Nov. 9, 2021
Preventing and treating food allergies with Dr. Kari Nadeau
Dr. Kari Nadeau discusses the causes, prevention strategies and treatment of food allergies.
Dr. Kari Nadeau is the Naddisy Foundation Endowed Professor of Medicine and Pediatrics and, Director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford University.
For more than 30 years, she has devoted herself to understanding how environmental and immune/genetic factors affect allergies, immune tolerance, and asthma. As one of the globe’s foremost experts in adult and pediatric allergy, immunology, and asthma, her research is laying the groundwork for a variety of potential future therapies to prevent and cure allergies and asthma. She also is an author of the Lancet Countdown in Global Climate Change 2020 and the book: The End of Food Allergy.
Food Without Fear by Ruchi Gupta, MD MPH
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Transcript
I'm Dr. Darya Rose and you're listening to the Darya Rose Show, where we bring a fact-based perspective to answer all those confounding questions that come up in our day to day lives. From achieving optimal health to making conscious choices about your purchases and raising kids that thrive. We are here to help you navigate your life with confidence.
Hello and welcome back to the Darya Rose Show. Today we are talking about one of the most common and frightening things you may encounter in your life. And that is allergies. As you probably know, allergies can present as anything from a mild annoyance to a life threatening condition. Bad allergies can cause parents, children, and grown adults to live in constant fear of exposure. Allergies have also become much more common in the past few decades. And it is something I've personally been dealing with as a parent with both of my daughters, despite the fact that I thought I was up on the science and knew what I was doing. In short, I wish I knew the information in this podcast much earlier.
The exciting part is that the science has come a really long way. In fact, since recording this episode, I found out that my daughter's egg allergy is most likely treatable and may even possibly be eliminated.
Today's guest is one of the founding scientists advancing this work. Dr. Kari Nadeau is a Naddisy Foundation endowed professor of medicine and pediatrics and Director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford University. For more than 30 years, she has devoted herself to understanding how environmental and immune and genetic factors affect allergies, immuno tolerance, and asthma. As one of the globe's foremost experts in adult and pediatric allergy, immunology and asthma, her research is laying the groundwork for a variety of potential future therapies to prevent and cure allergies and asthma. She's also an author of the Lancet Countdown and Global Climate Change 2020 and the wonderful book, The End of Food Allergy.
Kari and I have a fascinating discussion about the causes of allergies and the science of how they can be both avoided and even treated through therapies that she has created. I seriously think I have learned more in this show than in any that I've recorded so far.
If you're a new or expecting parent or have allergies yourself, this episode should be especially helpful. Here is Dr. Kari Nadeau.
Kari, thank you so much for coming on the show. I am so excited to talk to you.
Thank you so much.
As a scientist I thought I- I knew a lot about allergies and how to prevent allergies in young kids. But I [laughs], despite my best efforts, I ended up with two little, little ones that have food allergies/sensitivities. We're still trying to figure it out. So I know that I am not alone in this issue. A lot of parents struggle with this. And you have been doing such amazing work in this field that I just cannot wait to ask you so many questions [laughs].
Yeah, no. I feel very lucky to be here today. And you are one of many people in the United States and the world who have children with food allergies. So I'm so glad you're having this because it is one of 13 in every classroom in the US. And we need to be able to help parents and help you and help others.
Yeah, yeah. So let's just start at the beginning. So can you talk a little about a- do we know, at this point, what causes allergies?
I think thanks to a lot of great epidemiologist, we do have some notion of what could be associated with the food allergies. In any one individual, it's going to be different. And what's really important to note is that anything that you did or your children did or that you did in pregnancy, you cannot blame yourself if your child has food allergies. So many people have children with food allergies, or get food allergies themselves and they never had it before.
And so we can give you some recommendations based on the science, based on the data, as to how to help change behavior. But most importantly is that we can't guarantee it because we don't exactly know the cause. And it might be somewhat genetics. But it also is probably a lot environment. So people that you have to kind of play with dirt a little bit to be able to make sure you have good microbiome. And then you have to have enough Vitamin D, that's the next D. And then you have to avoid dry skin. That's the third D. And then, with that, avoid harsh detergents, 'cause that can make your dry skin worse. And then diversity of diet is really important. So we know that of all the things it's really important to probably diversify your diet early and often to make sure that your body learns to accommodate and tolerize to those foods.
