I welcome back Dr. Shreya Patel, an Allergist and Immunologist. We spoke on episode 7 about Eczema 101 and she’s back to talk all about FOOD ALLERGIES and FPIES.

What are the most common allergenic foods?
Can children outgrow food allergies?
When can you introduce allergenic foods?
What’s the deal on allergenic food programs like Spoonful One, Ready Set Food, and Lil’ Mixins?
What is FPIES? And what are the signs?

00;00;05;28 – 00;00;37;17

Dr. Mona

Hey, everyone. Welcome to the PedsDocTalk podcast. I’m your host, Doctor Mona, where each week I hope to educate and inspire you in your journey through parenthood with information on your most common concerns as a parent and interviews with fellow parents and experts in the field. My hope is you leave each week feeling more educated, confident and empowered in the decisions you make for your child.

 

00;00;37;20 – 00;00;57;14

Dr. Mona

Hello and welcome to this episode. Okay, this is an episode that so many of you have been DMing me about and commenting about, because you really want to know about food allergies. And I am so happy to have doctor Shreya Patel, who’s back again. We actually did an eczema 101 episode that was episode seven and she’s back again.

 

00;00;57;23 – 00;01;01;09

Dr. Mona

Talking about food allergies. Welcome, Doctor Patel.

 

00;01;01;11 – 00;01;06;21

Dr. Shreya Patel

Hi, Mona. Hi, everyone. I’m so excited to be back to talk all things food allergies today.

 

00;01;06;23 – 00;01;33;10

Dr. Mona

And doctor Shreya Patel, she’s a, allergist immunologist. As you guys probably know, if you listen to eczema 101. And so we’re going to be talking again all about food allergies. Introduction of food allergies and just some of the basic kind of statistics on it. We hope this episode really provides you some reassurance. We know that a lot of people and my patients who are patients are very scared of introducing allergenic foods.

 

00;01;33;15 – 00;01;54;18

Dr. Mona

We’re going to go over, obviously, signs and symptoms, and we’re also going to be talking about f pies, which is a condition that I don’t think a lot of families know about. So first of all, Doctor Patel or Shreya, we’re going to go first name basis here. Tell me just basically the statistics, you know, for food allergies in general, you know, obviously in the pediatric population.

 

00;01;54;21 – 00;02;16;17

Dr. Shreya Patel

Yeah. So kind of based on literature, national surveys, the prevalence of food allergies is kind of between they say about 7 to 10% of the population have specifically for children. It’s a little bit on the lower end of that 7 to 10%. But it’s if you think about it, 1 in 13 kids. So when you think about classroom sizes, that’s about 1 to 2 kids for every classroom, if you think about.

 

00;02;16;17 – 00;02;36;15

Dr. Shreya Patel

So that’s actually pretty high. And what’s interesting when we report prevalence in food allergies is self-reported prevalence is higher than the actual prevalence. So self-reported prevalence is closer to 13 to 14%. And remember I said the actual prevalence is 7 to 10%. So I think that’s interesting because more people think they have food allergies than they actually do.

 

00;02;36;15 – 00;02;46;20

Dr. Shreya Patel

So that kind of stresses the importance of really talking to your doctor, seeing a specialist, finding out is it really a food allergy, or are you avoiding a food for another reason, or are you missing something else? So I thought that was interesting.

 

00;02;46;23 – 00;02;53;17

Dr. Mona

So is it more that maybe, families or patients think that a symptom is an allergy, when in reality it’s not?

 

00;02;53;19 – 00;03;02;02

Dr. Shreya Patel

Yes, exactly. Or it could be not a real food allergy, but something else, like an intolerance or something, which, of course, we’re going to get into I think a little bit later.

 

00;03;02;04 – 00;03;16;12

Dr. Mona

Awesome. And in terms of, you know, many families will say like, you know, I have a family history. Is it always a family history of allergies that predisposes someone to have a food allergy, or can someone just develop it without any family history?

 

00;03;16;15 – 00;03;41;19

Dr. Shreya Patel

Yes, I like to say that children, they’re not born with food allergies. They’re not born with allergies. What they’re born with, though, is a genetic predisposition to develop allergies in general. So to answer your question, you have to have allergies, in the family. No. And also, you don’t have to have food allergies, which I think is interesting because I have patients who come in, you know, and they tell me, I’ve been avoiding seafood my whole life because my mom’s allergic to shrimp.

 

00;03;41;22 – 00;04;01;26

Dr. Shreya Patel

Right. And that’s not necessarily how it works, actually. So your mom can be allergic to shrimp or seafood, and you might now present with allergies that are totally different, like seasonal allergies or asthma. Eczema. Now you kind of had this as, allergy, predisposition because of your genetics. But it doesn’t have to be the same kind of allergy.

 

00;04;01;26 – 00;04;17;16

Dr. Shreya Patel

Okay. Now to address the whole issue of children who don’t have a family history. So why is that? Well, we know genetics play a role in food allergies, but also environment plays a role too. There’s like an interplay between the two. Now, the million dollar question in the food allergy world is why do some people have food allergies and others don’t?

 

00;04;17;16 – 00;04;36;27

Dr. Shreya Patel

We don’t know all the full answers to that quite yet. But we do know that there is, a role that both genetics as well as environment plays. So, based on some of the surveys and the, and the studies that have been done, they say that about 70% of children with food allergies have a family history, but that leaves about 30% that don’t.

 

00;04;36;27 – 00;04;40;12

Dr. Shreya Patel

Right. So, it’s not necessary that you have it.

 

00;04;40;14 – 00;04;50;21

Dr. Mona

And you kind of mentioned that there’s obviously there’s so much to learn in the food allergy world. In allergy world. Do you do you feel like food allergies are more prevalent now than, say, 20 years ago?

 

00;04;50;23 – 00;05;12;06

Dr. Shreya Patel

Yeah, I do, and actually so if you look at the CDC report, they, reported that the prevalence of food allergy in children increased by about 50% between 1997 and 2011. That’s pretty high. Peanut and Trina with that, that have tripled in incidence. So, it’s definitely on the uprise now. Again, another important question. The food allergy world is why?

 

00;05;12;06 – 00;05;29;21

Dr. Shreya Patel

Why is that? Why are food allergies so much more prevalent? So I think that there are a lot of theories out there, but the two most widely accepted ones are going to be the hygiene hypothesis. And then you have the dual allergen exposure hypothesis. Okay. So let’s start with the hygiene hypothesis. I think that’s the one that at least everybody’s heard of.

 

00;05;29;21 – 00;05;50;20

Dr. Shreya Patel

Kind of knows a little bit about it. So the hygiene hypothesis suggests that early exposure to microbes or, you know, microorganisms in your environment, it helps train our immune systems and also helps build our gut microbiome. We talked about this a little bit in the eczema episode, right. The gut microbiome. What is that? That’s basically the normal healthy bugs in our GI system okay.

 

00;05;50;23 – 00;06;13;12

Dr. Shreya Patel

So if you lack this initial exposure then you can actually develop a dysbiosis or an imbalance in this, in the microbiome. And then this can lead to actual sensitization in your immune system rather than tolerance. So what does that mean? What does sensitization mean. Right. So so take a child for example okay. They’re introduced to dairy okay.

 

00;06;13;12 – 00;06;35;27

Dr. Shreya Patel

In their diet now instead of the immune system tolerating the dairy like it should or like in most people it does. The immune system detects it as foreign for some reason okay. And it develops an antibody against the milk. So this antibody is the IgG antibody or immunoglobulin E. And that’s the allergic antibody okay. And the more and more this child is then introduced to dairy.

