Today as our guest we have Dr. Kari Nadeau, renowned physician and director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford University. With food allergy rates more than tripling in the last twenty years, many parents want to know what is contributing to this phenomenon, and what can be done to prevent and treat food allergies... Luckily there are many simple changes parents can make to help prevent them. And for those children (and adults) who do have food allergies, there are now exciting treatments to end food allergies. n.
And, parents, there is no reason, Dr. Nadeau reminds us, to feel guilty about food allergies.
Below is a transcript of the episode, modified for your reading pleasure. For more information on the people and ideas in the episode, see the links at the bottom of this post.
Agatha Luczo: Hi! I'm Agatha Luczo, mother of four.
[00:00:08] Dr. Greene: And I'm Alan Greene, pediatrician.
[00:00:10] Agatha Luczo: Welcome to Bambini Furtuna’s podcast. Mom Driven.
[00:00:14] Dr. Greene: Dr. Aligned.
[00:00:16] Agatha Luczo: Hello Dr. Greene.
[00:00:18]Dr. Greene: Agatha!
[00:00:18] Agatha Luczo: And Dr. Kari Nadeau. So our topic today is food allergies. I always get super excited about this topic and it is our pleasure to have as our guest today, Dr. Kari Nadeau. Dr. Kari is the director of the Sean Parker Center for Allergy and Asthma Research at Stanford University. The co-author along with Sloan Barnett of a new book, The End of Food Allergy. And someone, our family knows very well, I feel completely lucky and less than fortunate to have Dr. Kari and Dr. Greene as our resources here.
[00:00:55] And as our doctors for our children, two of our children had food allergies, and it's amazing what you have done to help our son overcome his food allergies. I never knew that was possible. And I bet a lot of people don't know that's possible. And just educating parents on food allergies and the possibilities out there is really important.
[00:01:16] Dr. Greene: Pretty incredible. And I have to say that I have never seen families as happy and as grateful as when they have had a life-threatening food allergy in their kid, that's then been reversed. It just lifts such a weight off of the child that off of the family, it's really, really dramatic. And I'm so excited, Kari, that your book is out, The End of Food Allergy. What great news for families.
[00:01:44] Kari Nadeau: We're so grateful. It takes a team approach. And I'm so glad to have written this with Sloan who's also a mom who has children with food allergies and I can't thank you and Agatha enough for inviting me here today and being able to speak about the book. But also to have a conversation and to ask questions freely, and there's so much we know and so much we don't know. So I'm excited about today and I want to thank you so much for inviting me here.
[00:02:11] Dr. Greene: So super glad to have you here. And food allergies have been going up a lot over the course of our careers. We've seen them at least triple the hospitalizations for food allergies in the last couple of decades and maybe even quadruple or more. So a lot of families are dealing with this. So it used to be that you didn't necessarily know a child who had a severe food allergy and now most people do.
[00:02:35] Kari Nadeau: That's right. And the children of the families with food allergy as Agatha can really speak well to, they are the heroes of this story. And it's a story that continues to evolve. But importantly, like you mentioned, Alan, this is an epidemic. This is not necessarily the same epidemic of let's say COVID, but this has been around for years now and we've been studying this and initially it was thought to just feel a little bit of an increase. And unfortunately, after the year 2000, it went up like that.
[00:03:06] So nowadays in the U.S. about one in 13 children have a doctor's diagnosis of food allergy that's two in every classroom. And that's people under the age of 21, but over the age of 21, we just published a big study recently with our colleagues in Chicago and with a big national questionnaire, we looked at how many adults have food allergy and 10% of adults have a doctor's diagnosis of food allergies.
[00:03:38] So this is not going away. We used to think that food allergies are increasing. We knew that, especially in children and especially in some allergenic foods like tree nuts and sesame, they're also on the rise they're doubling every 10 years. Well, we were surprised to know that a lot of the allergies are not going away.
[00:03:55] So many adults have them into adulthood and of the adults that we questioned, 50% of them could eat the food when they were children, but had allergies when they were adults. And so what does that mean? That means that something in the environment is changing. And so we're doing a lot of studies at Stanford now. And I mentioned this in the book in terms of how does the environment affect the genes and how does the environment affect our guts to then induce food allergies?