Amazing. So how many D's were there?
[laughs] So there's, there's, there's DNA. So there's, to some extent, genetics but not very much. There's dirt, you know, good dirt, good microbiome is really important. There's vitamin D, that's really important we think, but we don't know exactly how much. And then there's dry skin and detergents. I kinda lu- lump those together as two D's because detergents can make dry skin and then dry skin is kinda where allergies can begin.
Mm.
And then finally diversity of diet, which seems to be the most important of all the five to be important to be able to decrease the risk of food allergies.
Wow. So when certain people are more susceptible than others, that's- there's gonna be a genetic ponent- component and then also these environmental components. And it sounds like those environmental components are largely controllable, which is great.
Yes! That's right. Right. It doesn't always have to be genetics. You can have families that have a high history of allergies in their family and then they don't have children with food allergies. The opposite can happen too. 65% of the time we could have parents and families without any allergies or food allergies and then their child has food allergies. So we do think the environment plays a really important role.
And you're absolutely right. This is where we can manage. This is where we can take control and change our environment to the extent that we can change it and help our children and help ourselves.
That's, that's fascinating. Yeah. My family had never had any allergies at all. And my- but my husband's family has- his niece is like allergic to everything under the sun. And, so yeah. So I- but I was still- I, I feel like I did the other- I do the five D's. Or at least do the four D's.
Yeah. That's good.
And [laughs], and still I don't- still we have, you know, we- we have some issues-
Yeah.
So, um-
That's right. There's no guarantee but at least you- you only had ... You know, the, the nice thing is, on the flip side, you only had one allergy for your one child, compared to maybe many different ones that might have occurred if you had not done it. So we kind of see it as perhaps a silver lining? So that's good too.
Yeah. And, and actually while we're- while we're on the subject, so my- so I, I can just tell people since it's kind of interesting. So my oldest child is almost four. And when she was six months old, I was- gosh, like, giving her peanut butter and giving her eggs and giving her ev- everything. And she- I, I had given her eggs several times. And, and then for some reason on, like, the fourth or fifth time, she started vomiting uncontrollably, turning blue. And we had to take her to the ER. It happened twice in a weekend 'cause I also was giving her fish eggs. And I didn't think it was the same. I gave her, like, some salmon roe and it happened again just a couple days later. It was awful.
And she was diagnosed with ... She had red, redness on her skin as well. So she was diagnosed with anaphylaxis. Although, you know, I've had- spoken to other allergists since then that think she might have FPIES instead. Can you talk about FPIES and allergies and how they're-
Sure.
... different and similar?
Sure. Well I'm sorry you had to go through that. It is hard. Egg and peanut and sesame and milk are some of the most common allergies early on in life. And we do see this connection. And it's harder and harder to grow out of these allergies now. And it is true that there are so many things that are inter-related. So it's really important to know what those are. But not, you know, the typical person doesn't know that. So the- you, you should know that you did everything right. And it is hard to see.
And what we do know about diversifying the diet early and often is that you probably should do it every day to be able to introduce those foods to start to tolerize. So you were doing everything right. We think now, based on the science, that to take it every day really helps tolerize. It's that circadian rhythm. Just little bits every day. So I hope your daughter's okay.
When we think about FPIES though, it is a different reaction. The typical allergy reaction happens within two hours of taking the in- the basically the insulting food, right? The inciting food. But with FPIES you get diarrhea, blood pressure drop, dizziness, about four to five hours after the food. That's the typical time frame. So the time frame of the symptoms are different. The symptoms-
Yeah.
... themself are different.
Interesting. So yeah. My, my- that was one of the reasons the, the later allergist said it might be FPIES is because her reaction was- it was like three and a half hours later. Something like that.
Okay. Okay. And did she have diarrhea or dizziness? Or did she kind get- go very white and blank?
She turned kind of blue after-
Yeah.
... vomiting a lot. Uh, you know-
I see.
... she was like vomiting every 45 seconds or something like that for- after like seven or eight times-
Mm-hmm [affirmative]. Yeah.
... that was when we called the ambulance. Yeah. But, but, uh, you know, so she did look very pale and have the vomiting. And, and we did notice a little bit of skin reaction as well where the, the egg had touched her chin.
