Are you still hearing that you should wait days between introducing new foods—or that food causes eczema? Are you stressed about feeding your baby the top 9 allergens?

In this episode, I sit down with pediatric allergist Dr. Dave Stukus to bust the biggest myths about food allergies. We’re talking real science, not fear: when to introduce allergens, why elimination diets can do more harm than good, and what’s actually driving the rise in allergies today. 

We discuss: 

• Early allergen introduction helps prevent food allergies.

• Food doesn’t cause eczema—here’s what actually does.

• Vaccines don’t cause allergies—here’s what’s behind the rise.

To connect with Dr. Dave Stukus follow him on Instagram ⁠@allergykidsdoc⁠, check out all his resources at ⁠https://www.nationwidechildrens.org/find-a-doctor/profiles/david-r-stukus⁠

00:00 – Meet Dr. Dave Stukus

03:50 – Myth: Delay Introducing Allergenic Foods

06:23 – Feeding Should Be Fun, Not Fearful

08:05 – Are Babies More at Risk for Severe Reactions?

10:15 – Parking Lot Peanut Butter & Allergy Anxiety

11:01 – Benadryl vs. Modern Antihistamines

13:02 – What a True Food Allergy Looks Like

15:31 – The Truth About Food and Eczema

18:13 – The Exception, Not the Rule

22:19 – Eczema and Future Allergy Risk

24:11 – When to Start Solids for Prevention

25:08 – Why Food Allergies Are Rising

27:55 – Final Takeaways & Stay Updated

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00;00;00;00 – 00;00;19;00

Dave Stukus

And as far as you know, the one new food every three, 4 or 5 days. I’ve talked to the the leading, you know, food allergy dieticians in the world, and they all tell me the exact same thing. Ready for this? It’s completely made up. It’s just it’s made up. It’s a highly conservative approach. Where we, you know, we used to tell families.

 

00;00;19;00 – 00;00;35;05

Dave Stukus

Well, if something’s going to occur, if you do one new food every 4 or 5 days, then we’ll know exactly which food caused it. But now I look at it, the flip side. So if we say that food allergies affect 5 to 8% of all children, that means 92% of children will never develop a food allergy, no matter how you feed them.

 

00;00;35;08 – 00;00;47;09

Dave Stukus

So if we’re telling 100% of families to be extra cautious, that’s a huge disservice to the vast majority of families. So I like to say feed as many foods as you want. If something worrisome happens, we can figure it out.

 

00;00;47;11 – 00;01;09;08

Dr. Mona

Welcome to the show. It’s me, Doctor Mona, your trusted online pediatrician, parenting cheerleader and mom friend who’s also probably forgetting what day it is, especially when I’m trying to remember what I fed my kids yesterday. You’re listening to the PedsDocTalk podcast, where we turn overwhelm into clarity, and parenting this into mic drops. Today’s episode is one of those conversations I wish every parent could hear.

 

00;01;09;08 – 00;01;42;03

Dr. Mona

We’re diving deep into food allergy myths like wait three days between new foods or don’t give peanuts before age one with the incredible doctor Dave Stuckey’s, who’s a pediatric allergist and immunologist. In honor of Food Allergy Awareness Week, I want you to get ready to feel both validated and enlightened. Oh, and before we jump in, hit that. Subscribe and download your favorite episodes not just because it helps the show reach more parents like you, which it does, but because parenting is chaotic and you deserve to never miss a golden nugget of myth busting brilliance.

 

00;01;42;06 – 00;01;51;17

Dr. Mona

Trust me, your future sleep deprived self will thank you. Let’s get into it.

 

00;01;51;20 – 00;01;53;24

Dr. Mona

Thank you so much for joining me today.

 

00;01;53;26 – 00;01;57;15

Dave Stukus

It is my pleasure. Thanks for having me. I’m excited to be here. This can be great.

 

00;01;57;18 – 00;02;23;02

Dr. Mona

Well, I joined social media in 2019. I found you early on in my journey. Thank you. Because obviously you are a wealth of information. I know you are so busy with all the clinical work that you do, the research that you do, and also getting that little pockets of time to combat the misinformation online. But before we get into this conversation, tell everyone more about yourself and the why behind your love for pediatric allergy.

 

00;02;23;09 – 00;02;43;25

Dave Stukus

Yeah, so you nailed it. I am an academic pediatric allergist. I am a professor of pediatrics, and I work at Nationwide Children’s Hospital in Columbus, Ohio, and I do everything that an academic allergist will do. So I see patients at our food allergy treatment center, where I’m also the director of our center. And I do research and I participate quality improvement.

 

00;02;43;25 – 00;03;06;10

Dave Stukus

I do a lot of work with our professional organizations, lots of work with advocacy. And then every once in a while, when I find some spare time, I post some stuff on Instagram as well. But the reason I got into pediatric allergy is because, unfortunately, it affects millions of children. You know, if you think about the most common chronic health conditions, we’re talking about asthma and allergic rhinitis and eczema and food allergy.

