allergic reaction
high swelling, trouble,breathing.
This typically occurs within,starts to occur within 30
minutes.
Pretty much definitely isoccurring by two, maybe three
(32:01):
hours.
So that is what a wheat allergyis.
Who's thought of the?
Pam Lestage, MBA (32:07):
epinephrine.
Alice Hoyt, MD (32:09):
Yes, treatment is epinephrine for wheat induced
anaphylaxis, and I talkedearlier in this episode about
food dependent exercise inducedanaphylaxis.
That's also wheat, but is thereweird stuff that we see wheat
doing?
Yes, or that we see glutendoing which is different than
wheat yes.
So in this case, this isdefinitely something that I
(32:33):
would encourage that person tosee a board certified allergist
about, because it's awesome thatthis person had improvement of
whatever symptoms they werehaving with wheat here in the
States.
But I would also look at firsttry to give this person a
diagnosis.
What really is their diagnosis?
Why are they having anysymptoms anytime here in the US
(32:55):
or wherever they are?
And what they might also begetting at is some of the
changes that have been made towheat plants and all of these
things.
Right, genetic modification offoods, blah, blah, blah, blah,
blah.
I'm not going to go down thatrabbit hole, but of course, if
we're having geneticmodifications of foods, could
(33:18):
that impact the way the immunesystem recognizes them?
Just like if we process foodsdifferently, can that affect the
way the immune systemrecognizes them, interacts with
them?
Sure, but really this personneeds to have a diagnosis from a
board certified allergist sothat they really can live their
best life.
Figure out what's safe, what'snot safe for them and in what
context?
Pam Lestage, MBA (33:39):
Yeah, and the reason that I really wanted to
bring it up was mostly becausethose are the types of things
that we can sometimes see onsocial media that if you're not
well informed, then you maybehave celiac or you have a wheat
allergy and you think toyourself oh well, joe Blow said
that he went to Europe and heate all of these things.
(33:59):
And if you take that informationand without asking an allergist
or a doctor, and you go toEurope and you eat it and you
have a reaction, I just thinkthings like that are so
dangerous, and so that's why wewanted to ask some questions and
why we've had, in the past,podcast about the dangers of
social media, because while, yes, it is good and it is good for
(34:22):
someone to share their story,but you have to remember that
people sharing their stories onsocial media are just people for
the most part, and they mayincorrectly use terms that make
other people think, oh well, ifyou were able to do that, then
that means I can do it, becausein no world I would imagine that
(34:42):
a celiac person would.
I mean, you're still a celiac inEurope and so it's just such
wrong information and you don'twant to be a person who maybe is
following these people andthink, oh well, they had such a
great experience, I'm going todo it too.
And then you have adversereactions.
(35:03):
And so just remember that, that, yes, good community, but
remember who the source is and,as always, go see a board
certified allergist.
This was fun.
Yeah yeah, I think it was fun.
It was fun.
I have more questions, but youknow we're on a time limit, so
we'll have to do this again Nexttime.
(35:25):
Next time, Part two.
This was a lot of fun, Thankyou, and I think we'll have to
do this again.
For families who well, all ofour families but who sometimes
go to social media to ask things, I think it'll be helpful for
them to understand that.
Okay, well, I can maybe startgetting formulating an idea from
there, but I need to bring thatback to my MD.
Alice Hoyt, MD (35:47):
And this is also I'm going to plug our office
hours, because this is where wehelp families navigate.
It's not a medical appointment,but we help families, we guide
them and what questions theyshould be asking to their
allergist to get really goodanswers.
Yeah, sure Love it.
Thanks so much, Pam.
(36:08):
Thank you, I enjoyed this.
Thanks so much for tuning in.
Remember I'm an allergist, butI'm not your allergist.
So talk with your allergistabout what you learned today,
Like subscribe, share this withyour friends and go to
foodallergyandyourkiddoscomwhere you can join our
newsletter.
God bless you and God blessyour family.
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