[00:04:23] Dr. Greene: That reminds me of a story. My wife, Cheryl, as you know, we were having dinner with Agatha and Steve and she got up from the table to go to the restroom and didn't come back for a while. And I went and found her in the bathroom having an anaphylactic reaction and it had to give her epinephrine in the restaurant.
[00:04:39] Kari Nadeau: Uh! I'm so sorry!
[00:04:40] Dr. Greene: And it was a complete surprise because she didn't have food allergies. We took the menu of everything she had that night and learned that she had allergies to what was it? Lima beans, sweet chestnuts and abalone.
[00:04:55] Agatha Luczo: Yes.
[00:04:55] Dr. Greene: In adulthood with nothing before.
[00:04:58] Kari Nadeau: That's exactly right. And, and Alan, this is where we need to get on top of this for you to understand why we need to understand why children get allergies, why adults get allergies and then how we can prevent it and how we can treat it.
[00:05:08] Agatha Luczo: Can some children grow out of their allergies as they grow up?
[00:05:12] Kari Nadeau: That's a great question Agatha. So for some milk and egg allergies in a lot of times, that's what people get when they're infants and toddlers. Those are the top two allergies around the globe, for example, in China and Korea and the U.S. and Australia, milk and egg. But unfortunately, nowadays less and less people are outgrowing it. It used to be thought that about 80%, eight out of 10 children with milk and egg allergies or milk or egg allergies just grow out of it by the time they were over 18. But now that's less, it's only about 50% are growing out of it. So there's something different in our environment. And we want to be super careful about this epidemic and how to get in front of it, both in a proactive way and a reactive way for prevention and therapies.
[00:05:59] Agatha Luczo: What do you recommend for being proactive and getting in front of it and making sure your child doesn't get the allergies?
[00:06:07] Kari Nadeau: It's an excellent question as well Agatha and I want to make sure everyone knows they're on the line that a lot of times as parents, and we all are parents, and it's pediatricians too, both Al and I are dealing a lot with patients and families as pediatricians. I always say to the parents, it's not your fault. And it's not anything you did in pregnancy. Not anything you did in your family genetics, not anything you did during breast feeding or your diet because the data show overwhelmingly now that it looks like environment plays a role, but not during pregnancy. And how do we know that? If it was all about pregnancy, you'd expect twins, whether or not they're identical twins or fraternal twins to help sustain the rate of food allergies, because they grow up in the same household. They grow up in the same uterus, that they're exposed to things, but that's not the case.
[00:07:01] And it's not just genetics. Otherwise identical twins would have the same food allergies or have food allergies together and they don't. So, what we talk about in the book is that the environment can be changed and we need to get back to more of a natural environment. And that's why items like what you and Alan are promoting and helping get out to the public with Bambini Furtuna and the wonderful products there. That speaks to how important it is to give back to nature. Get back to natural products, but we talk about in the book is the importance of diversity of diet early on and often that we used to think that, and I know Alan and I know this. Alan trained me and I'm so grateful that we had to delay the introduction of peanuts and shrimp and milk and nuts. And that's actually not true. That's not the case. In fact, there was just a big paper coming out in Japan that if we could start a little bit of cow's milk early we can prevent cow's milk allergy. So diversity of diet, regular, and often small little bits of proteins to help educate your gut, that this is not a foreign thing, but this is natural, that you can use this as a way to protect your immune system against developing allergies. And so that's good. Diversity of diet.
[00:08:13] The other thing is dry skin. I've been lucky enough to see the beautiful products that you've made with Bambini Furtuna, and that you have these beautiful skin lotions that are natura and help regain the moisture in the skin. And that's one of the things we talk about in the book that moist skin is good, having that skin layer to be totally protected because unfortunately, if that is irritated and scratched and there's little bits of allergens in the air that gets through those openings, that can start an allergy.
[00:08:44] So dry skin, diversity of diet, dry skin to be protected with lots of nice lotions. And to make sure you avoid detergents. Another D.
