Food allergies affect millions of children and their families. With the back-to-school season in full swing, it’s the perfect time to explore how food allergies impact kids in the classroom, at lunch time and even during after school activities. In this episode, experts from Stony Brook Medicine discuss how to keep children safe, included and empowered.
The Experts
What You’ll Hear in This Episode
- 00:00 Opening and Introductions
- 1:26 Food allergy versus food intolerance
- 2:02 Signs and symptoms of food allergies
- 2:40 Signs and symptoms of food allergies in children versus adults
- 3:14 Common food allergies in pediatric patients
- 4:10 What to do if your child is having an allergic reaction
- 5:05 Neffy – nasal spray containing epinephrine
- 5:57 Preparing for the school year, including college
- 9:22 Emergency kits for food allergies
- 10:08 Treatments and therapies for food allergies
- 15:55 Prevalence of food allergies
- 17:11 Closing Remarks
Full Transcript
00:00 Opening and Introductions
Announcer
Welcome to HEALTH Yeah!, where experts from Stony Brook Medicine come together to discuss topics ranging from the complex inner workings of an infectious disease to tips and tricks for staying safe and healthy all year long.
Brianne Navetta-Modrov, MD
Hi, everyone, and welcome to HEALTH Yeah!. My name is Dr. Brianne Navetta-Modrov, and I’m an allergist and immunologist at Stony Brook Medicine.
Today we’re talking about something that affects millions of children and their families: Food allergies.
With the back to school season in full swing, it’s the perfect time to explore how food allergies impact kids in the classroom, at lunch time and even during after school activities. We’ll be talking to experts from Stony Brook Medicine about how to keep children safe, included and empowered. I’d now like to take a moment to ask our experts to introduce themselves.
Diane Cymerman, MD
Hello, I’m Dr. Diane Cymerman and I’ve been part of Stony Brook for many years practicing allergy and immunology.
Susan Schuval, MD
Hi, I’m Dr. Susan Schuval. I’m the Chief of Pediatric Allergy at Stony Brook and we see a lot of children with food allergy.
Brianne Navetta-Modrov, MD
Great. Thank you both for being here today.
Whether you’re a parent packing lunches, a teacher managing classroom snacks or just someone who wants to better understand the challenges that many face when it comes to food allergies, I hope you will find today’s program informative.
Let’s dive in.
1:26 Food Allergy Versus Food Intolerance
Dr. Cymerman, what is the difference between a food allergy and food intolerance?
Diane Cymerman, MD
So sometimes to the patient, they seem exactly the same, but they are different. A food allergy is basically something that on a cellular level looks a whole lot different than a food intolerance.
Both of them can give stomach aches or GI symptoms. A food intolerance will never be, or should I say rarely be, a life threatening issue.
Food allergies can be a life threatening issue and therefore we need to plan ahead for situations.
2:02 Signs and Symptoms of Food Allergies
Brianne Navetta-Modrov, MD
Thank you. Dr. Schuval, could you speak to some of the symptoms of food allergy, particularly in pediatric patients?
Susan Schuval, MD
Sure. The symptoms are variable depending on the age of the child. For young children that might be hard to determine if they’re having an allergic reaction.
Older children might complain of hives, swelling of the lips, tongue.
And the most serious reaction that we see is anaphylaxis. That’s the stomach reaction where you can have trouble breathing, your whole body can swell up and people can actually die from fatal food anaphylaxis.
So that we really try to prevent. It’s fully preventable if patients are empowered and knowledgeable.
2:40 Signs and Symptoms of Food Allergies in Children Versus Adults
Brianne Navetta-Modrov, MD
Yes. Okay. Dr. Cymerman, is there anything different about the presentation for food allergy in adults versus pediatric patients?
Diane Cymerman, MD
I would say that either age group could have similar symptoms. Generally, though, in very small babies, generally it’s more presenting with a rash or GI symptoms.
It’s pretty rare for a baby to present with severe anaphylaxis, but otherwise either can give issues with breathing or rashes, or GI symptom.
3:14 Common Food Allergies in Pediatric Patients
Brianne Navetta-Modrov, MD
Okay. Thank you.
Dr. Schuval, can you discuss the most common food allergies in pediatric patients that you see?