 

00;03;06;13 – 00;03;21;26

Dave Stukus

And I love that being able to offer. Not only can I clarify the diagnosis, which I think we’re going to talk about today, but offer, you know, individualized solutions, for each single family and each single child, we can really make their lives better. And, you know, these children are impacted by these conditions on a regular basis.

 

00;03;21;26 – 00;03;28;07

Dave Stukus

It interferes with their sleep quality of life. Miss school. And we can provide help. And it makes me feel pretty good about that.

 

00;03;28;10 – 00;03;50;03

Dr. Mona

Yeah. And again, the work that you’re doing is so incredible online. And also obviously in the in real life education and clinical practice that you do and we are going to be talking about allergy myth busting. So that was kind of the purpose of this episode is to kind of talk about food allergies and some myths that we hear all day, all recommendations versus new recommendations.

 

00;03;50;10 – 00;04;15;20

Dr. Mona

So one of the first things that I think parents, even in 2024, when this episode is being recorded, have is they are being told still by some doctors out there to wait to introduce allergenic foods, or also to wait 3 to 5 days between introducing new foods. I’m curious about, you know, the current recommendations and where it stands on needing to wait 3 to 5 days between introducing new foods allergenic foods.

 

00;04;15;21 – 00;04;19;11

Dr. Mona

Is this needed? Is there some nuance to this? Tell us more about that.

 

00;04;19;13 – 00;04;38;09

Dave Stukus

Yeah, I think we need to acknowledge the elephant in the room collectively, as medical professionals, myself included, we’ve done a really good job at just scaring the hell out of parents over the last 20 years at feeding your babies. Oh my goodness, we did such damage. But the evidence, the evidence changes over time. The evidence is very reassuring.

 

00;04;38;11 – 00;04;59;15

Dave Stukus

And if we if we follow what the actual evidence shows, we want to encourage, you know, introducing, you know, solids to babies when they’re ready, usually around 4 to 6 months of age. And this includes all of the allergenic foods. So milk, egg, wheat, even peanut butter, you know, age appropriate tree nut products, because that’s the best way that we can actually promote tolerance and prevent allergies from developing.

 

00;04;59;18 – 00;05;13;10

Dave Stukus

We don’t need parents to, you know, drive to the parking lot of the local bathroom the first time they feed peanut butter. And as far as you know, the one new food every three, 4 or 5 days. I’ve talked to the the leading, you know, food allergy dieticians in the world, and they all tell me the exact same thing.

 

00;05;13;10 – 00;05;31;11

Dave Stukus

You ready for this is completely made up, you know. Yes. Yeah. It’s just it’s made up. It’s a highly conservative approach, where we, you know, we used to tell families, well, if something’s going to occur, if you do one new food every 4 or 5 days, then we’ll know exactly which food caused it. But now I look at it, the flip side.

 

00;05;31;17 – 00;05;48;29

Dave Stukus

So if we say that food allergies affect 5 to 8% of all children, that means 92% of children will never develop a food allergy, no matter how you feed them. So if we’re telling 100% of families to be extra cautious, that’s a huge disservice to the vast majority of families. So I like to say feed as many foods as you want.

 

00;05;49;04 – 00;05;52;18

Dave Stukus

If something worrisome happens, we can figure it out, right?

 

00;05;52;20 – 00;06;09;09

Dr. Mona

And also, I think what happens there, and I think that recommendation is outdated and that then people are overthinking the whole feeding process. Right. And I think our generation especially has gotten so stressed about okay, well, you know, puree baby led weaning and then you add what to make. And then you’re saying, well you can’t give this, you can’t give this.

 

00;06;09;09 – 00;06;23;03

Dr. Mona

You got to wait three days. I personally I mean, who has that mental load to be able to like think like, what did I give on Monday? I don’t even know what day it is. Regardless if I’m feeding my kid, let alone what I. What I ate two days ago, right? Like, I mean, it’s it is so much more stress.

 

00;06;23;08 – 00;06;30;17

Dr. Mona

And I think by saying that not only is it not evidence based, we’re taking away the joy that I think exists when we introduce solid foods.

 

00;06;30;20 – 00;06;42;15

Dave Stukus

I couldn’t agree more. You know, feeding our babies, it’s not a medical procedure, right? Right. It’s like we need to feed our babies. It should be fun. It should be exciting. Let them explore, you know, different tastes and textures and expand their diet. I agree.

 

00;06;42;15 – 00;06;58;14

Dr. Mona

Yeah. And I love that because yes, I think I still hear it to this day and on my social, I’m sure you hear it and you’re hearing maybe that outdated information and it you know, it, it kills me when my colleagues have my own practice or like, still saying this rule and I’m like, guys, let’s get up to date here.

 

00;06;58;14 – 00;07;15;00

Dr. Mona

Like, what is the reason? And again, you brought it up beautifully. Like, well, how will we know? I’m like, well they’ll tell us that they eat yogurt, a toast and peanut butter and then we’ll figure that out like it’s it’s okay. Like like you said, it’s a rare situation. And I rather have it that we don’t have the stress.

 

00;07;15;00 – 00;07;31;25

Dr. Mona

And also this can just delay the the exploration of yummy, delicious food if we’re doing five days. I had a parents say that someone told them to wait a week in between foods and I’m like, oh, week. If you wait a week, your child’s only going to get introduced like a certain number of foods in their first few months.

