Kids' Wellness Matters Podcast Ep. 9: Navigating Food Allergies in Kids

March 7, 2024

Food allergies are one of the most common chronic childhood diseases, and several studies have suggested that food allergies have increased dramatically over the past several decades. Ruchi Gupta, MD, MPH, is a Lurie Children’s physician, food allergy researcher, and food allergy mom, who has been at the forefront of improving childhood and adult allergic diseases for the past two decades. In this episode, she discusses the prevalence of food allergies in children across the U. S., the latest treatments and research, and things we can all do to keep children with food allergies safe.

“We’re trying to help (food allergy) families with their daily lives by giving them resources that they can use in these important areas — where you don't have to go in alone. We're all here with you.”

- Ruchi Gupta, MD, MPH

Show Notes

A true food allergy is an immune-mediated condition where the immune system perceives a food type as an invader and attacks. About one in 13 kids have a food allergy.
Common symptoms include hives, itching and redness, throat swelling, GI symptoms, vomiting, trouble breathing, tightness in the chest, as well as cardiovascular symptoms.
Allergies to peanuts, tree nuts, shellfish, finfish, milk, eggs, wheat, soy, and sesame are common in children, though children can also outgrow these.
A study in 2017 showed that introducing peanut products to babies early can decrease the development of peanut allergy by 80 percent. The study also showed family history has no impact on allergy development.
For children who do not outgrow their allergies, many treatment options can mitigate effects including oral immunotherapy, sublingual immunotherapy, and epicutaneous immunotherapy. Additional options are on the horizon as well.
Severe allergic reactions such as anaphylaxis can be scary, and it’s important to keep epinephrine auto-injectors (EpiPens) on hand. If you’re unsure if epinephrine is needed, Gupta encourages caretakers to administer it anyway, as it won’t cause harm.
Allergy prevalence is increasing in the United States and there isn’t one exact reason why, but Gupta says some possibilities could be antibiotic use, which wipes out the microbiome, increased sanitization and pesticides. A recent adult allergy study showed that one in 10 adults has a food allergy, and 50 percent of adults developed a food allergy as an adult.
Internationally, allergies can vary by country as well. At the same time, families who immigrate have higher rates of food allergies.
For families struggling with food allergies, Gupta suggests joining support groups, seeing a pediatrician as well as an allergist, designing an action plan if a reaction occurs, and educating everyone around you about the allergy.
She also suggests empowering your children to understand and learn to manage their allergies themselves under your supervision.
Children with food allergies report positive feelings around advocacy for themselves and for others. They also reported greater empathy as well as healthier diets overall.

Transcript

[00:00:00] Nina Alfieri, MD: Welcome to Kids Wellness Matters. I'm Dr. Nina Alfieri.

[00:00:04] Rob Sanchez, MD: And I'm Dr. Rob Sanchez. We are both parents and pediatricians at the world renowned Ann & Robert H. Lurie Children's Hospital of Chicago.

[00:00:12] Nina Alfieri, MD: On this show, we'll chat with a wide range of experts about caring for children from newborn to young adult. Because Kids Wellness Matters.

[00:00:27] Rob Sanchez, MD: Food allergies are one of the most common chronic childhood diseases, and several studies have suggested that food allergies have increased dramatically over the past several decades. Today's guest, Dr. Ruchi Gupta, is a physician, food allergy researcher, and Food Allergy mom, who has been at the forefront of improving childhood and adult allergic diseases for the past two decades. She joins us today to talk about the prevalence of food allergies in children across the U. S., the latest treatments and research, and things we can all do to keep children with food allergies safe. Dr. Gupta is a professor of pediatrics and medicine at Northwestern University Feinberg School of Medicine and a clinical attending physician here at Ann & Robert H. Lurie Children's Hospital of Chicago. Dr. Ruchi Gupta, welcome.

[00:01:10] Ruchi S. Gupta, MD, MPH: Thank you so much, Rob. So happy to be here.

[00:01:12] Rob Sanchez, MD: First off, can you explain what constitutes a food allergy in infants or children?