 

00;06;36;02 – 00;06;54;06

Dr. Shreya Patel

Now in some children it’s right away versus in some children it takes more exposure. But your body makes more immunoglobulin or more antibody against it. And eventually this can then turn into a clinical allergy. And this is when the child is, you know, then exposed to the dairy and now has, an actual clinical allergy, like an allergic reaction.

 

00;06;54;06 – 00;07;24;00

Dr. Shreya Patel

Okay. So, the basis of this theory of the hygiene hypothesis came from really comparing children in the developing world to children in developed countries. Okay, the initial hypothesis is that living in dirtier environments would result in more allergies and more asthma. But now we know that that’s actually not the case. That’s the opposite. Right. That this initial exposure to a quote unquote dirty environment is actually helping to train your immune system, and it’s protective against developing allergies.

 

00;07;24;03 – 00;07;45;03

Dr. Shreya Patel

So that’s kind of the hygiene hypothesis. Okay. Now the second hypothesis is a little bit more simpler. But that’s the dual allergen hypothesis okay. And what this one suggests is early oral exposure to allergenic foods is protective. And that helps train your immune system and helps you tolerate it so you develop less allergies if you start allergenic foods earlier.

 

00;07;45;16 – 00;08;02;14

Dr. Shreya Patel

But the dual part of that is that early exposure through the skin can actually increase your risk of developing food allergies. And so again, that stresses the importance of, strengthening that skin barrier, right. In children with eczema.

 

00;08;02;17 – 00;08;20;21

Dr. Mona

Yeah. So I agree, you know, the I also kind of have always thought about the hygiene hypothesis and a lot of it has to do with, the research that’s done about dogs. Right. Like pets in the home can obviously reduce the incidence of allergies. But it’s not always that anyone who has a pet, it automatically equates to that child not having allergies.

 

00;08;20;21 – 00;08;27;19

Dr. Mona

There’s obviously multiple things that go into a child’s gut microbiome. And you know, obviously immune system. Right?

 

00;08;27;21 – 00;08;53;04

Dr. Shreya Patel

Right. Exactly. And remember it’s genetics too. It’s the environment too. So yeah, you have the child that grows up in a home with animals who is now protected against developing that allergy because they were exposed early on. Their immune system is trained to it. And so now, you know, they’re not going to develop an allergy. But then you have the opposite, where you have a child who, comes to see me for the first time when they’re 4 or 5, they have a dog in the home, and they’re severely limited to the dog, and that’s why they’re coming to see me, you know?

 

00;08;53;04 – 00;09;00;16

Dr. Shreya Patel

So so there’s just so many things to kind of think about, that, that are going on that predispose this child to having allergies.

 

00;09;00;19 – 00;09;24;22

Dr. Mona

And, you know, I think I spoke about it with you on the eczema episode. But of all the things in pediatrics, GI research and allergy immunology research, research is very fascinating to me. Meaning, obviously the the benefits of probiotics, like obviously all this kind of stuff that’s going to continue to come out. Right. How we can externally or artificially impact our immune system.

 

00;09;24;22 – 00;09;41;02

Dr. Mona

Right. And right now there’s just not a lot of data. Right? Because I think parents are always like, well, how can I help my child’s immune system, especially in like, this pandemic? And really, there’s really no knowns known, way right now that we can say, okay, do this and you’re going to have an amazing immune system, correct?

 

00;09;41;05 – 00;10;00;12

Dr. Shreya Patel

Correct. I mean, it’s all anecdotal or you’ll hear people all the time saying, I take, you know, x, y, z, whether it be an either elderberry, something that people talk about all the time, you know, and like they’re just really isn’t enough literature out there that definitely supports it, that it actually, you know, strengthens your immune system. Really.

 

00;10;00;12 – 00;10;04;13

Dr. Shreya Patel

There’s nothing like that. I mean, the only thing we know really is vaccinations. That’s that’s it.

 

00;10;04;15 – 00;10;27;11

Dr. Mona

Yeah. I mean, I’m definitely intrigued. And I love I love making you as having you as a friend now because any of the new research that comes out, I’m going to be like, sure, you need to let me know because it is an area of such research, especially in pediatrics. So that’s awesome. Now the next thing I wanted to ask, obviously, is there are many things that children can be allergic to in terms of food, but what are the most common foods that cause food allergies in children?

 

00;10;27;13 – 00;10;48;21

Dr. Shreya Patel

Yeah. So, the top eight food allergens are really going to be milk, egg, wheat, soy, peanut, tree nuts, shellfish and fish. Okay. Those are going to be your topic. So that’s the most common ones. Now remember Peanut and Trina are two totally different things. Peanut is a legume and tree nuts. Are you know, just like in, in its name, nuts that grow on trees.

 

00;10;48;21 – 00;11;10;19

Dr. Shreya Patel

So tree nuts include walnut, pecan, cashew, pistachio, almond, hazelnut. Brazil nut is another one as well. Now, just because you’re allergic to one does not necessarily mean that you’re allergic to the other, meaning peanut and Trina. But there is about a 30% chance, you know, peanut allergic children have a 30% chance of also being allergic to peanuts.

 

00;11;11;03 – 00;11;30;23

Dr. Shreya Patel

But not necessarily always the case. The other thing, same thing with fish and shellfish. Know that those are different as well. Fish is going to be like tuna, salmon, flounder. Shellfish is going to be your shrimp, crab, lobster. So just because you’re allergic to one doesn’t necessarily mean you’re allergic to the other. Sesame is unofficially kind of considered right now the ninth most common food allergen.

 

00;11;30;29 – 00;11;38;12

Dr. Shreya Patel

But remember that the seed sesame seed, it’s not a nut. But, but that’s still that’s still pretty up there. And it’s pretty common.

 

00;11;38;14 – 00;11;48;21

Dr. Mona

And can kids of all of those, are there some that kids are more likely to outgrow, or are all of them pretty much lifelong? What are the what is kind of the data research on that?

 

00;11;48;23 – 00;12;10;19

Dr. Shreya Patel

Yeah, it definitely depends on the food. So milk, egg, wheat and soy those are the ones I usually think kids are more likely to grow out of. I typically tell parents that your child has about an 80 to 85% chance of growing out of those from milk, egg, and soy by the time they’re in their teenage years. So that’s a really good chance, you know, a growing out of it.

 

00;12;10;29 – 00;12;29;00

Dr. Shreya Patel

Peanut, Trina and seafood, those are unfortunately, the ones that are going to likely be more lifelong allergens. Only about 20% of people are likely to go out of peanut. 14% Trina, and only about 5% seafood, which is why adults have the most common food allergy in adults is seafood.

 

00;12;29;02 – 00;12;48;28

Dr. Mona

And in terms of. So, I think the big question that everyone has every parent is what are the signs and symptoms? And I think this is might be a big discussion because, you know, there we’ll talk about, you know, introduction of these actual foods and foods in general. But what would be a symptom of a food allergy? And you know, obviously the timing and also what would be the difference?

 

00;12;48;28 – 00;12;56;29

Dr. Mona

You know, you can get into this between a intolerance of a food, maybe if you can see that on an exam versus an actual allergy.

 

00;12;57;02 – 00;13;13;29

Dr. Shreya Patel

Yeah. So if you’re allergic to a food, right, and you have exposure to actually your child’s allergic to dairy and you know, they have the some sort of exposure to dairy, usually your symptoms are going to start what we call immediate, you know, it’s immediate reaction. So within the first 30 minutes to an hour are usually going to see some sort of symptoms.