 

00;07;31;25 – 00;07;44;02

Dr. Mona

Like that’s not enough. Like I need them to explore. And this includes allergenic foods as well, right? Meaning allergenic non allergenic foods. You don’t need to have the sort of, you know, 3 to 5 day rule with all foods. Correct?

 

00;07;44;04 – 00;08;05;24

Dave Stukus

That is absolutely correct. Yes. We in fact we want to actively introduce allergenic foods. And here’s the important part and keep it in the diet consistently. So if we give a little nibble of say peanut butter and then wait another 3 to 4 months, that’s where we may actually promote allergy development. Whereas if we keep it in the diet several times a week or ideally every day, that’s how we promote tolerance and we prevent allergy from developing.

 

00;08;05;26 – 00;08;20;07

Dr. Mona

Now, why are some babies more at risk of severe reactions compared to older children? You know, in terms of allergies, do we see that or is it more that you can have a bigger reaction as an older child? What is it about the reactions?

 

00;08;20;10 – 00;08;41;05

Dave Stukus

Yeah. So interestingly, babies are less at risk to have severe allergic reactions or anaphylaxis. And there’s new, anaphylaxis practice parameters, which are our guidelines that actually go through. And they have a consistent consensus based statement, a recommendation that basically says for babies is pretty rare for their first reaction to be, you know, severe or require epinephrine or emergency care or things like that.

 

00;08;41;11 – 00;08;58;08

Dave Stukus

More often than not, they’ll get some hives or maybe they’ll vomit and they feel better. Now, can they have more severe reactions? Absolutely. It can occur. And when it does, it’s pretty scary for parents. And unfortunately, those are typically the stories that get shared on social media that just scare all parents. But the typical story is, you know, I see this every day.

 

00;08;58;08 – 00;09;13;18

Dave Stukus

That’s all I see are food allergy, concerns at our food allergy center. Every single family comes in with a similar story of we fed this, we noticed a rash. We noticed hives that they threw up, so we stopped feeding it. We’re seeking evaluation now. So that’s the most common presentation of food allergy in babies.

 

00;09;13;20 – 00;09;30;22

Dr. Mona

Yeah. Happy to provide that reassurance because I think, like you said, when we introduce solids, the the fears that I hear commonly from parents are the mess. What to feed this whole delaying, you know, the 3 to 5 day rule. All of that choking gagging which we’re not talking about. But then the another big thing is the allergenic reaction.

 

00;09;30;22 – 00;09;48;11

Dr. Mona

Well, what if they have it and I don’t know what to do, and I cannot get to a doctor in time. And you had alluded to the fact that some parents are so scared of this reaction that they’ll sit in the parking lot and, you know, outside of a hospital and introduce peanuts. And, you know, what would you say to that parent who’s like, listen, I just want to sit outside.

 

00;09;48;13 – 00;09;58;24

Dr. Mona

And it’s the first time ever introducing peanuts because we also know that you’re not going always you’re not going to get a reaction often the first time you have an exposure to this food. Correct. Not always.

 

00;09;58;26 – 00;10;14;26

Dave Stukus

Right. Yeah. So when. Right. So people can develop food allergies on, you know after eating it several times or maybe it’s a second or third time you feed it. So in all honesty, what I like to do, and there’s a reason we have two psychologists on our staff at the Food Allergy Center is because there’s such anxiety surrounding this diagnosis and feeding babies.

 

00;10;15;03 – 00;10;32;02

Dave Stukus

I ought to I like to have a conversation with families about why. Why are you so worried about this? Where does this come from? Is this what is influencing you in your life as an older child that has food allergies? Well, let’s have the conversation about this younger child and how we can approach this. I have the benefit I can offer to actually introduce foods in our office.

 

00;10;32;02 – 00;10;45;10

Dave Stukus

We do about a thousand oral food challenges a year. So if there if there is ever any concern, come hang out with us and we’ll have fun. We’ll have, you know, a nice little, you know, feeding party in the office and give you reassurance. But it really it comes down to that root cause of, like, what’s going on here.

 

00;10;45;10 – 00;10;47;13

Dave Stukus

Why are you so concerned in the first place?

 

00;10;47;15 – 00;11;01;20

Dr. Mona

And you mentioned for babies, you know, sometimes they may have vomiting or hives when it comes to a true, you know, concern for an allergic reaction. When are antihistamines useful. And also why has Benadryl fallen out of favor as an antihistamine?

 

00;11;01;23 – 00;11;21;15

Dave Stukus

Yeah, it all comes down to what are the symptoms. So if the symptoms are itching and hives and antihistamines are great, because histamine is the chemical that gets released from those allergy cells in the skin that causes the itching in the hives. We, you know, we’ve fallen out of favor for Benadryl, otherwise known as diphenhydramine, because, you know, just because it’s been around for 80 or 90 years doesn’t mean it’s the best option.