[00:01:18] Ruchi S. Gupta, MD, MPH: So it is very confusing. And this is very important because what we've seen is people don't really understand what a food allergy is. And often when they have a reaction to a food, they think it may be a food allergy. So what is it? So a food allergy, a true food allergy is an immune mediated condition. So your immune system is recognizing this food as an invader. And it just attacks. About one in 13 kids have a food allergy. And if you think about what's happening in your body, like I said, it's the invader coming in and it releases all these chemicals, things like histamine. And it causes your body to have this reaction that can be very severe and also can have mild symptoms. So the problem with food allergies is it impacts every organ system. So it's not like asthma where it's mostly your breathing or an intolerance which is mainly your gut. So in food allergies, some of the common symptoms include skin symptoms like hives, we often think of, itching, redness, throat can start closing, you can get GI symptoms, vomiting is really common. You can get lung symptoms, so trouble breathing or tightness in the chest, and you can also get cardiovascular symptoms. So you can have a drop in blood pressure and fainting, and it can progress rapidly. So this is why it's so important to recognize and know what it is.

[00:02:39] Rob Sanchez, MD: I love that explanation. I have those conversations often with my families and their children in my primary care clinic, and I really like that idea. It's this invader comes in, overreaction, the histamines get activated, and it's not like they're just going to one place. They're going all over. And that's why it can present in so many different ways. And so one common question is when this occurs. So how and when do most parents get this diagnosis?

[00:03:04] Ruchi S. Gupta, MD, MPH: That's a really important question. So it can really range. Often it's when your baby starts eating a new food, right? So we see it in the first year of life, you're introducing new foods and then they have a reaction and then they get to their pediatrician, like you or me, and then they're allergist and get the formal diagnosis, but it can occur later. And we don't know if certain foods we see higher prevalence at certain ages because that's when they're trying them. Things like shellfish or fin fish, we see those starting a little bit later in life and then increasing all the way into adulthood, most common allergen in adults even. But then other things like peanuts and tree nuts you see sporadically throughout childhood. The two biggest ones for babies are milk and egg. Those are the top ones we see in that first year of life. But typically they occur early in life. And then, some of them you can outgrow. Milk and egg, wheat and soy. About 50 percent tend to outgrow those at least. And then the nuts, peanuts, tree nuts, shellfish, fin fish, it's lower. Closer to 15 or 20 percent naturally outgrow those.

[00:04:08] Rob Sanchez, MD: Certainly reassuring information here that it is possible to outgrow them eventually in some of those cases, but while they are still allergic to those, certain risks certainly exist. If your child does have a food allergy, can you speak to that? Can you explain the risks that children with food allergies face?

[00:04:26] Ruchi S. Gupta, MD, MPH: Absolutely. I mean, personally, I live this every day. My daughter was diagnosed at age one when my four-year-old son was eating a peanut butter and jelly sandwich and playing with her and probably got some in her mouth. And so she had those symptoms of hives and vomiting. Got to the hospital and got her a diagnosis. And this was after I had already started researching food allergies. So, now it was everything I do 24/7. So, it is very scary for families because food is a part of everything, especially little kids and sending them off to school having them play with other kids and share foods. I mean, those are all things that are very risky and very scary. What's great is in the past 20 years, there has been such tremendous awareness, so most schools hopefully are better about keeping kids safe, but it's really, really important for families to help educate the schools to understand what safe foods are for their child and make sure, that they are in a protected environment everywhere they go. But because food is everywhere, I think that's what causes a lot of stress and anxiety, and quality of life really does decrease, when you have a child with food allergies. But, as a parent whose daughter now is 17 and now I'm stressing about her going off to college with food allergies, you can take control of it and you can manage it and your child can live an amazing life through their food allergies.

[00:05:47] Rob Sanchez, MD: That's so important and relevant and empowering to hear that your work as a physician, but also just how personal this is to you as a parent, that you've had so much of that experience inform your work. You mentioned that you were already researching allergies prior to it and then your child developed this allergy. Can you say even more about how that experience, like just informed your work, impacted it? You know, I could just imagine just how important that experience has been.