[00:08:54] Dr. Greene: Right.
[00:08:54] Kari Nadeau: Three " D"'s. Try to make sure that the detergents that you use are healthy for the planet. So that means they'll be healthy for your baby.
[00:09:02] Dr. Greene: And that's true for dishwashing detergent as well as laundry detergent.
[00:09:06] Kari Nadeau: Absolutely because we learned that the dishwasher detergent is so fast, it makes your plates so shiny. But unfortunately, if you actually wipe on your finger, the top of a plate, when you take it out of a typical dishwasher cycle, there’s still detergent on there. And so we're noticing that for babies, especially it gets in their gut. It starts breaking down the skin lining inside their guts, which is not healthy. And it also tends to get on the skin.
[00:09:32] Agatha Luczo: Yeah. I always say what you put on your skin is just as important as what you eat.
[00:09:37] Kari Nadeau: Yes, you're absolutely right.
[00:09:38] Agatha Luczo: And the whole school of thought of avoiding what to eat early on, I feel like it's a new thought that doctors are teaching parents... because just 10 years ago, I'll never forget this story. I was in Singapore. We had our two older children, George and Rosalia. George was four months old and there was a woman there with a six month old and she was putting peanut butter on her boob and about to breastfeed. And I was like, what are you doing? And she said, “Oh, you have to introduce all the nuts early. You know, and the best way to do it is with the breast milk.” And I asked our doctor at the time, it wasn't Dr. Greene, and he said, no, no, avoid all allergens until you know, they're not allergic. And she was from a Scandinavian country. And the school of thought, even in the Scandinavian countries 10 years ago, was introduce it early with breast milk so they don't develop the allergy. And I wish I listened to her at the time.
[00:10:31] And it's this thing of like, parents feel guilty. They feel like it's their fault. And I do carry sometimes like guilt around with me is thinking, 'well perhaps if I did that at the time we could have avoided the allergies'.
[00:10:43] Kari Nadeau: Yeah. It's so hard. It's not your fault.
[00:10:45] Dr. Greene: One thing is when you are starting solid foods for a baby, there's real value in doing it. If possible, when you're still breastfeeding, because breast milk seems to help modulate the immune system.
[00:10:56] Kari Nadeau: Yes.
[00:10:57] Dr. Greene: So I would encourage when you start these different proteins, if possible, do it while you're still nursing to small amounts, not huge amounts at first.
[00:11:06] And then the other thing is, I encourage people to avoid starting or even feeding the most allergenic foods when the baby has diarrhea or vomiting or is on antibiotics for any reason, because that disrupts the microbiome and you might be more likely to develop an allergy if you eat those when you're sick.
[00:11:26] Kari Nadeau: Yes.
[00:11:27] Dr. Greene: In my book, "Feeding Baby Green",when I first wrote that the idea was about exposing kids to a wide variety of food to teach their taste buds as well as to teach their gut and to teach their immune system. And the publisher wouldn't release it because they felt that was too controversial to introduce a wide variety of foods early on. But I said that it's not going to cause allergies. And I also said not to wait three to five days between new foods. And they finally did, but it wasn't until 2008 that they felt like there was enough cover.
[00:11:55] Kari Nadeau: Well, you were ahead of your time, Alan. Now, you know, based on a small amount of data and well-meaning people back in 2000, they made those guidelines. It wasn't based on a lot. It was just based on worry, unfortunately. Then come all these studies and now thousands of babies have been using this diversity of diet like you recommended Alan. And like you set out, they're like, wow. You know, there are some countries that never took the guidelines of delaying like Scandinavia.
[00:12:23] And so they have a lower rate of food allergy now. So I think we're looking at, in, especially in the book, I talk about this, that science can be a messy process that well meaning people can try to make guidelines, but nowadays, before we set anything in strong facts, they need the science to back it up. And now, thankfully there's been a lot more science.