Yeah. So one is not at the exclusion of the other. You can have food allergy and FPIES.
Hm.
But what's important is you need to go see an allergist so that you can know if you do have FPIES, the management is different.
Mm-hmm [affirmative].
And with FPIES you can have other proteins that can also induce the same symptoms.
Hm.
And there are- there are therapies for FPIES, which is great. So I would say definitely those- FPIES is rare. Usually it's with diarrhea. Usually it's with a lot of abdominal issues. But I- I h- I can't comment on your specific daughter's issues. But it might be-
Yes.
... that she has both, which is common. But I'm glad you're on it. And that you're being careful.
[laughs] Yeah. And then, so I- my youngest, the first day I brought her home from the hospital ... We- we were in the hospital just one night. And the first day I brought her home, we were nursing and as soon as- it was like the middle of the night and the- as soon as she finished, she just had the biggest spit up I've ever seen in my life from a child that size 'cause she was a little-
Aw-
... you know, seven pounds.
[crosstalk 00:11:16]
And long story short, but it took me five months to figure out, she was reacting to my eating wheat through my breast milk. And even if I would have- so if I would eat, like, a piece of bread, she would be sick, vo- like spitting up 40 to 50 times a day for five days in a row.
Ugh.
If I even had some soy sauce, like with- which just has a-
Yeah.
... tiny little bit of wheat [crosstalk 00:11:40], that goes through my breast milk, she would still be sick for three days. And then, you know, that was very, very difficult to figure out. But, you know, it didn't- she never was diagnosed with an allergy because all she did was, you know, have the abdominal distress. And once I eliminated those things from my diet, she was fine. And years later now, just, just- gosh, it was like a month ago or two months ago maybe, we tried again and with, with some wheat. And now she's okay. [laughs]
Oh, [crosstalk 00:12:05] that's great. That's the one thing about FPIES. It, it tends to get better over time. Whereas food allergy tends to get worse over time-
Mm.
... because they're building up the, the cells that can make the bad, uh, component that leads to allergy. And then if anyone wants to know, like, this has been written up in two good books for the public. One is called The End of Food Allergy, which I wrote with Sloan Barnett. And then Ruchi Gupta, my colleague, wrote another book called Food Without Fear. And so she also goes into the difference between FPIES and food allergy and, and importantly, like, wheat sensitivities and gluten allergies. So, so please know that luckily there's some really good books written by physicians that are specialists in this. And I think they're quite digestible. Hopefully people-
Fantastic.
... [crosstalk 00:12:53] find them to be helpful.
I am going to read those both this weekend. [laughs]
Good, good. They're on Audible if it makes your life easier. That's w-
It does. It does.
Mom of two children. Absolutely.
Wonderful. So speaking of severity, you were saying that allergies can become more severe over time. What is it exactly that makes that severity? What, what you mentioned some certain cells?
Yeah. And this is where you really have to be followed by an allergist. You cannot assume that you're growing out of the allergy. Even though people say, oh yeah, for egg and milk, it's easy to grow out. It's actually less easy now. And you don't know. Each person's different. So you cannot go on just kind of percentages of the public. You have to, yourself, get tested.
Mm-hmm [affirmative].
So in general, anyone that has a food allergy can anaphylax, no matter what, given a dose, given if they have a virus, given if there are certain conditions. It can just change your threshold for reaction. So people should be super careful. Because if you have a food allergy, you have a 25% chance of getting another food allergy down the line.
Hm.
A different one. And then you also have a 25% chance of severe anaphylaxis at some point in your life. So you have to carry an Epi.
Mm-hmm [affirmative].
You really have- should carry two at all times. Because if one doesn't work, you have the second one right there. You should always use it within a minute.
Wow.
And that's important. But it is true that if you don't- if, if you don't have access to therapy, typically what will happen is, over time, if you get accidental ingestions of that food, it's kind of like it goes to your system and then you get- your food allergies start to rise. Whereas if you start to give therapy every day, it will decrease your chances of reaction. So that's good as well in terms of hope and promise of therapy.
But in general, what we're finding across the globe is that allergies are harder and harder to lose. And that people tend to sustain their food allergies. And then what we also found, and this was published by Ruchi Gupta and myself and her group with re- Christopher Warren, is that we never expected this, but adults get food allergies newly when they- when they're in adulthood. I have plenty of 40 year olds that, as patients, that said oh, I could eat shrimp when I was little but now I can't eat them because I've become allergic to them. So we're trying to understand why it is that people are becoming allergic. So that's- that, to me, is worrisome. That we need to predict who can become allergic in childhood as well as in adulthood.