 

00;13;14;02 – 00;13;31;08

Dr. Shreya Patel

So what are the symptoms. They can be really anywhere in your body okay. What I like to do is kind of break it up into systems, like for example, the skin, if the skin is affected. I think that that is actually the most common. I was going to say. I think that’s what parents are post report as the most common, but that’s because it is the most common organ usually involved.

 

00;13;31;08 – 00;13;45;20

Dr. Shreya Patel

So that’s going to be your hives. And also swelling. Swelling is all part of the skin system okay. So when people come in and they say my child had hives all over the place and then a swollen like, right, that’s the skin, then you can also just have it anywhere itching on the skin, itching and throw it.

 

00;13;45;21 – 00;14;13;01

Dr. Shreya Patel

So people say like the roof of the mouth itches. Itching really anywhere. Okay. If the respiratory system is involved, you’ll have coughing, trouble breathing, even the subtle, throat clearing that is also kind of the respiratory system being involved. You’d be surprised. Actually. I’ve had these patients have anaphylaxis in my office, and one of the only, one of the main symptoms that they have is that their voice just changes or they have like that, and then their voice becomes hoarse.

 

00;14;13;01 – 00;14;31;19

Dr. Shreya Patel

And that’s really the rest of the system being involved as well as probably, you know, some swelling in the throat. You can also have lightheadedness, your blood pressure could drop. And then remember the GI system, the GI system is important. A lot of people forget that vomiting and diarrhea can actually be a sign of having an allergic reaction.

 

00;14;31;22 – 00;14;56;16

Dr. Shreya Patel

Some patients will even report to me that they have less sense of impending doom. And that’s when you really, are probably dealing with a more serious allergic reaction. Like I said before, you’re going to have these more immediate rather than delayed. So the delayed reactions are rare. And food allergies. Okay. Have I seen it? Yes, I’ve actually done food challenges in my office and they’re totally fine for four hours of observation.

 

00;14;56;16 – 00;15;19;14

Dr. Shreya Patel

And then they call me an hour after they go home. And now the eye is full or they have hives. So kind of happen. Yes, but it’s definitely more where you’re usually going to see it more immediately in the first, like I said, hour. You can have something called a biphasic reaction where you have the initial reaction to the culprit allergen and then, you know, you’re treated, whether it’s the EpiPen, you know, in a histamines, whatever you recover.

 

00;15;19;14 – 00;15;38;24

Dr. Shreya Patel

And then anywhere from like 4 to 24 hours later, you have this second reaction. It’s still the, part of the first, episode. So you don’t necessarily call it a delayed reaction, but it’s a like a biphasic reaction. Part of the first, allergic reaction. And then go ahead. Sorry.

 

00;15;39;05 – 00;16;02;21

Dr. Mona

No. And then I was going to ask because you were saying about the initial versus the, the, the delayed response being a little bit more rare, one of the most common, I think, misconceptions or not misconceptions, but, there’s no consensus on this is how many days you need to keep in between introduction of foods. Is there an official recommendation, or is this more of like a, just stall or some like basically how someone wants to practice?

 

00;16;02;23 – 00;16;28;02

Dr. Shreya Patel

There’s not an official recommendation, but but most I think pediatricians and allergist will say at least wait three days between, introduction of foods. And that’s because, you know, we kind of talked a little bit about the sensitization, right? That sensitization process you’re exposed to a food for the first time. Your body starts making that antibody if it’s going to you know, in some they just tolerate it and others it, it starts making this IgG allergic antibody against the food.

 

00;16;28;04 – 00;16;42;09

Dr. Shreya Patel

And then if upon re exposure they need to have a reaction at first time. But then upon a re exposure maybe the second day they need a little bit more Ige. And then by the third day now there’s enough that they’re actually going to have a clinical reaction. That’s what we usually say about three days to leave in between.

 

00;16;42;09 – 00;17;03;04

Dr. Shreya Patel

There’s no official recommendation. But I usually say wait, you know. And then the other thing is if you, it’s easier to identify what caused it versus then you’re coming in and you’re like, yeah, these are the five different foods that my child eat for the first time over the last three days. You know, just easier to identify than even for the doctor what actually caused the the problem.

 

00;17;03;06 – 00;17;20;03

Dr. Mona

And there may not be, concrete answer for this, but is there is there a number of exposures? Just say a mom gives their their child peanut butter or like, peanut butter powder, and they’ve exposed their child to that. Now for, you know, seven times. Eight times. Is it safe to say that they now have no allergy?

 

00;17;20;03 – 00;17;25;15

Dr. Mona

Is there a number of exposures that will tell us that? Oh, well, maybe we’re in the clear or. No.

 

00;17;25;18 – 00;17;40;20

Dr. Shreya Patel

No, there’s no number. I would say the more times they’ve had it. Yeah. You’re you’re less likely to ever develop an allergy. But I mean, there’s even adult onset food allergies, if you think about that, someone has been eating seafood their whole entire life, all of a sudden comes in and now they’re allergic. So no, you’re really never safe from it.

 

00;17;41;09 – 00;17;48;19

Dr. Shreya Patel

But it’s just it’s it’s more likely that you will tolerate it after you’ve had it, you know, a few days in a row.

 

00;17;48;21 – 00;18;06;07

Dr. Mona

And so you obviously talked about the, the symptoms. And you went through beautifully with all the different systems. So what should a parent do if they are concerned based on the symptoms. And what I’m asking is more, you know, is this worthy of just a phone call to the pediatrician? Can they treat it at home without calling a pediatrician?

 

00;18;06;07 – 00;18;14;07

Dr. Mona

Do they need to go to the E.R. if you can? Kind of, you know, in a nutshell, kind of say, you know, what your recommendations would be if someone’s concerned about their child having a food allergy.

 

00;18;14;09 – 00;18;31;08

Dr. Shreya Patel

Yeah. So I think that a lot of that depends on whether it’s a known food allergy and how comfortable the family is, really. So first of all, if it’s not a known food allergy, I would say any sort of reaction, you would definitely call it call your pediatrician, especially if it’s mild. Can we kind of talk a little bit about, what those symptoms are?

 

00;18;31;08 – 00;18;48;13

Dr. Shreya Patel

And I’ll go into what what I deem mild versus more severe. But, you know, when in doubt, always call your doctor. And the thing is, is if you don’t if the child doesn’t have a known food allergy, then you may not be prepared with the right medications, whether it be antihistamines, you probably most definitely don’t have an EpiPen at home, you know?

 

00;18;48;13 – 00;19;04;05

Dr. Shreya Patel

So so definitely you want to be calling your doctor at that point. Okay. So mild versus severe, what are you going to call your doctor versus when are you going to go to the emergency room? So we kind of talked about the different systems that are involved. Right. So usually when it’s deemed a milder reaction you’re talking one system involved okay.

 

00;19;04;05 – 00;19;23;05

Dr. Shreya Patel

So your child is allergic to dairy. They may have been exposed to a little bit of dairy, whether it be cross-contamination or actually, you know, just eat a piece of cheese or something like that. And now they have hives. Okay. Otherwise your child’s acting fine. Just a little bit itchy, maybe, then, you know, I would say you could treat if this is a known allergy, you already have a plan.

 

00;19;23;05 – 00;19;42;20

Dr. Shreya Patel

With your doctor in place, you potentially already have an allergist, and you could potentially just treat with an antihistamine and call your doctor. Okay, now, when we’re talking about one system involved, but it’s severe okay. So you don’t have a rash. There’s no swelling or anything. And the only thing that’s involved is the respiratory system, the lungs.

