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Bill Klaproth (Host): Up to fifteen million Americans are affected by food allergies, and for many, an allergic reaction can cause a potentially life-threatening medical situation. So what do you need to know and how can you successfully manage and control your condition to enjoy a full active life? Well here to talk about food allergies is Dr. Amit Kumar, an asthma and allergy specialist at Southern New Hampshire Health. Dr. Kumar, thank you for your time today. So let's start at the beginning; what are food allergies?

Dr. Amit Kumar, MD (Guest): Yeah, so food allergies are almost like your body's over-reaction to foods when you ingest them. So a lot of times when people get food allergy symptoms, the main symptoms that we worry about are what are termed anaphylaxis, and anaphylaxis can mean anything from hives, to throat swelling, to tongue swelling, lip swelling, wheezing, vomiting, at times people can even pass out during the course of a food allergic reaction.

Some kids when they have a reaction to a food, it may be a little bit different. They can sometimes get eczema from having ingested a food within a few hours' time as well, and so usually when we think about classical food allergies it's either anaphylaxis or having the eczema symptoms after eating the food.

Bill: So a food allergy is basically the body fighting itself?

Dr. Kumar: Well what it is really, if we think about the basic science behind it, it's that you make antibodies to various things in the world, and there's an antibody in your body that's more associated with allergies, and that's called IGE. And IGE goes up when you're allergic to anything. So if somebody has, for example, a cat allergy, they're making IGE to cats. In food allergies, they're usually making IGE to that food. So somebody who's nut allergic or milk allergic is making this antibody directed against those foods, and when that happens it sort of sets off a cascade in the body so when you eat the food, and the antibody gets a chance to bind to that food, it releases systemic mediators in the body that cause the symptoms that we think of with food allergies, whether it be anaphylaxis or eczema.

Bill: Okay, got it. So you just mentioned some symptoms earlier. How do you diagnose a food allergy?

Dr. Kumar: That's a great question. So you know, with food allergies, when we're diagnosing them there's multiple ways that we can go about it. The first is sometimes when patients come and visit an allergist, we will do skin testing where we'll have the child or adult come in and we'll do what's called a scratch test where we take a little device and we just lightly superficially scratch the skin and apply the allergen to the skin, and if you're allergic, the little droplet on the skin turns red, itchy, and bumpy right away.

Another way of looking at it is you can also get bloodwork which will also show you if you're making the allergic antibodies to that food. But the gold standard for food allergy is if we're not quite sure, if the skin testing is unclear, or if the history is very suggestive of a food allergy, or if we think maybe somebody has outgrown their food allergy, the gold standard is to have the person eat the food and see what their reaction is.

So sometimes if we're not- if we think somebody's outgrown an allergy we'll have them come in, and we'll give them the food in small controlled amounts, and we'll see if they react against it in any negative way, and that's called a Food Challenge. So a lot of allergists perform those as a way of sort of establishing if one is really allergic or not. If they can eat the food, and even if the blood test or the skin test is positive but they can eat the food and they're not having any symptoms, then they're not really allergic to the food. They probably are sensitized by skin testing or blood testing. But the gold standard is if you can eat it and you're asymptomatic then you probably are not allergic at that point.

Bill: Alright Dr. Kumar, that's very good to know. So you mentioned outgrowing an allergy. Is that possible? And are there cures for allergies? Or in most cases of food allergies, it's just something you have to manage over a lifetime?

Dr. Kumar: So you know, it depends on the foods in a lot of ways. So for example, I oftentimes tell patients who are- if you're milk allergic, or you're egg allergic, or you're wheat allergic as an infant or a child, a good 80% of kids will outgrow those allergies by age five, and the way we determine that is to either keep the skin testing or bloodwork and see if it starts to get lower and lower with time, and if it does, then we try to re-introduce the food.

That's in contrast to other foods, for example nuts and shellfish, there's only about a 20% chance of outgrowing those on your own. So those are much less apt to happen but they can occur occasionally, and then that's why we still like to trend those values early on in life to see where they're sort of heading. And if the levels start to go down, then we're a little bit more optimistic that the child or adult has a good chance of outgrowing the allergy.