Yeah. I was gonna ask about adults. That ha- that did actually happen to my brother. He's the first person I know in my family that had a food allergy. And he told me he became allergic to grapes. 'Cause I offered him a glass of wine and he was like, "Oh no. I can't have wine anymore. I can't-
Wow.
... I'm allergic to grapes." And I'm like, that is literally my worst nightmare. [laughs]
[laughs]
You know?
[crosstalk 00:15:50]
So, like, like, I- as you said, there's- we don't know how that- how that's happening?
We're trying to understand it because you can take identical twins with the same genetics and one becomes food allergic and the other one does not.
Wow.
So we published this work showing that their microbiome is different. And so we don't know which came first, the chicken or the egg. But importantly is that it looks like their gut bacteria are different. So maybe if people can take good intake of, uh, fermented foods and continue to really make sure they maintain good gut health with good fibers and good vegetables, that those are the twins that tend to not get the food allergy. But the other twin will get the food allergy in adulthood.
Not to say anything your brother did was wrong. I'm not saying that. But we are trying to look [crosstalk 00:16:41]-
We have very different diets. [laughs]
Okay. We are trying to look at those factors that-
Yeah.
... let adults become healthy versus those adults that get food allergy. There's also data to show that if you take a lot of chronic antacids, that changes how you digest food. And so people on chronic antacids can actually have an increased risk of food allergy later on in adulthood.
Fascinating. So is it allergy an immuno- like autoimmune issue? Like what-
Ah, great question. So we don't call it autoimmune 'cause you're not attacking against yourself.
Mm-hmm [affirmative].
But we call it an immune disease because it's mediated by this, what I call, the match that lights the fire. It's mediated by this one little molecule called IGE. And that little IGE, it literally looks like this, like my hand, and it binds to the food grabs it. And then, unfortunately, it, it sees it as foreign. It doesn't see it as food. And so it reacts in a way, like you would have a bee sting, to get rid of it. Or a parasite, get rid of it. So when it does that, it secretes lots of mucus and redness and itchiness. And so with that, it could go into double down mode, which can become dangerous and misdirected so within six minutes, someone's throat is closing.
So it's a really misdirected immune response. But it's for foreign items. And unfortunately, the way the body sees the food, for people with food allergies, the food is seen as foreign, not natural. And so that's why we need to start therapy and prevention to get the body to realize no, this is natural. This is what I should be using for nourishment.
Can you talk a little bit more about ... You ke- you've mentioned therapy a few times. What is- what is that?
Yeah. Luckily there's now an FDA-approved therapy for food allergy, specifically for peanut in children. We need to go a lot more and do it for all different types of foods, especially for children with- and adults with multiple food allergy. But be that as it may, what we call oral immuno-therapy, where you start really small and you go up and up, very carefully, and you basically build immune tolerance. You're building immune muscle. So it's like lifting weights. Every week you change your weight a little bit. And little by little you gain immune muscle to combat that allergy. So your body learns, literally it gets educated, to down regulate its allergy response.
And that's exciting. And it works really well. But because you're giving the same food that people are allergic to, you can have little reactions along the way. So you really should do it at a doctor's office with well trained individuals. But it is possible. And there's plenty of people in Oregon that are actually doing this, which is great.
But of course, with FPIES, you wouldn't wanna do it with FPIES.
Hm.
Because it can actually induce the FPIES. You have to be super careful. That's why the diagnosis is so important first before you decide the therapy. There are new drugs that are becoming available that are shots. And there's vaccines. So there's a lot of new companies that are developing therapies. So that's great. So there's a lot of hope and promise based on science that I hope you and your family will get to reap the benefits of.
That is- that is really awesome. You- earlier you mentioned that detergents can be a, a factor. And, and I've read a little bit of that science as well. Can you- can you go into that a little bit more?