 

00;19;42;20 – 00;20;08;19

Dr. Shreya Patel

Right. And but it’s not just a little cough, it’s that they can’t breathe or there’s swelling, but it’s swelling of the throat. You know, anything like that? Of course. Even if it’s just one system involved, you obviously want to be probably at this point just calling 911, even just skipping the pediatricians office at this point, or even your allergist, two or more system involved, that’s actually one of the definitions of anaphylaxis, and one of the indications for you to use your EpiPen and call 911.

 

00;20;08;21 – 00;20;35;21

Dr. Shreya Patel

So what that means is hives plus swelling, difficulty breathing plus vomiting or even just a subtle throat clearing. Those are kind of the reasons when you’re giving the EpiPen, you’re not waiting, you’re giving the EpiPen and you’re calling 911. You’re not driving to the emergency room either. You’re calling 911 while you’re giving the EpiPen. Okay. Remember that with babies and younger children, this is actually a little bit trickier.

 

00;20;36;06 – 00;20;56;24

Dr. Shreya Patel

Because yes, they can have the typical symptoms hives, swelling, vomiting, cough. You know, you might notice that they’re breathing a little bit, more. They’re struggling to breathe a little bit more, but they can also have this sudden tiredness. They’re land. They’re lethargic. These are kind of different signs that babies can present with. But it is indicating that it’s a more severe allergic reaction.

 

00;20;56;24 – 00;20;59;24

Dr. Shreya Patel

And again this is when you probably want to be calling 911.

 

00;20;59;27 – 00;21;15;20

Dr. Mona

So if it is a mild you know what you say like them one system involved. I’m going to use an example which I commonly get of it just being a rash. Right. Like a child eats egg. And then all of a sudden mommy says like the cheeks are red, the chest is red. Are those mouth symptoms the rash especially?

 

00;21;15;20 – 00;21;26;00

Dr. Mona

Is it a full body or can it just be cheeks, or can it just be? I commonly get asked about diaper like the diaper is red and nothing else. Or would you really see it throughout the whole body? Or can it just depend?

 

00;21;26;02 – 00;21;45;05

Dr. Shreya Patel

It can depend. It can be anywhere. And the other thing to think about is, with food allergy, especially in babies, it can present as two different kinds of rashes. Really hives or even just an eczema flare. Right. So I find that when the cheeks are kind of flaring, it’s probably more the eczema versus if they actually have that blotchy red rash throughout the body.

 

00;21;45;05 – 00;22;03;29

Dr. Shreya Patel

That’s hives. I haven’t had much experience with the diaper, the diaper turning red. That’s an interesting one. That’s a new one to me. That I’m not quite sure about. That one. That’s probably something that, you know, as long as the baby’s acting fine, you just want to bring them in and check them out and see. I always say with rashes, take pictures, you can bring them into pictures.

 

00;22;04;02 – 00;22;20;00

Dr. Shreya Patel

And even if you’re on your way, take pictures, because they tend to disappear when you get into the doctor’s office. And then we have a really hard time really deciding, is it just the diaper dermatitis, you know? Or is it really because eczema, as you know, commonly does not present in the diaper area. So and so it’s hard to say.

 

00;22;20;00 – 00;22;41;01

Dr. Shreya Patel

And hives just being present there, there and not anywhere else is also very unusual to me. So yeah, but if it’s just mild rash, known food allergy, already have a plan in place. Have an EpiPen just in case. It’s okay to give an antihistamine at home. Again, antihistamines are, you know, the Benadryl is or Claritin.

 

00;22;41;01 – 00;22;56;10

Dr. Shreya Patel

Allegra, those are things you want to talk to your doctor about what you should have at home, the appropriate dosing for it, when to give it, and then what to look for afterwards, to know what else to do. But I would say, you know, after you give the antihistamine, you still want to call your pediatrician or urologist and just discuss what should I do now?

 

00;22;56;12 – 00;23;13;05

Dr. Mona

And so if it is a and again, I’m to, a lot of my, a lot of my listeners maybe first time parents that they’re trying they’re about to introduce solids. So if it is that it’s a mild reaction going back to that. Right. Let’s just use that rash of the rash as an example. And then they call their pediatrician, they say, okay, just monitor.

 

00;23;13;11 – 00;23;28;03

Dr. Mona

Do they need to do testing at that point or do they monitor for further, reactions or what’s kind of the, I guess, the the testing protocol or food avoidance protocol, once they have a mild right, mild presumed reaction.

 

00;23;28;05 – 00;23;44;22

Dr. Shreya Patel

Is really dependent on the patient. And the entire all the details of the reaction. So at that point they should be seeing an allergist. I mean, we ask questions like, okay, what exactly did you eat? How much of it did you eat? Did you eat one bite in it? Did you eat two bites of it? Okay. If it’s egg, how did you eat the egg?

 

00;23;44;22 – 00;24;07;07

Dr. Shreya Patel

Was it, cooked? Was it partially cooked? Was it baked? I mean, there are so many questions we asked. Then we asked, when did the reactions occur? How soon after? What did you do? How long did it last? You know, there are so many things that we asked. So I really think it’s important at that point, even if you think there may have been some sort of a reaction at that point, you should really be going to see the specialist and then getting skin tested.

 

00;24;07;07 – 00;24;22;07

Dr. Shreya Patel

If if you know, most of the time we’re not sure either. And so at that point we, we do skin tests because a lot of times it is a convincing history. You know, after you do all that questioning it’s convincing. So usually you don’t want to just do it at home. If you’re unsure, I would at least talked to a specialist at that point.

 

00;24;22;12 – 00;24;40;18

Dr. Mona

That is great. Now that is great advice because, you know, there’s common what I what I found through my obviously practice is when I as I started, I’ve only been practicing for five years. But even that mild reaction like the the little bit of hives, right, like that can actually be something. And so parents will say, oh, okay, maybe it was nothing.

 

00;24;40;18 – 00;24;56;11

Dr. Mona

I don’t need to really evaluate it ever. But I think it’s a good idea. And I agree with you. It’s not going to hurt anyone just to get it evaluated. And definitely a family should let their pediatrician know if there’s any sort of reaction after eating, especially obviously, with these allergenic foods that were mentioned. But any sort of food, right.

 

00;24;56;11 – 00;25;17;10

Dr. Mona

It’s it’s any, any reaction of any kind, especially that’s ingested into the body. You want to you want to make sure, my, you know why I asked about the diaper question and I agree with you. I don’t think the diaper is any indicator of a food allergy, but I’m going to speak to what I think just commonly that I, you know, for all the families, like, oh my gosh, yes, my child, eat this fruit.

 

00;25;17;10 – 00;25;35;21

Dr. Mona

And then all of a sudden had a rash in the diaper. I think sometimes the food may change the, acidity of our poop. And that poop when it comes out can cause more rashes. So I think that’s what parents are probably seeing. I agree with you. I do not think it’s a food allergy per se, but of course if it’s persistent and all over or cheeks and swelling.

 

00;25;35;24 – 00;25;54;18

Dr. Mona

But I think that’s kind of why I brought up that common is that sure, foods can change with our GI system a little bit and can cause the poop to change, but I wouldn’t call cause that and call that an allergy. But that’s why I ask that. But I was curious. So when is the big question, when is the best time to introduce the common allergens?

 

00;25;54;18 – 00;26;01;22

Dr. Mona

You know, all those eight that you said, is there a time frame that is ideal based on obviously the literature in your experience?