[00:12:45] And so now the guidelines really do reflect some state of the art ways of thinking about how to prevent food allergies. Thank goodness, because we need to get ahead of this epidemic. So the other things we've learned is, you know, good microbiome, good gut health, eat a lot of fresh vegetables, even a lot of good ingredients, eat what your grandmother would be eating.
[00:13:04] Try to avoid preservatives. I think, Alan, you talked about this in the book, get those taste buds excited when they're infants. Right? Because diversity will also help them choose the right foods when they get older. And then growing up and I know this is sort of interesting for some people that have dog allergies, but if you actually grow up with a dog, that actually helps prevent allergies and asthma and food allergies, as long as you're not allergic to the dog.
[00:13:28] Dr. Greene: Yeah. Having a dog is one of my favorite probiotics.
[00:13:31] Kari Nadeau: Exactly!
[00:13:31] Agatha Luczo: Wait, but isn't it that it's early on it has the most effect like in the first six months or the first year, and then afterwards that percentage lowers?
[00:13:41] Kari Nadeau: Yeah, you're absolutely right, Agatha. So, usually it's nice to have the dog around when the baby's crawling on the floor and kind of sharing some things with the dog. But it unfortunately is that diversity of diet, like what Alan suggested his book and what we recommend in the book as well is between four to six months, when that baby's interested in trying new food, make sure you diversify the diet. Also there's no reason to stage it. There's no reason to do one thing at a time.
[00:14:07] Dr. Greene: Yeah, no evidence for that.
[00:14:09] Agatha Luczo: Does that include introducing not so early on as well?
[00:14:12] Kari Nadeau: Yes, it's totally fine to introduce nuts early. In fact, we went around the world and I'm so glad that the book is in different languages too, because we want this not just to be a book helpful to one particular group. We want it to be helpful for people with and without food allergies throughout the world. So it's been translated into a lot of different languages now.
[00:14:32] Dr. Greene: Fantastic!
[00:14:33]Kari Nadeau: The reason why we did that is because I had been visiting different countries over the past five years. And when I would visit those countries that had started to diversify the diet early and even nuts and seeds and different proteins like shrimp.
[00:14:48]Dr. Greene: And faish.
[00:14:49]Kari Nadeau: And fish. Those are the cultures that almost had no food allergy whatsoever in their whole population.
[00:14:56] Agatha Luczo: And could a baby starting solids between four to six months old, have an allergic reaction?
[00:15:01] Kari Nadeau: It's a great question. So we've now given this particular diversity of diet instructions, as well as provided them with 16 different food proteins. We have about 10,000 people that have used this now. We're so excited. There are a lot of different products. We have SpoonfulOne. But with that, we have only seen two reactions in all of those children and they already had food allergies before they started. And it's very safe. We saw a rash. And so then we said, okay, go see your doctor.
[00:15:32] So if anyone has a baby and they start eating something and they have a rash within two hours or have vomiting within two hours of eating that food. You should go see your doctor and get diagnosed. But before the food allergy starts, it's possible to diversify the diet to try to decrease it.
[00:15:51]Agatha Luczo: I remember after knowing that George had food allergies and when we had our third and fourth child, I remember being nervous when they were babies. So I brought them in to get skin tested.
[00:16:04] Kari Nadeau: Yes! That's right.
[00:16:06] Agatha Luczo: Just to relieve my fear. So once I got those results back, that they're safe to start eating the nuts. Then I introduced it to them.
[00:16:14]Kari Nadeau: You had that forethought. Right? And I'm so grateful to you for thinking about all these things for your children.
[00:16:20] Agatha Luczo: So if you do have the fear of feeding, I think getting a skin test to relieve your fear early on is also a good…
[00:16:27] Kari Nadeau: Yes!
[00:16:27] Agatha Luczo: I'm grateful for your book that you wrote it and that it's out and available to the world because I talk about you all the time. You mentioned that we parents are heroes. You're the hero in my life. You're the biggest superhero possible, you and Dr. Greene, to be able to heal children like this from living their life in fear of having an anaphylactic reaction. It's huge. And to be able to now recommend and give your book as a gift out to people, I'm so grateful and thankful for that. I just want to share your message and all of your knowledge to the world.