 

00;11;21;15 – 00;11;45;22

Dave Stukus

We have such better options available. So we have these non sedating Long-Lasting Second Generation antihistamines, the brand names of things like Zyrtec and Allegra and Claritin. Not only do they work faster than Benadryl, but they last four times as long and they don’t have the terrible side effects that Benadryl has. You know, we’ve been giving Benadryl to babies like its candy for years, but I don’t know if it would be approved by the FDA if it went before today, because of the terrible side effect profile.

 

00;11;45;22 – 00;12;06;19

Dave Stukus

So we really have altered our approach to using any histamines. But then, of course, if there are more severe allergic reactions. So anything more than hives. So if you start to have repetitive vomiting, if you start to have coughing, difficulty breathing for any reason, that’s when epinephrine is going to be the treatment of choice. And that’s the first line medication to treat anaphylaxis, which is a severe allergic reaction involving more than one part of the body.

 

00;12;06;21 – 00;12;18;24

Dave Stukus

So for, you know, for those who don’t have a diagnosis of food allergy, you’re not going to have epinephrine at home, nor do you need it at home. But certainly those that have that diagnosis, if they have future episodes, then that’s how we educate them how to use epinephrine and when to use it.

 

00;12;18;26 – 00;12;39;24

Dr. Mona

Well, you had already mentioned about the fact that, you know, babies are less likely to have a severe reaction compared to an older child with a food allergy. And I think that’s hopefully reassuring to our listeners, because I think the fear that I hear a lot of parents have is that, like I said, they’re going to eat something, they’re going to have a severe reaction, and that’s going to be what happens mostly when we know that that’s not usually the case.

 

00;12;39;27 – 00;12;57;00

Dr. Mona

And so if they end up having a reaction, let’s say again, going back to the hives or, or vomiting, obviously calling the pediatrician, letting them know what happened. Typically, I know a lot of my patients get advised on the nursing line to give an antihistamine and follow up the next day is that usually what you recommend as well?

 

00;12;57;00 – 00;13;02;07

Dr. Mona

If there’s that first concern of an allergy, an allergic reaction that’s mild. Yeah. Yeah.

 

00;13;02;09 – 00;13;18;00

Dave Stukus

Yeah. Absolutely. So yeah. So if you have concerns. So it really helps to know what did your child eat within that one hour window before symptom onset. We don’t need to take a history of what did they eat over the last 3 or 4 days. Because food allergy reactions happen within minutes, rarely longer than 1 or 2 hours later.

 

00;13;18;02 – 00;13;32;21

Dave Stukus

With, with, you know, some rare exceptions. So let’s focus on that food or snack they had right before the symptom onset. I often hear from families, you know. Well, how do I know if my child’s having an allergic reaction? Let me say, for 16 years of experience as a pediatric allergist, you’re not going to miss it.

 

00;13;32;21 – 00;13;49;15

Dave Stukus

Trust me. You’re going to recognize your baby’s going to have an acute change. And in babies who can’t verbalize what’s going on, oftentimes you’ll see a change in their behavior. They’re going to be pretty fussy or irritable because they’re probably itchy or maybe a little nauseated. So they’re not going to look, well, which is very different than those infants.

 

00;13;49;15 – 00;14;05;22

Dave Stukus

They get these contact non allergic rashes from like strawberries and tomatoes and sauces where they get some redness on their face, but they look happy as can be. That’s very different than an acute allergic reaction. So if you have those concerns definitely call your pediatrician and be prepared to talk about the foods that they just prior to symptom onset.

 

00;14;05;25 – 00;14;23;29

Dr. Mona

Well, thank you for bringing up that differentiation. Because like you just brought up sometimes just from the context of a food around like the baby’s mouth, it could be just like a little irritation that feeds the babies happy. That is a really important distinction. Would a food allergy sort of hive rash that you’re mentioning, would that be more of a full body?

 

00;14;23;29 – 00;14;27;18

Dr. Mona

Would that be isolated if someone is like unsure of what that might look like?

 

00;14;27;20 – 00;14;43;16

Dave Stukus

Yeah, it can vary. And, you know, I educate our residents and fellows that rotate with me of when we diagnose food allergy is kind of like Mad Libs, you Mad Libs. Yeah. So you have to like, fill in the blank. So we need to hear from the families of like, okay, what was the food of concern? What was the period of time before symptoms occurred?

 

00;14;43;16 – 00;14;58;08

Dave Stukus

What were the symptoms. Where do they occur? How long do they last for. So if you come to me and you say, I’m really worried that my child has an allergy to carrots, because when they eat carrots four days later, they get itching on their foot. I believe you and I hear you, but I’m not worried about food allergy because it’s a very common cause of allergy.

 

00;14;58;15 – 00;15;16;16

Dave Stukus

If you say I gave them peanut butter within 15 minutes, they had hives head to toe, now you have my attention. That’s more likely to be food allergy. So it always goes back to what the history is. Hives can be localized. They can be more generalized. It can be a combination of the symptoms. But it really comes down to what was the food that they ate and how how soon after before you notice those symptoms.

 

00;15;16;19 – 00;15;31;04

Dr. Mona

I love that. What a great approach. I mean, again, going back to what we had talked about, about taking out the stress of like that 2 to 3 day window, like we can just have a conversation, ask the family. People can remember, yeah, we had this, that or the other. And then we kind of dive in and go from there.