But going back to your second question, is there a cure for food allergy? At this time, no. There are many things that are sort of in development in terms of trying to come up with ways of trying to either instill some of these food allergens into the diet in graded amounts, or sort of building up one's body tolerance to the foods. And so many academic centers throughout the U.S. are trying to study if food desensitization is something that will be an option for our patients with time.

What that would mean is that instead of just waiting for somebody's body to outgrow the allergy, we would be able to actually come up with a protocol where we could try to administer very small amounts and then build up the person's tolerance over time, meaning that they would come in every week, or every few weeks, and get a higher amount of that food, and kind of keep ingesting it every day as a way of trying to instill tolerance or outgrowing the food allergy.

But that's still sort of in academic development, meaning like it's still being looked at in clinical research trials, so the Academy of Allergy has not at this point in time suggested that we try that therapy yet on our patients, but in the future it may offer some possibility.

Bill: And then we hear a lot about gluten, people allergic to gluten. Can you quickly talk about that?

Dr. Kumar: So yeah, so gluten- there can be multiple sets of issues with gluten. Gluten sometimes can cause what's known as Celiac disease, which is oftentimes managed by gastroenterologists. But patients in that situation can sometimes have difficulties with digestion of wheat or gluten-containing products, and that can include things such as diarrhea, or bellyaches, or bloating, or sometimes anemias, or malabsorption. So that's one example where somebody is not able to eat- not able to digest gluten.

On the other hand, you can have wheat allergy, which would be again, all the symptoms I mentioned before like throat swelling, tongue swelling, lip swelling, those kinds of issues. And then there's a little bit more of a nebulous category where people are just gluten intolerant, and the hard thing- it's almost become almost like a fad diet where people have taken gluten out and they just sort of feel better in general.

The problem with the intolerance is that there's no great test for that, so people oftentimes come to see me and they think that they're gluten 'allergic,' and really what they're alluding to is they just feel better with gluten out of their diet, or digestively they feel better with gluten not being in their diet. And I oftentimes tell patients, "Well there's no great validated test for that. If you feel better with it out of your diet, then certainly you can remove it, but it's not the same as being anaphylactic to the food where we have a validated test."

Bill: And lastly, Dr. Kumar, are they any new treatments for food allergies that we should know about?

Dr. Kumar: Well you know, as I was alluding to before, they are trying to move forward with some of these new desensitization protocols which are, like I said, in academic development. You know, this coming year they are probably going to be releasing two treatments that sort of allude to that. There's a peanut- two peanut products, one that's going to be given sublingually, and one that's going to be given transdermally, almost like you're going to be wearing a little bit of a patch that sort of helps the person who's allergic to peanuts to see if they can help to sort of outgrowing the food allergy.

The problem with those therapies at this point in time is that they sometimes have a high potential for side effects, and they're not fully effective in terms of eradicating the food allergy. So at this point, what I oftentimes tell patients is although we don't have the best treatments at this time, certainly keeping an EpiPen at all times is highly suggested so that in case you accidentally ingest the food, you can give yourself a medicine that will help to quickly reverse the symptoms of a food allergy. So oftentimes our patients will be armed with EpiPens, they'll learn how to use those, they'll be taught on how to do good label reading, and how best to avoid the food for themselves or their children. And you know, with time it's worth relooking and seeing if their lab levels happen to drop on their own because, as I mentioned before, to do a Food Challenge at some point for somebody who we think has maybe outgrown their allergy is invaluable. It's our way of being able to basically tell the adult or child that they're no longer allergic to that food. I think that's sort of where we are in terms of our therapies right now.

Bill: Well Dr. Kumar, thank you so much for the great information today. For more information on food allergies, please visit www.SNHHealth.org. That's www.SNHHealth.org. This is Simply Healthy; a podcast by Southern New Hampshire Health. I'm Bill Klaproth, thanks for listening.