Susan Schuval, MD
So even though our diet consists of hundreds of foods, there are nine foods that cause the majority of allergic reactions. That’s milk, soy, egg, wheat, peanut, tree nut, fish, shellfish and sesame seed, which was recently added in 2023.
So we see most commonly allergic reactions to these foods, but we do see reactions to pretty much every kind of food.
Brianne Navetta-Modrov, MD
Thank you.
Yes. I don’t know if you both feel the same way, but I find the seeds particularly hard. Sesame was added, but that comes with a whole host of other seeds, poppy seeds and mustard seed. And that can be very difficult to navigate because we don’t have as much experience with that being one of the top allergens.
So I’m not sure if you guys feel the same way about that.
Susan Schuval, MD
We might see a lot of hummus reactions because people give babies hummus and that’s sesame seed. And we do see that often.
4:10 What to Do if Your Child is Having an Allergic Reaction
Brianne Navetta-Modrov, MD
What should a parent or guardian do if they feel that their child may be having an allergic reaction? Dr. Cymerman, do you mind answering that for me?
Diane Cymerman, MD
Okay. So it somewhat depends upon the severity of what the parent is seeing. And we would hope that if it is not the first time that the parent would be equipped with an epinephrine device and we now have three to offer, which is great.
We have EpiPen and AUVI-Q and a Neffy, which was introduced recently. So we hope that if there’s a severe rash in the patient, a parent would know that they’re going to give their child that and seek out emergency care.
If it’s a mild allergic reaction, I tell families just to be prepared. And you can give a patient an antihistamine and monitor the patient.
5:05 Neffy – Nasal Spray Containing Epinephrine
Brianne Navetta-Modrov, MD
Excellent. Dr. Schuval, Dr. Cymerman mentioned a product called Neffy. Do you mind talking a little bit about that and your experience with it thus far?
Susan Schuval, MD
Okay. So sure, Neffy is a new product. It’s actually a nasal epinephrine spray and it’s indicated down to age four for anaphylaxis.
So we always want to make sure our patients are prepared with epinephrine in case of anaphylaxis. So we have the auto injectors, we have the talking auto injector, which is AUVI-Q, and now we have the nasal spray, which is very easy to use and very easy to carry.
So it’s a new product that we feel will be very helpful for our patients for food allergies.
Brianne Navetta-Modrov, MD
Great. And so Neffy was recently FDA approved in the fall, and there are both adult and pediatric strengths available. And so it’s really important that our patients now know that this is an option. And I get a lot of questions about this now, even from other providers, honestly. And so I think it’s really important to touch on that.
Thank you so much.
5:57 Preparing for the School Year, Including College
So how can parents prepare for the school year when they have a child who has food allergies, Dr. Schuvall?
Susan Schuval, MD
So we find education is a really important component of our allergy visit. So at every visit, we want to discuss emergency preparedness.
And we give all of our patients what we call an anaphylaxis action plan, which lists the medications and when to give them. If a child’s having hives to give Benadryl or Zyrtec, if it’s a severe allergic reaction, anaphylaxis, wheezing, trouble, swelling up, progressing really rapidly, epinephrine is indicated, call 911.
And then revisit, we go over how to use whatever auto injector device they have and make sure the patients are comfortable so they’re not fumbling during an emergency.
Brianne Navetta-Modrov, MD
Great. Thank you. And Dr. Cymerman, what can schools do to help create a safe environment to work with the parents who are trying to be prepared for their children when they’re sending them to school?
Diane Cymerman, MD
So I usually tell the parents in the summertime, if they are there, to make sure that we have paperwork that explains to the school nurse what the problem is and what the plan of action is.
As Dr. Schuval indicated, preparation is key and both the school nurse and the family need to have an action plan. And the action plan should be pretty specific. It shouldn’t be just, oh maybe the patient ate something that they were allergic to and we’ll do the following…
We should have some definite steps involved, and that includes the older kids going off to college. And that’s important too. I had someone in the office recently and I said, you know, you’re going off to school, make sure you have a conversation with the college nutritionist and explain what you are allergic to and what you should be careful of.
Brianne Navetta-Modrov, MD
Yes, perfect.