[00:17:04] Dr. Greene: Both the book and SpoonfulOne, you went by it pretty quickly, but SpoonfulOne is this really cool thing so that you can expose your kids simply to the most common allergens, food allergies out there, the 16 different proteins that they can get used to so they're less likely to become allergic and it's so simple.
[00:17:23] Kari Nadeau: Yeah. And to have it convenient, right. To make sure it's there... 16 foods. You don't even have, like, it would take how long to bake that or to make that right. And they have high integrity. So that it's a nice way to feed it to the baby and hopefully it's fun for people because you know, why do we have to do this? Why do we have to proactively readjust the immune system so that it can gain strength so that it can not be allergic. And we're trying to understand that too. The environment is not the same as it was 20 years ago.
[00:17:52] Dr. Greene: Right.
[00:17:52]Kari Nadeau: So now we have to counter that and these are natural things to do. What I like about it is it's natural, just like what you and Agatha are doing as well.
[00:18:00] Agatha Luczo: What I love about it is that it comes in three different stages. It comes in a powder formula for newborns that you can mix in the baby food. Then there's a second stage of puffs. And then the last stage is the cookies. And my sister and I are enjoying the cookies right now.
[00:18:17] Kari Nadeau: Oh, good.
[00:18:17] Agatha Luczo: Yeah. And so I love that you can start early on and you've really done so much research and thought and counting the right amount of proteins of each of the allergens. I remember you sharing the powdered formulas before it was even launched.
[00:18:32] Kari Nadeau: Well, you were one of the pioneers. I truly believe that heroes are the patients and the families. You are the pioneer Agatha with your family, trying one of the beta testing aspects of this, but we really want to help patients. You really want to help families. We have to make sure we deliver on the hope and promise of science and the fact that these are instructive to our immune system to help us not misfire, to help us make sure we don't get allergies to make sure we protect our skin and all these things.
[00:19:00] But I feel so lucky to be part of teams that do this type of research, because we want to make sure that any research we do helps someone. Helps a family. Has real time applications to people's lives because there's a lot of questions about food allergy around the world, and we need to provide some answers.
[00:19:19] Agatha Luczo: And also the immuno therapy for children. If your child does have an allergy, the whole entire immunotherapy process of overcoming the allergies is pretty amazing.
[00:19:29] Kari Nadeau: Yes. And I've been really grateful because Alan and I have done immunotherapy for a lot of patients now together as a team and your son, George, has been the recipient of these types of immunotherapies, both for environmental, as well as food allergies. We're trying to get better. The reason I called the book, The End of Food Allergies, because this year was the first year that we have an FDA approved drug. And that was just for peanut allergy. But like you know Agatha, there are many people with more than just peanut allergy. Many families have multiple food allergies and Alan and I are taking care of them.
[00:20:05] And we always need to be excited about the first kid on the block, i.e. Palforzia and it's use to be able to treat food allergy, i.e., peanut. But we got to think about what's coming to make sure again that science helps us know how to best give therapy and one size doesn't fit all. Different people have different reactions to the food therapy. So we have to make sure it's safe. And that's why some of these biologicals might help us better. We have vaccines. We have really neat drugs now, patches and sublingual immunotherapy that I talked about in the book. So there's a lot of hope and promise, and I hope that the book is helpful because there's a lot of companies now that are looking at developing food allergy therapies.
[00:20:49] Agatha Luczo: Well, I love that your method is all natural.
[00:20:52]Kari Nadeau: Yes.
[00:20:53] Agatha Luczo: And that there's many different options for parents to choose from.
[00:20:56] Kari Nadeau: Exactly. And of course, if you do have a reaction, people should use the injectable epinephrine device. We talk about that in the book about when to use it when not to use it. And then the other thing we also felt like our research around the world has helped with is better diagnostics. So many times people don't know if they have a food allergy or a food sensitivity. And we talk about what is what in the book. And then we also talk about how to best diagnose it and who to go to. Go to a doctor like Dr. Greene, a well-trained doctor so that we know who has allergies versus sensitivity.