[00:06:12] Ruchi S. Gupta, MD, MPH: Oh, absolutely. I had started researching it because of another family I had met who had two young children with food allergies. And so their passion around this space is really what prompted me to look at it. I had been studying asthma prior to getting into food allergy and there was so little we knew at that time. So, you know, I started learning about it, studying it, understanding prevalence. Those were some of our first studies. And then when my daughter developed it, it really opened my eyes to the impact on quality of life. Every day, everything we did focused around her food allergy for a while. Everywhere we went to eat. People's homes we went to because I had a, I mean, I still have a son. My son is now 21, but he did not have food allergies. Life was very different and watching them both grow up and how different their lives are. He can freely go anywhere, do anything, and we have to do some prep when it's about her. So I think what it did for my research is really pull me into studies related to how do we improve quality of life? You know, how do we have more families in school? So we've created, and it's all on our website freely available, but we've created videos for elementary, middle, high school, even daycare centers, educational videos, and now college. We have a group of college students who are really interested. And so what we're trying to do is help families with their daily lives by giving them resources that they can use in these important areas where, you know, you don't have to go in alone. We're all kind of here with you. And so I think the biggest influence is as I went through life with her, I noticed areas of need and I'm fortunate enough to be able to take those ideas into my lab and do something about it. I think that was the biggest change. So now we study a lot around public health impact, so prevalence, disparities are really important in food allergy. Then we also study, or we do a lot with communities. So, all the school research, quality of life research. And then interestingly, prevention. Because the New York Times wrote an article when early introduction was big, or it came out in 2017 and I did an interview with them, and then the last thing they said was, Dr. Gupta is slapping herself on the wrist for not introducing peanut to her daughter earlier. So parent guilt, so then it was like a new mission, well we really need to get the word out and really try to prevent food allergies in as many babies as we can and turn this whole epidemic around. So that's the third area of research that we're really focused on.

[00:08:47] Rob Sanchez, MD: With that food introduction, I know that parents, and I see this in my day to day work, there's a lot of anxiety. There's a lot of concern about that, that first introduction of foods. And that might be a natural question that parents have. I know you spoke to your child's first exposure and first experience. When it comes to that first time exposure, is it possible for a first time exposure to be life threatening?

[00:09:09] Ruchi S. Gupta, MD, MPH: Very good question. And I do want to help families with those fears, cause it is scary. Because for so long we've heard on the news, peanut allergies are deadly, but what we have found is that this epidemic of food allergy started increasing. In the year 2000 when I was training, the American Academy of Pediatrics put out a statement for pediatricians to tell parents to wait to introduce peanuts till three, an egg till two. And a lot of this, we didn't have any data, but I think it was based on fear, right? Because you saw this increase in peanut allergies and we're like, we don't want those babies having any of those types of reactions, is my thought. So then in 2008, there was no data still, so they said, alright, we're taking that away, but do whatever you want. But us as pediatricians, we kept encouraging the wait, right? Wait till age three. So, fast forward 2017, a study came out, the LEAP study out of London, showing that introducing peanut products early to babies can actually decrease the development of peanut allergy by 80%.. That number was so dramatic that here in the U. S., the NIH called a group together, which I was fortunate enough to be on, to say, what do we do with this? And so those guidelines got reversed. And now we say, introduce peanut products. And, when we say peanut products, we also mean egg. There's a lot of great data on egg, milk products, things like yogurt, a lot of these allergens because when your immune system is developing in that first year of life is when you have the highest chance of your body not thinking it's an invader, right? You take it in, and your body says, oh, okay. This is cool. This is normal. Well, we're going, we're going let you in.