Sure. You know what, what we've looked at is why is it that babies have more and more dry skin? We tried to- we first realized that dry skin, when the skin is irritated where the skin is broken, that can serve as a conduit, as a pathway by which the allergens from the air, even the smallest amount, can get into the skin. And just like a bee sting or a mosquito bite, when something enters into the skin that way, our body is get rid of that. So it makes it itchy. And then it starts to have this allergic pathway that gets activated. We call it the [alarmin 00:20:48] pathway.
So we knew that dry skin wasn't great, especially in babies. And then we tried to understand why is dry skin on the rise? Because in London, for example, 50% of babies have dry skin.
Hm.
And eczema. Like really irritated dry, raw skin. So we looked at this. And anywhere that touches the air in our body, so our gut, where we swallow, that's all touching the air. Our lungs touch the air. So anything that touches the air is lined with skin cells. So people talk about leaky gut. And I think that's a real biological principle. That same thing that we see in the outside of someone's skin might be happening inside in their skin as well.
So we realize that detergents are so powerful and they're meant to get things clean. But in the meantime, a lot of these detergents have enzymes or chemicals that can actually break down the skin.
Mm-hmm [affirmative].
And in babies, it doesn't take a lot to break down their skin, 'cause it's even more sensitive. And so with that we realized that those detergents actually are irritants for the baby. And so now that there are many products out there to be able to give people more of a green earth, those are the same chemicals that are safer for babies.
Mm-hmm [affirmative].
Because they don't damage the earth. And used in very low concentrations, they don't damage the baby's skin. But I would say, to try to avoid harsh soaps. To try to- you don't have to bathe the baby as much as people think you do because what we're finding is that those detergents, when they lie on top of the skin, they can really be a problem. And, of course, now your dishwasher detergent, it's so concentrated, that it takes two extra rinse cycles to get rid of every single piece of detergent on that plate. So we think that those detergents are also probably irritating and bothering the gut.
Interesting.
So these detergents are everywhere. And if we can try to convince the manufacturers to be lighter on the detergent, to- you can make detergents that aren't as concentrated. And you can still get a good effect.
You know what they're doing as well? A- the- I know the- to- also to be environmentally friendly, the dishwashers laws, [laughs] like there's like the DE- the Department of Energy, is requiring less and less water to be used.
Yes. Exactly!
I'm having this issue. I was- 'cause I was- I'm very sensitive to smell. And my- I just recently got a new house and had a new dishwasher and a new, uh, washing machine. And I was s- appalled at this smell from the detergents. And I couldn't get it off. And I- I was like calling the- calling the repair [laughing] guys. I'm like, "What's going on?"
And they're like, "Actually, there's nothing we can do. You have to just run and extra rinse cycle if you want things to get clean. Because they're- this is just- this is just the law. We- we're not allowed to ... " You know, they're- they're not allowed to-
Right.
... have as much water in the- in the machines.
That- that's exactly right. So if you're trying to save the earth but, in the meantime, these detergents are so concentrated. And chemical sensitivities, like what you suffer from in terms of the smell, are becoming more and more frequent. And so you have this wonderful sense when there's some chemical around. Some people don't have that sense. But it really bothers you. People get headaches and they can go on and get other reactions. So we need to understand more about that disease in and of itself.
But with that, I would tell people, you know, try to use less detergent. Use one tenth of what you think you might need. 'Cause you-
Mm-hmm [affirmative].
... probably don't. And then good old fashioned baking soda and vinegar and things like that still work, right? And they're not as toxic to the environment. And definitely not as toxic to the skin. So for as much as we can go back to ways that don't require bad, synthetic chemicals, I think we probably should.
That's amazing. So it's, it's really fascinating that just touching the skin with a food- so, so let's ... There's soap on the skin and it breaks down the barrier. Food could actually enter through the skin and then your body understandably is like, "This can't be food. It's coming through the skin. Food doesn't come in this way."
[crosstalk 00:25:13] That's right.
And it attacks. And-
You got- you've got it. You totally get it.
And then the dishwasher detergent is what is happening in the gut. It can break down that barrier-
Yeah.
... and let thing- and create more leaky gut.
Exactly. Whereas, you know, what we like to say is through the skin, allergies can begin. Through the gut, allergies can stay quiet. But, but, but if your gut is irritated, if your gut is broken down, it also serves as a pathway by which you can activate allergy.
That is fascinating. Oh gosh. [laughs] It's brutal. 'Cause there's already so much dishwashing to do. I always make sure that things get hand washed and-
Sure.