[00:21:31] Agatha Luczo: . Oh, I'm so excited that all of this is available for everyone in your book.
[00:21:34] Dr. Greene: It seems to me that it really is good news in a backwards way that this epidemic is caused by environmental changes, because that means that we can make environmental changes and reverse it to reverse that sort of tsunami of food allergies. And a lot of that's going to be going back to real food as it was before.
[00:21:54] Kari Nadeau: Yes!
[00:21:54] Dr. Greene: And to clean our clothes and clean our dishes in ways that are the ways that we used to do it and cultivate the microbiome inside. It's really good news.
[00:22:03] Kari Nadeau: Exactly. I think all of us learned a lot about things to avoid, things to embrace and embracing the natural products and embracing good eating habits is so important for children. And I know that, you know, we both espouse that, and Agatha I know that's what you've done for your family to be proactive about these things, because the world is changing and like you said, Alan, if we have it in our power to change behaviors, let's do it. And let's help others.
[00:22:31] Dr. Greene: And that's not to say that genes don't play a role in allergies. It's just that they're not responsible for this dramatic increase. Our genes haven't changed in the last 20 years.
[00:22:40] Kari Nadeau: That's exactly right Alan. The genes have not changed and we've done identical twins where one will get food allergy and one will not, and there's nothing in their genetics. So it's to say that there are families that have allergies. That's true. But food allergies don't seem to be totally genetic. There's some very rare cases, but they're rare. So I think most importantly we can do something to change this. We can do something to try to prevent as well as treat. And we've got to think about both for any given family,
[00:23:11] Dr. Greene: And really effective options already on both ends of that. It's just been such a delight again to work with you and see people where allergies were a huge problem disappeared.
[00:23:20] Kari Nadeau: Yes, we're so happy about that. And we want to make sure that we do define a cure and end the food allergies for everybody. So it's just a great start and we're on our way, but there's lots more to do, and I'm excited to do it with both of you. And Agatha and Alan, it's just fantastic to work with you together. And I hope we can continue to do so.
[00:23:40] Agatha Luczo: Yes! We're excited!
[00:23:41] Dr. Greene: And thank you so much for being with us today.
[00:23:43] Agatha Luczo: Yeah, so I think for our takeaways today; One, parents should not feel guilty if their kids have food allergies. Two, when you are starting solids, if you have concerns that your child may have a food allergy, please talk to your pediatrician before introducing solid foods. But most parents will not have to avoid allergic foods. In fact, starting allergic foods early will likely help avoid food allergies.
[00:24:08] And three, if your child has food allergies, please talk to your pediatrician about immunotherapy and figuring out the next steps. Four, if your child does undergo immunotherapy, it's important to stay vigilant and to continue to take the maintenance dose and to carry epinephrine as the backup.
[00:24:26] Kari Nadeau: When you're doing any of these types of immunotherapies, it's really important to make sure that you slowly go up on your doses very carefully to maintain good safety and do it with a well-trained physician and staff. And it's better to do it in a clinical trial if you're not using an FDA approved drug.
[00:24:44] But importantly is when you're doing immunotherapy, when you get up to maintenance, you're going to need to keep on taking that maintenance dose. And that's important to just stay protected. So we really think it's critical and I hope that helps everyone when we talk about that in the book.
[00:25:00] Agatha Luczo: Yes. And five, if you have concerns, please buy Dr. Nadeau', book, The End of Food Allergy. It's amazing and I can't wait for the whole world to read it. And Dr. Kari Nadeau, thank you so much for all of your work and your dedication to this because the work you do is truly life changing.
[00:25:23] Kari Nadeau: It's my pleasure. And it's a blessing to work with all of you. Thank you.
[00:25:26]Dr. Greene: And so great to work with you.
[00:25:28] Agatha Luczo: Yeah. Thank you.
[00:25:29] Dr. Greene: I appreciate it. Thank you.
[00:25:30] Agatha Luczo: Thank you everyone for joining us today. And please join us next time and please rate, review, and share Mom Driven. Dr. Aligned
[00:25:39] Dr. Greene: Until next time. Be well.