[00:10:55] Rob Sanchez, MD: You're cool. Come on, come on in

[00:10:57] Ruchi S. Gupta, MD, MPH: Yes. Join the party. Yes, so that is the goal with early introduction in terms of how. So for parents, a couple of things that are really important are when you introduce peanut products, do it early. When your child starts getting ready for solid foods, around four to five months, usually most kids are, don't make it the first food, but soon after. And take a little bit of peanut butter, a teaspoon, mix it with breast milk, formula applesauce, water, whatever you want, just to thin it out, and put a little bit on their lip. And let them taste it. Usually, most babies love it. And then they'll eat that up, and then give them a little more. And do it slowly over time. What you look for is the reactions that most babies have if they are going to be allergic are hives. They tend to get hives or a rash, a lot of times on their face but going down their neck, and vomiting. Those are the two most common things we see in infants younger than one age. You can have other symptoms, but they're very rare. And if you go slow like that, chances are they won't have any of the more severe symptoms. So highly encourage parents to do it. The second big tip, I've seen this in practice, you probably have. They'll introduce, they'll say, great, we got it in, all good. Three months later, they'll feed again and reaction. So the important thing is keeping it in their diet. So try to give it to them two to three times a week. Around two teaspoons is ideal, but if you can keep it in their diet on a regular basis, that is the maximum chance of success to avoid that allergy.

[00:12:35] Rob Sanchez, MD: I love that. I remember doing it with my firstborn. This would have been about a year and a half ago too. And we followed that exact same thing. Did a little mixture with the breast milk. I had the camera on him and everything. And even knowing that we were following these guidelines, yeah, you still have a little bit of anxiety. That's just natural. But I think there's so much importance in knowing and your advice and your expertise to know that, hey, this is okay. There's good reason for it. And we can provide support. I think oftentimes in the conversations I have with families, when I give this advice is, hey, have a camera close by if something happens that you're not sure about, take a photo, take a copy of it, bring it over to us. We can talk about it and then we can help guide you forward. And I've had conversations where it's been totally benign, totally okay. And we've guided them and given reassurance and other ones where, Hey, there might've been a reaction. Then we can give them guidance and support if that does happen. And I think that does help provide those support for families. And I imagine those are conversations that you've had with families throughout your career as well.

[00:13:29] Ruchi S. Gupta, MD, MPH: Absolutely. I mean, we hear, you probably do too, so many of my patients are like, we introduced it in your waiting room, or we introduced it in the parking lot of the emergency room. And I don't want families to think they have to do that, but there's always going to be a little bit of that anxiety, but the majority of kids, especially if they're not high risk, do totally fine. So let's talk about high risk real quick. So, one of the biggest risk factors for developing food allergies Is eczema. Severe eczema. So if your child has severe eczema, do talk to your pediatrician, and it may be more advantageous for you to actually see an allergist and just do it in their office. People ask about family history. My older kid has a peanut allergy. Is it okay to introduce my younger child? This is also really important because in the study, in the LEAP study, they found that family history did not have an impact. So just keep your younger child in a safe space, keep the peanut butter or whatever away from your older child. But get it in them, and you don't necessarily need to see an allergist or do it there. However, we always say both of us, like if parents are scared, if you're worried and you're not comfortable doing it, then we will get you to an allergist. We'll get you in so that you can do it under supervised conditions. But just do it. I don't want any other kids ending up like my daughter. Not, I mean, she's amazing. I love her. But, the, peanut and tree nut allergies have been so challenging and if we can avoid it, more power to you.

[00:14:59] Rob Sanchez, MD: Right. And, it's understandable. Like, it's so important to do. It's a little bit like Nike, you know, just do it, but, I also want to normalize that as parents and pediatricians, as providers, we understand the nerves, the anxiety, the worry that goes into it. You talked about the possibility for some of these allergies to be outgrown. And I wanted to get a sense of what your experience was with your daughter, how it was kind of assessed and was she able to outgrow some of those or did they continue on? It would just be great to get your experience as we ask, like can children such as your daughter have the possibility of outgrowing food allergies.