 

00;26;01;25 – 00;26;21;11

Dr. Shreya Patel

Yeah. The new recommendations based on all the recent studies in the last few years is really that introduction of allergenic foods is going to be done with all the other foods between 4 and 6 months of age. So, you definitely still want to talk to your pediatrician kind of about what’s the best foods, to introduce first as an oatmeal cereal right here.

 

00;26;21;11 – 00;26;47;28

Dr. Shreya Patel

I mean, nutritionally speaking, you know, and also just developmentally speaking. So starting with the cereals and vegetables, fruit, things like that. And then one by one starting to introduce kind of the allergenic foods. And then of course, talk to your pediatrician about whether your child falls into more of a higher risk, category where maybe they need to get tested first or try for another just first before we determine whether they should just go ahead and introduce between 4 and 6 months with all the other foods.

 

00;26;48;00 – 00;27;08;14

Dr. Mona

And if for anyone listening who has not listened to my intro to Solids episode, I actually we talk. I talk with, Caroline Weeks. She’s a dietitian about the intro to solids. So this episode is all about food allergies. You know, one of the common things that parents are asking now because, you know, under obviously 4 to 6 months or 4 to 7 months, a baby may not be ready to eat.

 

00;27;08;14 – 00;27;26;22

Dr. Mona

Like if they’re doing like table foods or a baby lid weaning. So there’s a lot of products on the market right now. Ready? Set food spoonful one. Mixins like, you know, the powdered kind of allergenic foods. What are your thoughts about that? Do you think that they are beneficial or do you think parents need to use them just overall kind of on that?

 

00;27;26;25 – 00;27;43;29

Dr. Shreya Patel

So I definitely don’t think parents need to use them. Do I think they’re beneficial for some parents? Yes. Especially the ones who are a little bit more nervous and don’t necessarily, you know, understand how to start introducing some of the allergen foods. They can definitely be useful. Okay. Now do you need to go out and spend a lot of money on them.

 

00;27;43;29 – 00;28;03;28

Dr. Shreya Patel

No, because even allergist, if you just talk to your pediatrician or your allergist, they can give you certain recipes. For example, you know, I have my children a little bit older, so we didn’t have these these little mix ins before. And, and I just took peanut butter and mixed it with a little bit of water. Now, like I said, there’s actual recipes that, that, that are online that are available that you can talk to your doctor about.

 

00;28;04;07 – 00;28;33;02

Dr. Shreya Patel

And then I just kind of introduce peanut butter like that, you know, between I think my both my kids were around 5 or 6 months old when I kind of started introducing that. So there are ways to do it without purchasing those things. However, for parents who maybe, like I said, are not as comfortable, it’s definitely it makes things sometimes a little bit more streamlined and a little bit easier because they are like pre-mixed portions size, almost like powder packets that you can just mix directly into, like the applesauce or whatever you were already feeding your child.

 

00;28;33;02 – 00;28;35;06

Dr. Shreya Patel

So some some parents love it.

 

00;28;35;08 – 00;29;04;01

Dr. Mona

Yeah. And I, I was actually kind of looking at all those products and they definitely there’s been a boom of those products definitely in the last I would say 2 to 3 years. As I think more literature and more understanding of food allergies has come out right. And I agree, I think it’s one of those it’s one of those things where I don’t think it’s a bad thing, but I don’t think every family needs it because I have tons of patients who are able to introduce these allergenic foods, without any sort of, you know, program or subscription services.

 

00;29;04;06 – 00;29;20;17

Dr. Mona

So if you’re listening to this and you feel like you want to buy it all, by all means do it. I think it like, for example, one of them, I think it’s ready said food. It’s like organized by day, like, okay, on this day you introduce this packet. I think it’s nice if you need to stay organized, but if you can come up with that plan on your own, I think, you know.

 

00;29;20;17 – 00;29;42;12

Dr. Mona

Okay, I’m going to introduce a little bit of peanut butter and water. I’m going to, you know, ground up some egg and make it obviously a little fine. I personally use the mixing because it’s powder and I like it just because it mixes into puree really easily. This is not sponsored. This is just what I use. But I obviously as Ryan starts to get older and starts to do more like table ish foods, I won’t need to do it.

 

00;29;42;12 – 00;29;57;24

Dr. Mona

So it’s really a short lived thing. There’s a lot of this stuff because at some point and I actually in the intro to solids, we actually talk about this. You want to give your child what you’re eating when they’re obviously developmentally ready. And that can be as early as seven months, guys. So you don’t really need all this stuff for quite some time.

 

00;29;57;24 – 00;30;17;15

Dr. Mona

It’s going to be maybe two months, three months. If you’re if your child’s, showing signs of readiness. So I appreciate your thoughts. You know, because obviously as an allergist, these things are really big and there’s definitely a lot of research that goes behind it. Some know that it is safe if you use it, but that you can still early, you know, introduce allergenic foods early if you don’t use these programs.

 

00;30;17;15 – 00;30;38;17

Dr. Mona

So 100% agree with you. So the other question that I commonly get asked, and I actually had put up a question box on my, my Instagram and this was one of them. What if a child, has a sibling or a family member with food allergies? What is can they still get that food? Do they have to get tested before there’s all these questions about that?

 

00;30;38;19 – 00;31;06;03

Dr. Shreya Patel

This is really tricky. Okay. So mostly because if one child or family member is in the same household and has and has a food allergy, let’s take milk again, for example. Right. And I typically recommend that there be no milk in the home. Right. Because you want to prevent accidental exposure or cross-contamination. Whether it’s realistic or not, especially if it’s a severe allergy, which we still do usually make that recommendation.

 

00;31;06;09 – 00;31;28;27

Dr. Shreya Patel

Now that being said, this is where it becomes tricky is if you have one sibling that’s allergic to milk, but then has maybe a younger sibling that’s not allergic to milk. Then, you know, they could benefit from both the nutritional aspects of dairy. Plus having Barrett in their diet to prevent sensitization in the future. So that’s usually when I say, okay, depending on you know, we talked about family history increasing the risk.

 

00;31;28;29 – 00;32;01;06

Dr. Shreya Patel

I think it’s about like if you have, a parent or a sibling, it increases your chance of a food allergy by about 20 to 25%. And if it’s like both both parents plus sibling, it’s even higher than that. So at that point, we probably would test that sibling, to see if they’re allergic or not. Now, if we test them and they’re not allergic, then, what I usually recommend is you can have the non allergic child ingest that food either outside of the home or if they’re going to do it in the home, kind of have like a safe room or a designated space that they that they can eat it only there

 

00;32;01;09 – 00;32;21;04

Dr. Shreya Patel

and then after they do you want to wipe it down, you want to clean it. But we’re all experts right now with this pandemic and I’m sanitizing. So you want to you want to just wipe everything down and sanitize it. You want to make sure to wash the child’s hands and mouth, potentially even just change their clothes too, in case they have any of the, you know, the food protein on their on their clothes before they have any contact with their sibling.

 

00;32;21;07 – 00;32;46;12

Dr. Shreya Patel

So like I said, this is really tricky. And that’s why it’s a very good question. But again, this is really when you want to have a specialist just involved anyways, because everything kind of like I feel like a broken record, but everything is very case by case, and it’s really a long conversation that you’re going to sit down with your allergist and you know, she or he is going to get the entire history of every family member of your current child that you’re talking about.

 

00;32;46;12 – 00;32;51;19

Dr. Shreya Patel

Do they have eczema? You know, do they have any other risk factors, really? And then you make a decision together what to do?