... [crosstalk 00:25:53] free and clear soaps and whatnot. But, you know, w- we do have a lot of glass. And glass does tend to go through the dishwasher. But it's like, you know-
Yes.
... it just ends up with kids, they just use so many [laughing] dishes.
Yes.
And especially if you're- have a pump or bottles or anything and you've got like-
[crosstalk 00:26:08]
... so many little parts to clean, it's just like so much work.
Oh, absolutely. So if- definitely, you know, the dishwasher's nice thing. But if you can just remember to try to- if you're pouring in your detergent or if you're using a tablet, just break it.
Mm-hmm [affirmative].
You don't need as much as you think.
And I imagine using those, like, short intense cycles where they probably use less, less water is probably-
Yes.
... not the best for maybe kids as well.
Yeah. Just the same thing for longer ... So I, I think most importantly is we're learning. We don't know all the answers yet. And I think parents, for what we can learn, we should pass it on to help parents do their best. But I don't want parents to go through a guilt trip because we already worry about so many things.
Yeah. [crosstalk 00:26:52]
So, as much as we can try to help our kids and know that, okay, we're doing the best we can with what-
Yeah.
... we have. Yeah. And enjoy life. Yeah.
[laughs] Try. I'm curious what is the relationship between food allergies and non food allergies? Like, for instance, like-
Mm.
... seasonal, hay fever. Like if you're- if you have that, are you more likely to have food allergies or how does that work?
Excellent question. So they are connected. We see a lot of people that initially have dry skin. Then they can get food allergies. And then they can get, like, sneezing and allergic rhinitis. Or hay fever. And then they can get asthma. We call it the atopic march. Like one thing leads to the other, A to B. Which is basically allergy.
But importantly, any one person some things happen along, but oftentimes, about 70% of the time, people with food allergies will have another type of allergy. And why is that? Well, it's really interesting. So if you're allergic to tree nuts, right, tree nuts are, in and of themselves, nuts from a tree. And you had to have that tree get pollinated in order for the tree to make the nut. We know that pollen has to happen. And so when that pollen comes to the tree and the tree makes the nuts, so the pollen comes from the male tree and the female tree has the nut and the female makes the nut, a little bit of that pollen is in the nut. Right? It's part of the DNA, the genetic transfer. So a lot of nuts have bits of their pieces of protein that are shared with pollens.
Hm.
And pollen, pollen like to birch, to ragweed, to grasses, there's bits of that protein which is very similar in tree nuts. So people with tree nut allergies oftentimes will have pollen allergies to birch or ragweed or other grasses.
So when we know that a baby has tree nut allergies, we'll oftentimes ask the parent, okay, watch out for environmental pollen allergies. It's not always the case that these two things go together. But typically the biology has shown us that you can get cross reactivity.
That is fascinating. You know, I'm curious ... So with my ... So let's- let's start with my, my oldest. We had a nanny at the time and she actually told me that before we had the, like, full blown allergic reaction to the egg, she said that Zelda had the, the skin reaction where it would just turn a little red on her skin. And I- I, you know, I- to, to the nanny's credit, uh, she was right. And I, I wasn't as- I didn't pay enough attention to that. And I was just like, okay, well, we'll just keep giving her eggs anyway. And [laughs] it's gonna- I think we need to keep doing it and keep exposing. And I, I worry that- you know, in retrospect that might have been a bad choice [laughing] since we ended up in the hospital.
But I'm curious, if you do see something like that, like if, um ... And actually, now I just noticed my, my youngest daughter, um, when I gave her almond butter the other day, you know, we've been pretty consistent with giving it to her. But she didn't have a reac- a, a full allergic reaction but her armpits and her elbows and her knees all turned a little red.
Mm-hmm [affirmative].
And, and it- and it made me pause. And I'm wondering if you see something like that, what- what's the best course of action? Should we just go straight to the allergist? Or should we stop giving it to her? Should we [laughing]-
Yeah. It's really hard. I see a lot of people ... There've been studies where they say, now to what extent is a rash, especially with a food, if you see it with a food, it's only associated about 5% of the time. So one out of 20 times will it actually be due to a food reaction. And it has to be within two hours. It has to be red and swollen and itchy.
Hm.
If it's not, then you probably can't say that it's the food that the person ate.