[00:15:31] Ruchi S. Gupta, MD, MPH: Absolutely. Let's start with what are common food allergies. So the top nine, we've talked about peanuts and tree nuts a lot. We talked about egg and milk, talked about shellfish, fin fish, also wheat and soy. And then the newest one that's up and coming, the hot new allergen is sesame, we're seeing a lot of it, especially in European countries, but in the U.S. as well. So those are the top nine. Those are foods that now the government has regulated have to be properly labeled but you can be allergic to anything, any foods. So, what you mentioned about outgrowing, so of those top nine, milk, egg, soy, and wheat are the ones we see kids outgrowing the fastest. And that's great because those are the hardest to avoid. So my daughter was diagnosed with egg, when she was diagnosed with peanut at age one, but she outgrew it by age three, which was great. So for families who have kids who have already been diagnosed with food allergy egg and milk, this is really important. So for egg and milk, we have new data that most kids can tolerate baked egg and milk, which is awesome because that's all they want.

[00:16:35] Rob Sanchez, MD: That's cookies. That's cookies. That's cake. That's so many things that kids love.

[00:16:40] Ruchi S. Gupta, MD, MPH: Yes, exactly. So get to an allergist and do a baked challenge. And if they can eat that baked food, they would be happy to keep it in their diet every single day. And, data shows that if you do that, then your chances of outgrowing that whole allergen is higher. So this has been great news. The others, peanut, tree nuts like I said, and shellfish and fish, those are tougher. For my daughter, she outgrew egg and then kept her peanut and tree nuts. This year we thought she may have outgrown peanut and we did a food challenge and she did not, she failed, but you know, what was great is she got up to half a peanut. So, the other thing I encourage families to do is to continue to go to your allergist on a regular basis. A lot of families I see, they have the allergen, they're like, oh well, and time goes by. But you want to get it checked. You want to see if your numbers are going down, and then when you might be ready for that food challenge. Because even if you fail. What was so empowering about that was my daughter now is not as scared. It's not going to be like just a crumb, you know, that causes her to have an allergic reaction. She can eat things with precautionary allergen labels now. And you know, it just opens up your world a little bit more. The other really exciting stuff in food allergy, I have to say, I've been studying this, like I said, 20 years. This field has changed so fast and gotten better. We have prevention, and now we have treatments.

[00:18:08] Rob Sanchez, MD: Yes. This is so exciting.

[00:18:09] Ruchi S. Gupta, MD, MPH: So when you said if your kid's not outgrowing it what is great is we have options. And it couldn't come at a better time, since I'm so nervous about her going to college with her food allergy. But now, many allergists do something called oral immunotherapy. So, what that is, is giving you a little bit of the food, slowly, and increasing it so that your immune system gets used to it. Something similar to allergy shots. So, increasing the dose. It's not a cure. But then frees you up, right? You know your kid can now eat a whole peanut, you know? And so it takes away that daily fear of what happens if they get a couple crumbs. So, oral immunotherapy is being done pretty much in every state right now by select allergists. The other couple things that are getting more popular is sublingual immunotherapy. So these are the same concept, but drops under your tongue. So smaller amounts. Third thing that they just published their data and I think will be out within the next year is epicutaneous immunotherapy. So it's a patch, same concept, little bits of protein getting into your body and you getting used to them. And then the fourth big area is biologics. So, there's certain medications that we've used for other conditions. So, one that is really moving fast is omalizumab or Xolair. We've used it for asthma for years but they've done some studies that look promising. And so that may be a biologic where you get a shot once a month, and helps protect you from those allergic reactions. So, there's a lot coming out in the next 5 to 10 years. So, it's not, oh no, they're going to have to live with us forever, but we will have treatments.

[00:19:51] Rob Sanchez, MD: That's so exciting to know that these novel therapies are coming out and that there is a lot of work, and folks that are dedicated to improving on this. And so I would love to get your experience with working with the current therapies that are there. And as we know, in cases of allergies such as anaphylaxis, so severe allergic reactions, our main go to are things like EpiPens or injections of epinephrine to help manage those. Can you speak to your experience and also give an explanation of what happens during severe allergic reactions and why we need this therapy to help?