 

00;32;51;22 – 00;33;23;22

Dr. Mona

I appreciate you saying that because it it is exactly that and especially this is why educational content on Instagram and podcasts can be pretty difficult, because it’s not a one size fits all. It’s, you know, medicine is such that it’s catered obviously, to the individual. Which kind of which kind of leads me to my next question. And I know, you know, this may require, obviously, the child’s pediatrician to be involved, but in terms of early introducing these allergenic foods to babies with eczema, I think there’s a misconception that all eczema children have to have delayed introduction of foods.

 

00;33;23;22 – 00;33;25;23

Dr. Mona

But that’s not the case, right?

 

00;33;25;25 – 00;33;47;27

Dr. Shreya Patel

Right. That’s not the case. So, based on algorithms actually, that Allergists have created from studies, if your eczema is mild, you can just introduce it as a, as if any other child just introduced the allergenic foods between 4 and 6 months. Now, of course, again, everything is individualized. If a parent is not comfortable, if they’re nervous, talk to your pediatrician about it.

 

00;33;48;02 – 00;34;03;25

Dr. Shreya Patel

But if it’s mild, usually it’s recommended that you can go ahead and introduce it and to kind of understand that mild moderate, severe, definitely. You know, go back to the extra episode we did has changed a little bit on that. Yeah. So that’s where you can get a little bit more information on that. But if it’s mild go ahead and introduce.

 

00;34;04;00 – 00;34;25;05

Dr. Shreya Patel

Now when you get into the moderate to severe eczema that’s where it gets a little bit tricky okay. Because now you’re now your child’s needs to be a little bit more of a higher risk for food allergies. So if it’s moderate to severe or and this isn’t the algorithm or the child has a known history of another food allergy, then that’s when you’re going to probably want to talk to your intuition about getting tested first, whether your pediatrician feels comfortable, sending bloodwork.

 

00;34;25;05 – 00;34;41;23

Dr. Shreya Patel

But most of the time, I find that most of the nutrition to refer to me will refer them right away. And then, you know, we’ll talk about testing first and then we’ll talk about, you know what? Usually peanut is the one that you’re the most concerned about. But, you know, we’ll talk about all the allergenic foods and what to do.

 

00;34;41;26 – 00;34;59;16

Dr. Mona

Besides, you know, babies with eczema being moderate or moderate or severe. Is there any other incidents where testing should be done prior to introducing foods? I think you mentioned, before about maybe if there’s siblings or whatnot, but is there any other kind of you need to get tested prior to introducing these foods?

 

00;34;59;19 – 00;35;31;01

Dr. Shreya Patel

Honestly, other than the family, family history, known history of eczema and known history of current food allergy for the child themselves that you know that we’re discussing, there’s really no other reason to be tested. And again, we talked about this in the previous episode that testing is not perfect. And we do have false positives. And so you don’t want a test in a healthy, normal child with no risk factors because then you might have a false positive and then you’re going to eliminate that food when you really didn’t need to eliminate that food.

 

00;35;31;03 – 00;35;47;02

Dr. Shreya Patel

And then this brings us back to the whole, you know, early exposure. If you don’t expose that child early on, they can actually then develop sensitizing antibodies and then actually develop an allergy later on. So that’s why you really don’t want to even talk about testing unless there’s some sort of risk factor there.

 

00;35;47;04 – 00;35;58;04

Dr. Mona

So, you know, you you briefly you mentioned you mentioned this throughout the episode, but overall, when then should a child be referred to an allergist overall or for testing and or. Yeah.

 

00;35;58;07 – 00;36;17;14

Dr. Shreya Patel

Well, so for sure, if any parent is concerned and you know, they’re nervous for any reason, like whether they have allergies or there’s a family history of allergies or they feel like they tried introducing and there’s some vague symptoms that they’re not really sure about, but that would be a reason to refer to an allergist, you know, known history of anything more than just mild eczema that’s easily treatable.

 

00;36;17;14 – 00;36;34;06

Dr. Shreya Patel

That should be a referral. At that point, they probably may have been referred anyways, or already probably in the care of an allergist. And then just no known food allergy history in the family or food allergy in another existing food allergy in the child. Those would be the kind of reasons to to refer.

 

00;36;34;08 – 00;36;50;10

Dr. Mona

You know, this is so great. I really appreciate this because these are a lot of the questions I get asked in my office and obviously on my social media. The one question I wanted to go back to, which I don’t think we we got into because I asked too many questions at once, but what the difference between an allergy versus an intolerance?

 

00;36;50;10 – 00;36;52;10

Dr. Mona

What’s that difference?

 

00;36;52;12 – 00;37;13;24

Dr. Shreya Patel

All right. So really, the basis of the difference between a food allergy and an intolerance is what’s going on inside the body. So with food allergy we’ve kind of talked about that many times involve the immune system. Right. So that that allergic antibody the IgG antibody detects this food that’s foreign for some reason. Right. And then it brings it to the allergy cell or the mast cell.

 

00;37;13;27 – 00;37;28;21

Dr. Shreya Patel

It activates the mast cell releases lots of different kinds of mediators. But the one the most people have heard about it, you know, histamine, histamine leads to the symptoms that we’ve kind of talked about. A lot of the symptoms that we talked about, right? Like the the itching, the hives or swelling, that kind of stuff. Right. So that’s a food allergy in a nutshell.

 

00;37;28;21 – 00;37;50;26

Dr. Shreya Patel

That’s the immune system. And when you’re talking about a food intolerance that’s different. That does that is a non immune system mediated issue here okay. What that involves actually is the GI tract or the GI system okay. And so here your symptoms are going to reflect just that. The GI system you’ll have stomach discomfort sometimes nausea vomiting diarrhea.

 

00;37;50;26 – 00;38;08;03

Dr. Shreya Patel

There’s not really going to be a risk of anaphylaxis here. Like I said because it involves the digestive system. This is where you can kind of see the more delayed reactions. You know how we said before with the the true immune system mediated food allergies, those are usually going to be more immediate, right? This one you can actually have a little bit more delayed.

 

00;38;08;10 – 00;38;28;11

Dr. Shreya Patel

It can, occur from the body not being able to unable, being able to properly break down the food. And so like enzyme deficiencies, this is where lactose intolerance falls into play. Some people have sensitivities to food additives, reactions to just naturally occurring chemicals in the foods. This one is a lot trickier to test for, right?

 

00;38;28;11 – 00;38;48;20

Dr. Shreya Patel

Because like I said, there’s just not the immune system. So we’re not testing for IgG or even the histamine response directly on the skin, which is what our skin test looks for. So this one’s a little bit trickier to test for. Oftentimes with the food intolerance, the person can or the child can actually tolerate small amounts of the food sometimes, but just not in larger quantities.

 

00;38;48;20 – 00;38;59;13

Dr. Shreya Patel

So some people can’t tolerate it at all. But oftentimes they can tolerate smallness. Whereas just a real food allergy there’s really no gray zone there. You’re either allergic or you’re not. You either candidate or you can.

 

00;38;59;16 – 00;39;13;24

Dr. Mona

That is a great that is a great way to put it. And I will probably be doing another episode with a GI talk about those intolerances. But like you said, that lactose intolerance like parents, we’re like, well, you know, my son will eat one yogurt and be fine, but then when he drinks a glass of milk, he’s bloated.

 

00;39;13;24 – 00;39;35;11

Dr. Mona

And so you’re right, it’s a dose dependent kind of situation. It is a completely different, physiology besides allergies. And so thank you for that clarification. Now, what I wanted to, you know, obviously talk about two, which I mentioned at the beginning is s pies. So if you can I have a feeling a lot of my, listeners may not even know what this is, but I think it’s important to know, what does it stand for?