 

00;15;31;07 – 00;15;52;11

Dr. Mona

This episode, we’re not talking a lot about obviously the testing and, you know, like all that. We’ll probably save that for a future episode. But of course, then there is a different workup that may be done once that child has a concern. On social media, we see a lot of accounts talking about foods causing eczema and also about elimination diets.

 

00;15;52;11 – 00;16;08;13

Dr. Mona

So there’s a lot of back and forth I’m seeing, you know, I see a lot of the allergy world obviously seeing one thing, and then I see a lot of parents saying, no, I took this out of my diet and you need to do the same thing. What do we know at this point about eczema and food allergies?

 

00;16;08;13 – 00;16;19;04

Dr. Mona

Is there an actual causation? When people talk about triggers for their eczema, do we actually see that? What is it that we know with food and eczema at this point?

 

00;16;19;06 – 00;16;41;04

Dave Stukus

Yeah, this is where it’s really important to understand. Anecdotes are not evidence. And if we look at the evidence, including the current, you know, eczema treatment guidelines, there’s a very strong statement that, you know, food avoidance is rarely, if ever, indicated. And the reason why is because eczema is a very complex, chronic skin condition. That’s a combination of a skin barrier defect where water escapes from the skin.

 

00;16;41;04 – 00;17;01;05

Dave Stukus

So it gets very dry, but it also allows irritants and allergens to enter. And there’s a very complex immunology underneath the skin that’s occurring as well. It’s, you know, eczema is not caused by one specific food in the diet. It’s just it’s way more complex than that. Now, as far as people thinking that foods are triggering eczema or contributing to it, a lot of times this is more correlation.

 

00;17;01;10 – 00;17;16;23

Dave Stukus

And this is where we talk to a lot of families about, well, you know, one, avoidance of food in the diet can actually be very harmful. So we know that children with eczema are at higher risk to develop food allergies if they’re eating a food and they’re sensitized to it, meaning they have elevated IGA on testing, but they’re not having reactions.

 

00;17;16;29 – 00;17;38;01

Dave Stukus

And then you take that food out of their diet. That’s how we create food allergy. So we now it’s well-established, like medical professionals are causing harm by telling people to take food out of their diet. It’s not causing acute allergic reactions, especially if they’re sensitized. We have to recognize that I’m in defense of breastfeeding mothers everywhere who are given these outdated blanket recommendations to just stop eating milk and egg and peanut and wheat.

 

00;17;38;04 – 00;17;55;07

Dave Stukus

It is extremely unlikely that any of that food allergen is passing through the breast milk to contribute to eczema. How do we know this? Because infants who have actual food allergies, including anaphylaxis, their mothers don’t need to stop eating the food. They’re not passing the allergen through the breast milk. They’re passing, you know, nutrients to the breast milk.

 

00;17;55;10 – 00;18;13;05

Dave Stukus

And then we just have so many great, effective, you know, topical therapies to treat eczema that we don’t need to go to, you know, food avoidance. Are there some infants out there that have truly severe refractory eczema that will benefit from avoiding certain foods in their diet or mom’s diet? Yes, but that is the exception and not the rule.

 

00;18;13;08 – 00;18;30;21

Dave Stukus

We hear all these emotional stories on social media, but we have no way of verifying whether any of that is true or accurate. Plus also all the biases that go into play. I have a lot of families who say, well, I stopped eating milk and egg and their eczema got better. And then you ask the follow up questions and they say, well, we also switch the type of soap we were using, and we started using a greasy moisturizer.

 

00;18;30;21 – 00;18;42;06

Dave Stukus

We found an effective topical steroid and all this other stuff goes into play. So it’s a complicated matter. It’s it’s rarely, if ever just an easy it’s a single food causing it. Well, let’s say I drove this.

 

00;18;42;06 – 00;19;03;03

Dr. Mona

Yeah, absolutely. And, you know, you said it perfectly that I not only in the allergy world, but in all things parenting and child health, I get tagged and all these videos of these stories of parents sharing this. And I also want to believe all those stories and, you know, say, yeah, okay, I’m going to use vaccine vaccines as an example, right?

 

00;19;03;08 – 00;19;25;23

Dr. Mona

A parent will say that, oh, my child got a vaccine. And so and so such and such happened. Maybe they’re on this sort of anti-vaccine platform. And I’m like, listen, I want to I want to believe you. But we also know and I’m going to be quite frank. And you know this too, that a lot of times people share stories to sell something that may not be actually in evidence.

 

00;19;25;23 – 00;19;48;26

Dr. Mona

Right. So for example, this example I cured my child eczema by taking this, you know, doing this elimination diet comment elimination diet. And I’ll send you my, you know, my ten step elimination diet for, you know, $20. And so then it’s like you got to remember that. Is there a conflict of interest because me and you are not charging people money to give them the evidence, right?

 

00;19;48;29 – 00;20;11;21

Dr. Mona

So if someone I always say that when when there’s misinformation, I’m like, if someone is giving you health guidance through a paywall, there’s something very fishy to me because health guidance should always be accessible, whether it’s through, you know, you going to conferences, the literature out there. My YouTube channel is free because I know that if it’s there, I’m going to give you all the evidence.