I actually had this just yesterday, a student who was going off to college. And in his allergy list, it listed tree nuts, but he didn’t actually know which tree nuts he was allergic to. And so I often have them specifically write out which tree nuts. So that way it’s communicated well with the staff at the school exactly what tree nuts means for that patient.
So the going to college and taking on as of your condition, I find a really important age or milestone. We also tell college students to teach their roommate how to use the epinephrine auto injector and their friends in case they’re out and about and they have an allergic reaction. The roommate could administer the medication.
Diane Cymerman, MD
And I might add, especially at that age with the kids going off to college, they want to be independent, but they don’t necessarily want to carry an epinephrine device with them. And I stress how important that is. And I always say to them, you know what? If you don’t know what’s in the food you’re eating, then just don’t use it.
Say I’m not hungry If somebody asks and it shouldn’t be a big, dramatic problem. So, you know, the kids are a little bit concerned about that. Just say, no, I’m not hungry. And then you eat what you know is safe for you.
Brianne Navetta-Modrov, MD
Great.
I find, too, there’s also so many different epinephrine auto injector devices now, Teva brand, EpiPen brand. And so there’s some great YouTube videos out there that I will often tell the students, even younger students, watch this. They explain to you how to use this device, which could be lifesaving for you. And so just another tip, especially before they go to college, if they haven’t done that yet.
9:22 Emergency Kits for Food Allergies
You both briefly touched on exactly what should be in an emergency kit for school or for college or even parents in the car. Could you just repeat that? Because I think that’s really important.
So, Susan, what do you recommend should be in every emergency kit for a food allergic child?
Susan Schuval, MD
So everyone with food allergies should carry an antihistamine. So usually Benadryl or Zyrtec and some sort of epinephrine device, whether it be an EpiPen, the AUVI-Q or the nasal spray.
And we do tell people that the EpiPens shouldn’t be left in the car because it’s a liquid that can evaporate in the summer. It can freeze in the winter.
However, the new nasal spray is stable, so they can leave that in the car and last up to two years. So it’s easier to maneuver that.
10:08 Treatments and Therapies for Food Allergies
Brianne Navetta-Modrov, MD
Great. Thank you.
Okay, so what is on a lot of parents and actually adults’ minds is are there any treatments or cures for food allergy?
This is a potentially fatal problem. And so that’s the first thing that comes to a lot of people’s minds. So, Dr. Cymerman, could you speak to potential treatments or therapies for food allergy?
Diane Cymerman, MD
So if you asked me this question 11 years ago, I would have said nope. But at this point, we have a lot more options that we can use.
Ten years ago, there was a very important study called LEAP Study that showed that if you restrict a baby from eating peanuts, they are much more likely to have a peanut allergy lifelong than if you don’t. And it was a big, big difference. I believe the statistics said the difference was almost double.
In other words, the children that wound up having peanut allergies were the ones that were restricted. The ones that were fed peanut crackers or peanut powder from a young age, they had a much lower likelihood of having peanut allergy. So that was a really, really important study. And that has pretty much changed the information that allergists and pediatricians are giving their patients.
As far as treatments, we now have a few different types of what we call oral desensitization, and they each have specific guidelines on how to be used, and they also work. So that’s a big improvement compared to, as I said, ten, 11 you.
Brianne Navetta-Modrov, MD
Great. So as food allergy was increasing, a lot of what we did just naturally was, oh gosh, delay the introduction of the highly allergenic foods. And so then we did not start introducing these foods until they were two. That used to be the advice of the pediatricians and the allergy community.
This study was pivotal for our field, telling us that early introduction for the highly allergenic foods, all the foods that Dr. Schuval mentioned, is very, very important.
And so now it’s the opposite, right? We encourage early introduction of these foods. So fantastic.
Susan Schuval, MD
However, there are high risk children, infants who have eczema, who have a strong family history of allergy, who are likely to react. So we do see infant anaphylaxis and we have an infant EpiPen as we are seeing it with various foods. So it seems to be on the rise with the infants.
Brianne Navetta-Modrov, MD
Yeah. And so that brings up what Dr. Cymerman said, which is this concept of desensitization. And so could you explain a little bit what desensitization is and exactly how that’s being used now in the food allergy world where it’s been used in allergic rhinitis for years. We’ve been using desensitization for drug allergy for years, but now it’s in the food world.