[00:20:21] Ruchi S. Gupta, MD, MPH: So, when you have a reaction or when your child has a reaction, it's so important to observe what's happening. So, anaphylaxis, the word you mentioned, is a severe allergic reaction that usually happens rapidly within minutes and keeps getting worse, so what I mean by that is, you know, you may start out with vomiting or hives and then quickly, continue to feel sick, maybe lightheaded or dizzy or start having throat closing or trouble breathing. All of this happens very rapidly and it's incredibly critical to know what's happening and get epinephrine in your child as quickly as possible. So, epinephrine auto injectors. We're very fortunate we have multiple to choose from now. Ones that talk to you, the normal ones from the past, but this is very important to get it into the lateral thigh. Hold it just for a couple seconds, not 10 anymore, it's about 2. Get it out of them. It doesn't hurt and it will help them feel better very, very quickly because what it does is it almost reverses that reaction that's happening. So it relaxes, kind of your breathing airways and it tightens up your blood vessels, so that drop in blood pressure doesn't happen and it's easier to breathe. So get epinephrine in. Now, A lot of people are like, Oh, I don't know if it's getting worse. I don't know when to use epinephrine. And it is hard. I've been in that situation. In fact, I was in that situation just a month ago when we were on vacation at a restaurant. And what I say to that is use it as quickly as possible. If you're at all in doubt, use it. It is not harmful. Epinephrine is what we have in our own bodies. It's adrenaline. You're not, putting in something brand new your body hasn't seen. We haven't seen negative effects from it. So get it in. If you're in doubt, just use it. So that is typically the management for anaphylaxis or one of those severe allergic reactions. And as someone who talks to parents about this all the time, does research on it, I know because when I sat there watching her, I was also scared and like, when do I use it? I would just highly encourage, go for it and use it. Now you know, if it still keeps progressing, this is why it's important to have two epinephrine auto injectors with you, because there is a chance it won't stop and it'll keep progressing. And so, You can give a second one, pretty quickly, and then, get to medical help.So, the other thing that's exciting on the forefront within the next year or two is, we're going to have new epinephrine auto injectors. There's a nasal spray that's coming out. There's two companies working on nasal epinephrine and there's one company I know of that's working on sublingual epinephrine. So, you're going to have choices and, you know, a lot of families feel more comfortable with that than an injection, and kids do too. So, it might make it even easier to give.

[00:23:04] Rob Sanchez, MD: That's great to hear. And I wanted to touch base to our experience that you mentioned about what we're seeing in the United States and in the larger area. We know that this rate of increase of allergies or the prevalence is increasing in the United States. I wanted to ask, can you speak to, is this a global problem? Is there something more unique to the United States that we're seeing? And is that also affecting the age at which these food allergies are arising, especially in young adults, teenagers, or other adult populations as well?