I feel pretty confident that this is almonds. 'Cause I'm a scientist. And the way I did it was at- you know, sorry. The first time I saw it I was like, that's weird. 'Cause she has the same exact breakfast every morning. And it was immediately after breakfast.
Oh, okay.
And, and- and it was- I took pictures, it was like so strange.
[crosstalk 00:31:07]
'Cause it was a very- not- it wasn't like she was hot or something like that-
Right, right.
It was very specific-
No, you were methodical. You're a scientist.
[crosstalk 00:31:13]
Exactly. That's great.
But then I went and I looked at the almond butter and I- to my shock, I actually thought I had bought an olive butter- almond butter that was just almonds. But [inaudible 00:31:21] in this one-
Yeah.
... palm oil and some other stuff.
Mm-hmm [affirmative].
And I was like oh, oh, oh, oh. So I just threw that one away. And then I ordered some pure almond butter-
Yeah.
... [crosstalk 00:31:29] it's like almonds and salt. And then I gave it to her and the exact same thing happened.
Okay. Well [crosstalk 00:31:34]-
Fairly confident it's the almond. [laughs]
Yeah. You ruled it in.
Yeah.
Almond also is associated with pollen allergies. So the- that, that is the case where if you know that it's happened in two hours, if you've seen [inaudible 00:31:45] especially with the food, luckily not many children less than two years of age will actually anaphylax. Like it- it's all on the skin.
Mm-hmm [affirmative].
So then you should bring them to an allergist to get full testing. And it's appropriate. And you did the right thing. But it is hard because a lot of rashes can happen. Like cinnamon and pineapple, they're, they're so irritating to the skin that they'll just cause that red reaction but it won't be an allergy.
Mm-hmm [affirmative].
But I would always be conservative. Like you can't assume it's not an allergy.
Sure.
Go to the allergist. Go to your pediatrician. Get tested. And then go from there. But regular feeding of the food does help decrease the risk of allergy. But, but if they do have red skin or irritations or vomiting within two hours, go to an allergist. Absolutely.
Okay. Let's talk about, uh, SpoonfulONE. [laughs] So-
Oh sure.
So you have developed this product and it's- my understanding is it's designed for infants, yeah? And, um-
Exactly.
... and it's designed to do kind of what you're describing to, to give a, a suite of common allergens in super low doses every single day for how long?
Well, the, the- that's a great question. So we developed SpoonfulONE for Stanford. I actually was incentivized because I kept seeing a lot of patients to treat them with food allergies. So their mothers were coming to me with, you know, the- their second child and saying, "How can I prevent my second child from getting food allergies?" 'Cause they've already lived through one that had [crosstalk 00:33:20] a disabling food allergy. And it's very hard. I totally feel for the parents.
So I said, okay, I've gotta design something to not just prevent peanut allergies. 'Cause the data was out there to try to prevent peanut allergies thanks to my colleague Gideon Lack in London. I was like, we gotta do better. We gotta do all proteins. And I'm a biochemist by training. So I said, okay, let's try to mix it all together. All the 15 major food proteins that exist in the world. And let's- I had no idea we could actually create a product out of it. I just wanted to do what's best for my patients and their families 'cause they were asking.
So I designed this study. And then we started feeding their babies, between four and six months of age, with this really small amount of protein. And we had a control group as well. And so with that, we gave it daily. I didn't give it every other day. I gave it daily. And the parents came in every two weeks to check up on their children. And so then when we saw their skin tests were becoming clearer or they weren't developing any allergies compared to the control, we said, oh gosh, you know, we need to do something about this. So then we patented it. Stanford then luckily started this company with us called Before Brands. And then we started the SpoonfulONE product.
And so with that product, it comes in- with 15 foods in one packet. And it's made in, like you said, a sweet, like different flavors of puffs, of crackers. And mix-ins. I mean, it's my dream to be able to prevent a disease. And I work with these incredibly wonderful, innovative scientists that help make it flavorful for children.
[laughs]
And I feel very lucky to work with Nestle, to work with Before Brands to take this global. So we tried to make it really convenient for moms so- and dads so that they just feed it once a day in these different types of products. And yes, what we saw in our study was that all you need is a very small amount of food every day and that will start to get the gut used to those foods and not see them as foreign.
Mm-hmm [affirmative].