So if you don’t mind explaining that a little.
Susan Schuval, MD
Alright, so desensitization is oral immunotherapy for foods.
But we always tell people this is not a cure. It’s not going to get rid of your food allergy. It’s just going to raise the threshold at which you’ll react. So instead of reacting to a trace amount of peanut, you could eat two or three peanuts before you have a reaction.
So for many people, this is really essential and important.
So the way it works is the food is given in very small amounts. Usually there’s a challenge at the beginning of the therapy. If you pass the challenge, then you get a daily dose of the food and then we up dose over time over a couple of months until you reach a maintenance dose, you stay in the maintenance dose and this will give you some protection.
You still need to avoid the food, you still need to carry an EpiPen. But you need to stay on this medication every day. And there are restrictions with activity. And if you get ill, you need to stop it. So there are a lot of things that the patients need to know. And patient education is very important.
Brianne Navetta-Modrov, MD
Great. Recently, there’s been an approval of an injectable medication to help with food allergy called XOLAIR This medication has been around for a long time for severe asthma and then nasal Polyposis. Can you speak a little bit about XOLAIR and how that’s being used in the food allergy world, Dr. Cymerman?
Diane Cymerman, MD
Yes. So that was granted approval, I think about a year and a half ago. And as you mentioned, it was originally for treatment of asthma and then you had additional approval for other allergic conditions.
But what XOLAIR does, and this is injectable, it reduces the incidence of food allergic reactions as long as the patient is taking the injection. And it’s been quite significant in the sense that it can give family some peace of mind that if they accidentally ingest something, eat something that they didn’t know had a small amount of an allergen, that they should be okay, or at least not have a severe and full access.
And it seems to be very effective, but it is available only by injection. So this is not something that you’re going to buy by prescription in your local pharmacy.
Susan Schuval, MD
Again, it’s not a cure. You know, it’s just what they call a mitigating factor. It raises the threshold and gives you some protection.
Brianne Navetta-Modrov, MD
Yeah. So are both of those treatments available for pediatric and adult patients or is it one or the other? Susan?
Susan Schuval, MD
Right. So the only FDA approved oral immunotherapy is for peanut, and it’s something called PALFORZIA, and that’s indicated for children one through 17.
In the studies it was found to be ineffective for adults. So here at Stony Brook, we have a number of patients who are doing well on PALFORZIA. There are other places that do oral immunotherapy to various foods, but it’s not FDA approved.
PALFORZIA is FDA approved. And we are starting to put patients on XOLAIR and people are very interested in that treatment.
15:55 Prevalence of Food Allergies
Brianne Navetta-Modrov, MD
Okay, so last question. Probably the one that we get most often is it seems like food allergies are increasing and can develop over time. And so are there any particular reasons why we know this is happening or hypotheses, Dr. Cymerman?
Diane Cymerman, MD
That’s a very dicey question and you know, I don’t claim to know the answer to that there. It’s interesting though, that in parts of, let’s say, sub-Saharan Africa, the food allergies are much fewer incidence than in our urbanized area.
But you can postulate, you can make up a theory that maybe it has something to do with the environment, but I personally can’t tell you a reason why it’s on the increase. But hopefully now with the change in offering these foods to infants, we will see the curve go back the other way.
Dr. Schuval, anything to add?
Susan Schuval, MD
Yeah, I’ll just say that we are definitely seeing a rise in food allergy in our clinics, with kids with food allergies, many food allergies, severe food allergies. But at least now we have treatments to offer these patients.
Brianne Navetta-Modrov, MD
Thank you. There’s this hypothesis called the hygiene hypothesis. I’m sure you both have heard, and I get asked questions about that frequently where kids aren’t outside as much as they used to be anymore. And so that’s one of the things I think you’re speaking to.
17:11 Closing Remarks
That’s all the time we have today. Thank you to our experts for your time and thank you to our viewers and our listeners.
Remember, food allergy is on the rise, and it’s important that if you’re concerned about it, you seek appropriate care for diagnosis and treatment with an allergist and immunologist.
Thank you.
Announcer
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