 

00;20;11;21 – 00;20;45;01

Dr. Mona

And so always remember that when you’re watching those stories and you’re like, well, and take it to your pediatrician. I mean, if you’re saying like this person cure their eczema, talk to your pediatrician. I hope that they also understand the most current evidence. Listen to this episode as well. Follow. You know, Doctor Stick is here because I really want us to do true diligence for our children and not do unnecessary testing and unnecessary elimination diets, like you said, because that can cause more harm than good by avoiding certain foods that may be useful for their diet and can avoid an allergy like you mentioned.

 

00;20;45;04 – 00;21;00;29

Dave Stukus

Well said. I couldn’t agree more. And frankly, if anybody listening right now are watching, if this conversation that sort of trigger something where you’re like, how can that be? You know, all these other people in my life are saying otherwise, don’t, don’t take my word for it. Go read for yourself. You know, you can search atopic dermatitis, practice parameters.

 

00;21;00;29 – 00;21;19;02

Dave Stukus

It gives you all of the evidence based information. And there’s a great summary and explanation for all of this. So this isn’t my opinion that I’m sharing here. I’m just merely relaying what the evidence to date shows. So yeah, I, I agree with you. If somebody is, you know, selling you something in exchange for information, that’s a huge conflict of interest.

 

00;21;19;04 – 00;21;41;12

Dave Stukus

The other thing is, I talk about this. I have this conversation all day, every day. Correlation does not equal causation. So, yes, I completely hear you that ingestion of a certain food correlates with worsening eczema. But let’s talk about all the the dozen other factors that can also worsen eczema, such as viral infections, weather changes, not using enough moisturizer on the skin, fragranced skincare products, all that stuff.

 

00;21;41;14 – 00;22;05;20

Dr. Mona

Exactly. And you mentioned that, right? Like the detergents. Maybe they changed something around the time that this happens. So that is such a key thing. And I think as, as academics, you know, I think we talk about that correlation causation all the time. And I love that you’re bringing that up because it is important to remember that so much of things can be correlated in a personal situation, but that doesn’t mean that there’s evidence and also that that applies to every situation, because we don’t know the details all the time.

 

00;22;05;23 – 00;22;19;16

Dr. Mona

I really appreciate that. But we so we talked about obviously how, you know, foods causing eczema. But we do know that children who may have moderate to severe eczema may be more at higher risk for food allergies. Correct.

 

00;22;19;18 – 00;22;20;22

Dave Stukus

Yes. Yeah.

 

00;22;20;24 – 00;22;29;09

Dr. Mona

So let’s talk about that because I know that can be confusing because we just said, well, food doesn’t cause eczema, but that eczema babies can be high risk. And why is that. Yeah.

 

00;22;29;11 – 00;22;48;09

Dave Stukus

Yeah. So thank you for bringing that up. So there is no single cause for why some people develop allergies. But at the to the best of our knowledge, there is a complex interaction between one’s genetics. What we get from mom and dad and our DNA and early life exposures. So eczema is often the first outward sign of that baby raising their hand, saying, pay attention to me.

 

00;22;48;15 – 00;23;08;28

Dave Stukus

I’m the one who’s likely going to go on to develop food allergy, asthma, environmental allergies. So eczema often improves within the first couple of years of life. But then things kind of shift and they start to develop allergies to things in the environment and asthma and things like that. Eczema doesn’t cause food allergy. Eczema doesn’t cause asthma. Bad eczema in early life is associated with later development of these conditions.

 

00;23;09;01 – 00;23;26;04

Dave Stukus

And as we mentioned before, we now know that, you know, early introduction of allergenic foods and ongoing inclusion in the diet is the best way to prevent food allergies. So if you have an infant with especially moderate to severe persistent eczema, they are the ones we absolutely want to get them to start eating allergenic foods early and keep it in their diet.

 

00;23;26;08 – 00;23;43;24

Dave Stukus

We can change their life. Is it 100% effective? No. Absolutely not. But, you know, it’s it’s one of those things doctor mode. We’ll never know. Like when we prevent food allergy, right? We’ll never know. It’s hard because we don’t know what that timeline is going to be. But this is the best advice that we can offer people, not food avoidance, but food inclusion.

 

00;23;43;26 – 00;24;11;02

Dr. Mona

Well, you had mentioned that, you know, starting solids 4 to 6 months. I remember when I joined social media, there was a lot of larger accounts than mine that were saying, no, you cannot introduce solids before six months, like, pediatricians don’t know what they’re talking about. And you just brought up a great example of an a situation where if a child is showing signs of readiness after four months for purees, for example, that perhaps the early introduction of allergenic foods between 4 to 6 months can be beneficial.

 

00;24;11;04 – 00;24;32;26

Dave Stukus

Oh, absolutely. Yeah. So everybody’s a little bit different. Some babies aren’t ready till are nine months old. That’s okay. It’s not like there’s a critical window and six months in one day that we miss this window where we can prevent food allergies. But some babies are ready sooner. And it’s interesting. So as this has been studied over the last oh my gosh, we’re coming up on a decade now from the pivotal sleep trial I love it showed early introduction of peanut and inclusion prevents peanut allergy.