And the data that we have so far is from a year of feeding. And we understand people are gonna forget to give it every so often. And that was okay. But after a year of feeding, we did something called a food challenge. And we showed that it worked in the-
Mm.
... children that got the mixture for all the foods that we were making sure they could eat. So that's good. Most importantly is they diversified their diet. Like they were able to eat table food and that's what was exciting to us. They didn't have to live in fear.
Gosh, that's amazing. And so I- that, that product specifically is, is, is you're- I assume you're supposed to start it between four and six months?
Yeah. We say to start between four and six months of age to be consistent with the HHF guidelines. 'Cause it doesn't replace breastfeeding. Because it's such a small amount. It's only 10 calories. So it's this little tiny supplement. And so you could still breastfeed and feed this to your baby at four to six months of age. But of course you can start after four to six months of age too. There's nothing that excludes you from doing that. We wanna make it convenient and easy and, and fun for parents.
Well, that seems like such a no brainer. I feel like if I have another kid [laughing], I would definitely start that and, and stick to it 'cause it sounds like such an easy and effective option. And I'm just curious I- it sounds like what- would something like that work for an older person who is already developed allergies? I mean, is this- is that kind of like the therapy that you're- you guys do when-
[crosstalk 00:36:50]
Not that anybody should do that at home without their-
Exactly.
But-
Exactly. Of course. The food product has a definitive, with high integrity, protein mixture in it, right? We know what we're gonna get there.
Mm-hmm [affirmative].
[crosstalk 00:37:03] get to scoop out peanut butter, chop up nuts. Like we know what we're getting in there. And it-
Mm-hmm [affirmative].
... has wheat, it has shrimp, it has sesame. It has all the major food allergies throughout the world. And there are some doctors that are deciding to use it as a way to desensitize their patients that already have food allergy. Because there's a known quantity in the product. We can't espouse that. We can't say that 'cause it's, it's not for that. But what's important is to know that there is a company that is making a product to be able to have a mixture so that people can desensitize themselves with a well-known amount of protein with foods, with m- multiple foods. So that's good. So that therapy will be coming. It's already in phase two trials. So that's, that's ex- excellent. So that people can see that we're getting there.
That is amazing. Well, thank you so much for all the work that you do-
Thank you.
I, I mean, this is- I mean, it's such a terrifying thing. I know for so many parents. And especially- I mean, to see a, a young child just be hospitalized and have to go through this super scary, that you have to stab ... I mean, you know, my husband [crosstalk 00:38:14] had to stab [laughing] my daughter- six month old with an Epi-pen. And it's li- it's so scary. And, um-
Yeah, yeah.
... you know, to- the- so much progress has been made and that you're helping people in this way is really, truly remarkable. So thank you for that and for sharing your wisdom with us today.
Oh my gosh. Well, thank you for sharing your wisdom. And, and, and for having me here. And it takes a team effort. And that's exactly what we all are about. And we're inspired by patients and stories of parents like you. So thank you. And I hope that we'll continue our progress for sure.
And what's- do you have any more resources for people? I mean, you mentioned the, the two books, which I will definitely link to my show notes. Is there anything else for parents who are concerned about these things?
Yes. There's a great group called FARE, Food Allergy Research Education. You can go on their website and there's tons of resources there. The NIH, the National Institutes of Health, also has a great webpage for food allergy parents. And the FDA also has great resources for food allergy in terms of labeling laws. But they also just convened a symposium for food allergy parents.
Amazing.
So we really wanna commend these wonderful institutions, nonprofit and government based institutions, for helping out and spread the word about food allergy.
Amazing. Well Kari, thank you so much-
Yeah.
... and I hope everybody learns a lot from you.
Thank you. Thank you for having me on the show.
Thank you so much for listening today and I hope you learned a lot from my discussion with Dr. Nadeau. If you found it useful or know someone who might, please share it with them, or on social media. Word of mouth is the best way for this show to grow and continue to get amazing guests like Kari. You can even tag me on Instagram. If you do, I am @DaryaRose. And if you follow me over there, you can see the hilarious antics of me trying to get my toddlers to eat beets and mushrooms and all the other vegetables [laughing] that I insist that they try to eat. Uh, spoiler alert. I usually succeed. But not without many hilarious refusals.
Um, thank you so much for joining me today and I will see you next time.
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