 

00;39;35;11 – 00;39;38;22

Dr. Mona

What is there just kind of a basic overview, first of all?

 

00;39;38;24 – 00;39;57;18

Dr. Shreya Patel

Yeah. So a lot of your listeners may not have heard of this because it’s actually pretty rare. They don’t know the exact prevalence of it. But but we do know that it’s pretty rare. So f PiS it stands for food protein induced enterocolitis syndrome. This is an immune system mediated food allergy okay. But it is non IgG.

 

00;39;57;20 – 00;40;21;01

Dr. Shreya Patel

So it does not involve that allergic antibody. So it’s different from these traditional food allergies we’ve talked about up until now okay. We know that like I said it involves the immune system. We don’t know exactly what’s going on. But we do know that something’s going on on the cellular level, whether it be the allergy cells like the mast cells or therapy, the T cells, which are kind of, a type of white blood cell that’s part of your immune system.

 

00;40;21;03 – 00;40;39;14

Dr. Shreya Patel

But we don’t know what’s going on. We just know that it involves the immune system somehow. The symptoms are different from the IgG mediated food allergies and that you’re not going to have, like the skin involvement, shortness of breath, that kind of stuff. You will still have the GI system going on though here. So you’ll have, vomiting, diarrhea, usually dehydration.

 

00;40;39;14 – 00;41;05;08

Dr. Shreya Patel

Now the difference is usually it’s going to be very severe compared to IgG mediated food allergies. And then just like food allergies, though, the reactions in f pies are usually triggered by ingestion of a particular food. Okay. The reactions usually mimic like this sepsis like picture or just having a severe GI bug with this kid, just having a lot of vomiting, a lot of diarrhea, you actually a lot of times it’s mistaken for a viral GI bug.

 

00;41;05;17 – 00;41;24;27

Dr. Shreya Patel

Or a stomach bug, I should say. And for the child to be hospitalized for the severe dehydration, they could have poor growth. Some have to go to thrive. They can be lethargic. Usually the symptoms are going to develop more hours after rather than, again, immediate like their typical food allergies, usually like 3 to 4 hours or maybe 1 to 4 hours later.

 

00;41;24;27 – 00;41;39;07

Dr. Shreya Patel

Sometimes they can be within an hour. And so it can be hard to identify exactly what food caused it, because it’s a few hours later and you have to rack your brain like, is this just a virus? You know, a stomach bug, or is it something that they eat?

 

00;41;39;09 – 00;41;47;10

Dr. Mona

Is there a certain age group that is more? And again, I know you said there’s obviously still so much coming out about it, but is there a certain age group that’s more affected?

 

00;41;47;12 – 00;42;06;00

Dr. Shreya Patel

Yeah, usually it’s going to be infants like it. Usually it’s going to affect infants and younger children. And if you think about it, the foods that are most commonly involved are cow’s milk, soy grains like rice, barley and oats. So if you think about when that stuff is introduced right in in, a child is going to be pretty early on.

 

00;42;06;02 – 00;42;25;08

Dr. Shreya Patel

So cows milk and soy that could be in formula. So really really early. Or it could be with the introduction of the first solid foods in the form of oatmeal cereal, rice cereal. So usually it’s going to present early on in infancy. So it’s usually kind of diagnosed based on history. Because again remember it’s not that IgG type food allergy.

 

00;42;25;08 – 00;42;46;23

Dr. Shreya Patel

So there’s no good skin or blood test for it. They’re pretty useless actually in this case. So it’s going to be getting a good history. Sometimes you have to do an oral challenge to the to the potential culprit. But a lot of times it’s just history. And, you know, once you remove it, if the symptoms are gone, you don’t really have to confirm it with a with a food challenge.

 

00;42;46;23 – 00;42;48;04

Dr. Shreya Patel

You just avoid that food.

 

00;42;48;07 – 00;42;58;19

Dr. Mona

And because it obviously is more kind of looking at the GI system, is there. Oh is there any blood in the stool or can there be or is there always blood in the stool. Is that one of the signs the symptoms are? No.

 

00;42;58;21 – 00;43;04;02

Dr. Shreya Patel

That’s not a common sign in symptom of I know it’s usually just diarrhea and and vomiting and dehydration.

 

00;43;04;08 – 00;43;16;28

Dr. Mona

And what is the overall prognosis. I know you earlier on mentioned, you know obviously that many children with food allergies can outgrow, especially if it’s not a peanut or, you know, treena. But what about with f pies? Can they outgrow these allergens?

 

00;43;17;00 – 00;43;46;13

Dr. Shreya Patel

Yeah, that’s a good question. So, there’s no treatment for it except avoidance, right? We talked about that. You remove the food, but the good thing is, is that the children will outgrow f pies, usually by age five, I would say most commonly by around 3 or 4, but definitely by age five. And then at that point, the way you’ll kind of determine whether they really grown out of it or not is by doing, a food challenge, usually kind of like every 12 to 18 months, you can try to introduce that food again if they feel like, you know, you wait another year, a year and a half and you try to introduce

 

00;43;46;13 – 00;43;50;18

Dr. Shreya Patel

it again. But like I said, by five, usually they’re just going to grow out of it.

 

00;43;50;21 – 00;44;07;21

Dr. Mona

And this is great. Shreya, I love having you on because again I’m like such an allergist. Like I just want to I want to learn all there is about allergies and I love educating people about this. So this is this is so great. We do have time actually, for one other topic, you know, I was hoping that we’d be able to get to this.

 

00;44;07;28 – 00;44;30;16

Dr. Mona

So you mentioned, you know, lactose intolerance, one of the biggest misconceptions I get is that people think that lactose intolerance is the same as something called cow milk protein allergy, and they are completely different entities. Can you talk a little bit more about what cow protein allergy is, and how it may present in the infancy period?

 

00;44;30;18 – 00;44;48;25

Dr. Shreya Patel

Yeah. So that’s actually you’re actually right. A lot of people mistake in that the the two. And so milk protein allergy is another non immune system mediated type allergy. And so I think that’s why a lot of times there’s some confusion there. And a lot of the symptoms are GI as well. And so people think you know my child is lactose intolerant.

 

00;44;49;13 – 00;45;09;06

Dr. Shreya Patel

But this one milk protein allergy usually is recognized kind of in the first year of life. Versus lactose intolerance is really rare in the first couple of years of life. Usually you’re going to have that later. So it’s more commonly going to be milk protein allergy. And this one, we do know that it’s about a fact that 15% of children, history alone is usually all you need to diagnose this.

 

00;45;09;06 – 00;45;28;17

Dr. Shreya Patel

So, you know, I’m sure you get this all the time because I don’t even think we see this as much as I would just because pediatricians have this on lock, you know? So, patients will come in the the parents will come in with their child and they’ll complain that, you know, my child is so, you know, gassy and crying all the time and upset and refusing feeding.

 

00;45;28;19 – 00;45;48;23

Dr. Shreya Patel

And then, hey, there’s a little bit of blood, you know, Mukasey in the in the stool. That’s kind of the give away right there. And then all you have to do to confirm it is really eliminate the, you know, the cow’s milk from the diet, by either telling a breastfeeding mother to eliminate all dairy from her diet, which can be very difficult, but at least and we’ll talk about this in a second, it’s not going to be forever.

 

00;45;49;10 – 00;46;05;21

Dr. Shreya Patel

And then also for formula fed infants, you’re going to use this hydrolyzed formula. So essentially what this means is the milk protein is already extensively broken down so that the baby doesn’t have to do it. So that’s usually kind of the treatment is eliminated. And then they’re fine. And then usually kids for out of this by the time they’re one.