 

00;24;32;28 – 00;24;49;02

Dave Stukus

So here we are ten years later still having this battle. But I get it. There’s a lot of confusion because we used to say avoid, avoid, avoid. And now we’re saying feed. But it’s all based on the evidence. So there was no evidence before this supported avoidance. It was sort of a best guess. Now we have really good evidence that supports early introduction.

 

00;24;49;02 – 00;24;50;27

Dave Stukus

So I think that’s what we need to promote.

 

00;24;51;00 – 00;25;08;26

Dr. Mona

Yeah. It came out that Leap study came out when I was actually in training. And so my whole training has been early introduction. But of course I was with colleagues and, you know, people who were trained before me that were like, wait, what, a year? You have to wait. And so, yes, do not wait until a year. If any of you take home anything from this message, do not wait until a year.

 

00;25;08;26 – 00;25;29;02

Dr. Mona

Unless, of course, you’re being guided by an allergist or something for whatever reason. But yes, there is no reason you have to wait. My my last question, I guess, is food allergies seem to be on the rise. I mean, I look back at my childhood and I know children who had, you know, my peers who had some allergies, but they definitely seem to be on the rise, I feel.

 

00;25;29;04 – 00;25;43;01

Dr. Mona

Do we know why and can we maybe squash the vaccines causing food allergy debate? What do we what do we know about this? Is it really on the rise? Any idea? And maybe obviously we need more research, but I’m curious where we stand at this point.

 

00;25;43;03 – 00;26;05;26

Dave Stukus

Yeah. Thanks. So, yes, we have seen it, almost, you know, a tripling in the prevalence of food allergies over the last couple of decades. So we are seeing an increased number of children with food allergies as well as allergic conditions in general and asthma. So that is without a doubt happening. Anybody who says that they figured out the single reason why has no idea what they’re talking about, we’ve already talked about this is a very complex issue here.

 

00;26;05;26 – 00;26;26;04

Dave Stukus

There’s no, you know, single predetermination, there’s no single exposure. There’s a lot of things that are correlated with it. The hygiene hypothesis has been around for decades. And that’s shown that basically as as humans have moved towards more urban environments and moved away from farms and specifically farm animals and more specifically farm animals that are eating poop and then licking babies.

 

00;26;26;07 – 00;26;47;11

Dave Stukus

Yeah, we we know that, you know, cleaner environments are associated with higher risk of developing allergies. And if you think about the allergy antibody called immunoglobulin E or IgG, there’s no evolutionary advantage for why somebody should have IgG towards peanut, right? This doesn’t provide us any protection as as a as a species, IgG was initially developed to protect us against parasitic infections.

 

00;26;47;13 – 00;27;03;19

Dave Stukus

So as we move away from these farming environments in rural environments towards, you know, cities and stuff like that, we don’t have to worry about parasites anymore. So the way I think about it, which may be incorrect, is IgG. You kind of got bored and it started, you know, directing itself towards things like ragweed and dog dander and peanut, which makes no sense whatsoever.

 

00;27;03;22 – 00;27;20;28

Dave Stukus

But it does line up with the hygiene hypothesis and why we’re seeing increases in allergy in general. As far as the vaccine stuff is complete nonsense, there’s actually very good evidence that shows, you know, children who are vaccinated actually have less allergies and those who are unvaccinated, which is interesting. You know, all the anti-vaccine propaganda.

 

00;27;20;28 – 00;27;38;12

Dave Stukus

This goes back to like the 1960s, where they were studying peanut oil as an adjuvant, which actually never went into commercial vaccines. But if we were injecting kids with, you know, food allergens with their vaccines, we wouldn’t be, you know, causing food allergies to develop. We’d be causing allergic reactions, which we’re not seeing. So it’s just all nonsense.

 

00;27;38;14 – 00;27;55;23

Dr. Mona

Yeah, I will, I love that. Thank you for sharing that perspective. That makes a lot of sense. You know, I love I actually do believe in the hygiene hypothesis myself. But of course it’s so layered. But how you described it with the IG board, it makes sense, right? They’re like, well, I don’t have parasites to fight because this this animal’s not licking my baby.

 

00;27;55;23 – 00;28;15;08

Dr. Mona

So let’s just find something else. I love the way you frame that. Thank you so much. This is such a great conversation. I, you know, hope we really busted a lot of myths about food allergies. And I, I hope our listeners really learned a lot because I think a lot of this misinformation is still out there. What would be your final message for everyone tuning in today?

 

00;28;15;11 – 00;28;24;16

Dave Stukus

If anybody told you something in regards to food allergy or allergen or feeding your baby, any time outside the last six months is probably outdated.

 

00;28;24;18 – 00;28;25;26

Dr. Mona

That’s very good.

 

00;28;25;28 – 00;28;43;25

Dave Stukus

But, I mean, this space is changing so rapidly, you know, things I’m recommending to families now, I wasn’t doing six months ago. I certainly wasn’t doing a year ago or two years ago. So, you know, follow the science. Don’t fall for the marketing, because the marketing is everywhere. And, you know, the evidence absolutely matters when it comes to this stuff.

 

00;28;43;25 – 00;28;54;25

Dave Stukus

So hopefully that you have a trusted relationship with your own personal pediatrician or allergist. And please go to them if you have any specific medical concerns. And don’t rely on folks on social media, because oftentimes they don’t know what they’re talking about.

 

00;28;54;27 – 00;29;11;18

Dr. Mona

Yeah. And oftentimes they’re not doing the work you’re doing in terms of staying up to date on this ever changing knowledge that we’re gaining in this field, it is actually, you know, I’m a general pediatrician. Of course, I rely on my specialists like yourself and all my other specialists, when I don’t know what’s going on or if I need more information.

 

00;29;11;18 – 00;29;29;09

Dr. Mona

And so I will say that the whole allergy world has always been very fascinating to me. Meaning, why are we seeing this? What can we do? Is there anything we can do? The early introduction of allergenic foods. All of this stuff is an area of huge interest, which is why I also wanted you on the show for just personal, you know, up to date knowledge.

 

00;29;29;09 – 00;29;49;20

Dr. Mona

For myself, we can consider this a CME session for myself. But also, I just think it’s really just important for all clinicians to stay up to date on this and for people listening to go to the evidence so that we will always provide you with the evidence. I mean, I think me, you, all of us in this world, in this job, we want to help our kids.

 

00;29;49;20 – 00;30;06;19

Dr. Mona

And we would love if we could prevent food allergies, seasonal allergies, all of that. But we know right now we do what we’re doing and we keep up to date. And that six month rule is right on. I might have to have you on again and another year for the latest and greatest updates and allergies. Because of what you said.

 

00;30;06;22 – 00;30;19;28

Dave Stukus

That would be great. And if I may, I frankly, I don’t want a job, I really don’t. I would love if I didn’t have if there were no children with allergic conditions or food allergies, I would be a jungle cruise ship or a Disney World or something like that. But, I’m here to help for as long as.

 

00;30;19;28 – 00;30;20;25

Dave Stukus

Yes. Yeah.

 

00;30;20;27 – 00;30;37;07

Dr. Mona

Same with me. It’s what it is. And you’re you’re fighting the good fight every day. Like I said, in person, with all the academic work that you do, but also on social. So thank you so much for joining us today. Where can people go to stay connected, share your Instagram Instagram handle again and any other resources that you want to share.

 

00;30;37;10 – 00;30;54;10

Dave Stukus

Yeah, so I’m on Instagram. I my handles at Allergy Kids. Doc. I can never give individual medical advice, so please don’t send me pictures of your child’s rash in my DMs. I have screenshots of all that terrible stuff, but, yeah, I’ll hopefully be able to, you know, provide, you know, perspective and the latest updates whenever new evidence breaks.

 

00;30;54;10 – 00;30;55;06

Dave Stukus

That’s for sure.

 

00;30;55;08 – 00;31;15;06

Dr. Mona

Yes. Thank you so much. I will be attaching that to our show notes, Allergy Kids docs, so that you can stay connected with him and his journey and all the research out there. Like I said, for me, whenever there’s an update or something in the news regarding a new medicine in the allergy world, I’ll immediately go to go to his page to see what does he have to say about this?

 

00;31;15;10 – 00;31;25;15

Dr. Mona

I know he’s busy, but eventually he’ll post something. But thank you. Thank you so much for the work that you do. It really means a lot to me as a general pediatrician, and also I’m sure all of our listeners today.

 

00;31;25;18 – 00;31;30;01

Dave Stukus

That well feeling is mutual. Thanks for having me.

 

00;31;30;03 – 00;31;47;09

Dr. Mona

That’s a wrap on today’s episode, and if your jaw dropped at any point, you’re not alone. Whether it was learning that babies are less likely to have severe reactions, or that the three day weight rule is completely made up, today was full of weight. Seriously, moments. Here’s your takeaway if your baby’s ready for solids, you don’t need to delay allergenic foods.

 

00;31;47;17 – 00;32;05;17

Dr. Mona

You don’t need a spreadsheet or a countdown timer to introduce allergenic foods. You can enjoy this messy, joyful, chaotic season of feeding your baby without all the fear. And if you’re someone who’s been holding back because of outdated advice, this is your permission slip to let go of the stress and embrace the science. Before you go, subscribe and download this episode.

 

00;32;05;17 – 00;32;27;18

Dr. Mona

It’s not just about numbers. It helps the podcast to grow, reach more families, and tells the internet gods that this kind of info matters to you. Plus, when you download, you’ll always have the episode on hand, even when your Wi-Fi is acting like a toddler. Very sporadic with listening to you and if you found this helpful, share it at the PedsDocTalk podcast at PedsDocTalk and at Allergy Kids Doc on Instagram.

 

00;32;27;23 – 00;32;45;01

Dr. Mona

You never know which friend mom, group chat, parenting group chat, or pediatrician’s office might need to hear this. Thanks for being here, for staying curious, and for choosing evidence over fear. You’re doing an amazing job and we’ll see you all next time.