 

00;46;05;21 – 00;46;17;25

Dr. Shreya Patel

And at that point you just say okay go ahead and try cow’s milk cheese yogurt, whatever. See, you know, it’s rare that the kids have issues, but if they do, then, you know, you stop it again. You avoid it maybe for another six months, and then you try it again.

 

00;46;17;28 – 00;46;36;19

Dr. Mona

And I’m happy that we’re talking about it in this episode, because I was going to talk about it with AGI doc, because again, it involves the GI system and some of the overlying, some, symptoms are colic symptoms, reflux, blood in the poop, but not all of those. And and eczema can sometimes be a sign of calomel protein.

 

00;46;36;22 – 00;46;54;12

Dr. Mona

But not all of those things always mean calomel protein allergy. Like you can have eczema on it. Not be not be a calomel protein allergy. But I think it’s important that parents understand that if your child’s exhibiting a lot of these symptoms, right. Spitting up eczema, colic, blood in the poop for sure that it’s important to talk to your doctor.

 

00;46;54;12 – 00;47;26;09

Dr. Mona

And you are right that we manage a lot of cow milk protein allergy without the help of our GI colleagues or allergy colleagues. I obviously use a lot of my allergist colleagues for what we just spent the whole episode talking about. But yeah, I mean, I wanted to put this in because it is the kind of first, quote unquote, allergy that a family could see because, if a mother is drinking milk and obviously is breastfeeding or if we’re giving a baby, a formula that has more protein in it, this could be one of the first allergies that a baby gets before they start solids.

 

00;47;26;09 – 00;47;50;15

Dr. Mona

So that’s why I wanted I’m happy that we went over that. Sure. Is there anything else you want to add? Because this episode is amazing. I know so many people are going to find it useful, but is there any other things that you want to add? Obviously. You guys all have to follow her. Shreya Patel, MD, on Instagram because she share so much about her, obviously field and mommy hood as well, but is there anything else you want to add today?

 

00;47;50;24 – 00;48;13;10

Dr. Shreya Patel

The only thing is that I just think, you know, remember, for parents out there, moms, dads just know guilt when it comes to food allergies, okay? There’s nothing that you did wrong. A lot of it is just, you know, unfortunately, genetic makeup, environmental triggers that we can’t really pinpoint. And so I have moms who come in to me sometimes, you know, and they’re like, I should have done this and I should have done this.

 

00;48;13;10 – 00;48;37;29

Dr. Shreya Patel

And, you know, there’s there’s really no need for that because it’s not your fault. And food allergies are something that they’re just going to happen, you know, unfortunately. But, they’re, they’re something that we can very, very well maneuver nowadays with these great, you know, plant based diets and, and the menus nowadays have gluten free everything. And so it’s definitely something that is, a lot easier to manage nowadays.

 

00;48;38;06 – 00;48;54;29

Dr. Mona

Oh, that’s such a great message because I get that a lot in my office. And, you know, as a new mom also that mommy guilt is going to it’s going to be around in every sort of facet of mommy. And it’s it’s so true. I mean, you’re right that there is nothing that was done that, you know, parents like, I should have introduced this earlier.

 

00;48;54;29 – 00;49;10;03

Dr. Mona

Why did I do this? Maybe. And I’m going to I’m going to say all the things that I’ve heard. I shouldn’t I should have breastfed longer, I should have. Why did I have a C-section? I mean, all these things that they’re like, they put their they put guilt on themselves. And I’m like, guys, no, it is so much more than that.

 

00;49;10;03 – 00;49;28;06

Dr. Mona

And allergy immunology, our microbiome, everything that goes into our immune system is not just one thing or two things. It’s a multitude of different things. Genetics being a huge component. Obviously environment we talked about. But I agree with you completely. Sure. I think that’s such a great message because I don’t want anyone listening to this to think that.

 

00;49;28;08 – 00;49;45;22

Dr. Mona

Also, one thing I hear is that, oh, I introduced I was told this in the office, I, I feel so bad. I introduce my my daughter, peanuts and she had an allergy. Why did I introduce it? And I should have just never introduced it. And I’m like, no, mommy, you did the right thing by introducing it. You know, you how would you have known?

 

00;49;45;28 – 00;50;07;22

Dr. Mona

How would you have known? And it’s the fear of not introducing it that I worry about more, right? The parents who wait till one to, like you said, like shellfish when they’re three, when they eat that as a family. The stuff you mentioned is so true. And if your family is eating all this stuff, like if you eat peanuts in your household, it is okay, obviously, unless there’s really severe eczema and the stuff that we mentioned to go ahead and introduce it right.

 

00;50;08;00 – 00;50;27;29

Dr. Mona

It’s really important also to ask your pediatrician at your four month visit. And again, listen to my Intro to Solids episode, why we discussed solids at the four month visit about what foods you know are safe, and your doctor should say that if you’re otherwise healthy, kid, that early introduction is the way to go. I’m bringing this up because still.

 

00;50;27;29 – 00;50;41;27

Dr. Mona

And I know you agree tria is that still there are doctors out there that are saying to delay introduction of allergenic foods to one. And this was old recommendations. This was like this is like I think probably up until like maybe 4 or 5 years ago.

 

00;50;42;05 – 00;50;43;08

Dr. Shreya Patel

And so it’s really.

 

00;50;43;08 – 00;51;01;22

Dr. Mona

Important that if you hear that and your child obviously does not have severe eczema or there’s no family history of severe allergies, then you kind of say, well, why? And maybe question them a little bit, because this is the kind of stuff that we need to stay on top of, right? As as pediatricians and allergist, we are on top of these changes in obviously, evidence based medicine.

 

00;51;01;22 – 00;51;15;07

Dr. Mona

So I think that’s a really important concept, because I literally got told that a few days ago and I was like, oh no, we’re going to be talking about this on the episode because mommy felt so guilty. She’s like, well, I called and they told me on the, you know, someone told me that I shouldn’t have introduced the tier one.

 

00;51;15;07 – 00;51;25;01

Dr. Mona

I’m like, no, no, no, no, no, no, you did the right thing. You and I’m I’m sorry your child had an allergy, but it wasn’t anything that you did wrong. So thank you so much for that message.

 

00;51;25;03 – 00;51;28;18

Dr. Shreya Patel

You’re welcome. This is really a pleasure. Thank you for having me again, Mona.

 

00;51;28;18 – 00;51;48;14

Dr. Mona

It is always a pleasure. And like I said, if you haven’t already, you have to listen to the eczema 101, because a lot of this kind of, ties into, eczema as well. And that was episode seven. And obviously follow Shreya Patel, MD on Instagram. We, Shreya and I have become really good friends because of this, because of Instagram and because of this podcast.

 

00;51;48;14 – 00;51;59;25

Dr. Mona

And I’m sure I’ll have her back on in the future. If you have any comments or questions, you can ask it on today’s post. Obviously we’ll just give you general recommendations, not personal advice. But thank you again for being here today.

 

00;51;59;27 – 00;52;02;12

Dr. Shreya Patel

Thanks so much, Mona. This is really fun.

 

00;52;02;15 – 00;52;21;06

Dr. Mona

Thank you for tuning in for this week’s episode. I hope you guys enjoyed it. As always, please leave a review, share it with a friend, comment on my social media and if you’re not already, follow me at PedsDocTalk on Instagram. I love doing this for all of you. Have a great rest of your week. Take care.

 

00;52;21;07 – 00;52;22;02

Dr. Mona

Talk to you soon!