[00:23:31] Ruchi S. Gupta, MD, MPH: We actually just conducted a study on adults a couple years ago, and to surprise, about 1 in 10 adults seem to have a convincing food allergy. About 1 in 5 think they have a food allergy. They said yes. And this goes back to getting to your doctor and talking about your symptoms because there's a lot of intolerances, sensitivities, and different things that can cause you to react to a food, but knowing what you have and kind of having that whole management we just talked about in place is really critical. The types of foods are a little bit different. Shellfish is the top, about 3 percent of U. S. adults say they have a shellfish or have a convincing shellfish allergy. Very, very interesting data. So, what's happening? Globally, yes, food allergies, we've been seeing them everywhere. Europe and Australia have probably the strongest data on prevalence, and their numbers are close to ours. So, like I said, about 8 percent of kids, 10 percent of adults having food allergies. We're seeing very similar data. What's interesting is the foods are different. So, it really does go to kind of the most common foods eaten in a place. For example, hazelnut is not a big food allergy in the U. S., but it's one of the top food allergens in France. You know, so, it is interesting the types of foods we're seeing. Many countries we don't have great data for, but the ones we do, we are seeing certain foods on the rise. The other really interesting thing is people who immigrate from another country. So, we've seen this. Australia's published data and we're doing some research on this right now, especially Asian countries. And I guess this is personal for me too. We had no food allergies. We had no atopic conditions, my husband and I, but both my kids are highly atopic, you know? So what is that environment piece that changed? And we're seeing that in the US, and like I said in Australia, when families immigrate, especially from Asia, they have higher rates of atopic conditions, especially food allergy, than even people locally. So what is the protective piece that they're missing that causes that? And everyone, a lot of us researchers are really trying to understand what is it. So two questions why, the big why, but the big area that is top of mind for most is the microbiome. So, what is changing in our microbiome? And I know that's a hot topic for all diseases right now, but if you think about food allergies, what's changed? So, more C section births, babies aren't getting mom's microbiome. More antibiotics, you know, in the past generation, like, I know we've stopped, but, I'm older than you, but when I was training, antibiotics, you know, we were just starting that, okay, we shouldn't be giving so much, right? And we should do watchful waiting more, but antibiotics were given a lot to a lot of these infants, which wipes out bad, but also the good microbiome. And then we've been so clean, right? We talk about that, how many antibacterial cleansers we're using everywhere and letting your kids be exposed and play in the dirt so they can actually develop that immune resistance to things they should be developing it to. Those are some of the common ones. And then, the next one is, what we eat. So the two pieces to that, like how has the food we eat changed in the last generation? More processed foods, we're not eating locally as much. What pesticides are helping the plants grow, but also may impact our gut, right? And so a lot of research is going into what are we eating and have we swung too far, and do we need to get back in the middle somewhere? So. It's interesting. And then adults, 50 percent of adults said they developed a new food allergy as an adult. They didn't have it as a child. So, we asked them why do you think you developed this food allergy? And a couple things that seem to be top of the list are having a viral or bacterial infection that may have Impacted their immune system around the time, a move, location move, so environment. And then the third for women are hormonal changes. That's really big. We see increased rates during different times. So puberty, pregnancy, and menopause. So those were some of the leaders and potential hypotheses.

[00:27:51] Rob Sanchez, MD: It's truly fascinating and probably explains why there's so much interest in exploring this, this larger question of the why, you know, as we're seeing this prevalence go up. And, the way I think about that is that so much of it comes down to exposure, but that's at the macro level, literally moving across the world or, or moving between continents can impact it. But at this microscopic level too, like we talk about the foods that we're eating, what our gut microbiome is experiencing and our hormones, the interconnectivity of that. I want to transition a little bit to what we can do to help keep children and families safe. And have to speak to your experience as a food allergy mom, as a food allergy researcher, what advice do you have for food allergy parents, both to the quality of life that you mentioned, but also just, working within this world of where folks are seeing an increased prevalence of allergies and how to live within it?

[00:28:40] Ruchi S. Gupta, MD, MPH: We have seen, from my early days, how much of an impact food allergy has on families. So know that you're not alone. So a couple tips I have. One, find other families, join support groups. There's really great advocacy groups across the U. S. There's support groups in every city. And you learn so much. I remember even though I was doing research in this and, you know, I'm a pediatrician, joining that support group helped me so much and how to manage and how to talk to people about it. And, really cool ideas for educating. Second, see your pediatrician, see an allergist, get your management action plan . Get your epinephrine. Be ready and prepared, educate everyone around you. There's some really cool ideas on how to do this. I remember in my support group here in Chicago, I learned about having parties with your kids, and bringing their friends in because one of the biggest things is if their friends are supportive, they do so much better, right? They're not feeling alone. So bring their friends and do a fun activity. It doesn't have to be a lecture, but what we would do is get grapefruits and you have expired epinephrine auto injectors and let them use them and they have so much fun and then they're not as scared of them anymore, it's very, very empowering. So, do things where your child also has a group of friends that understand what the food allergy is and can help advocate for them. That was really big. Third thing, you know, we see a lot of discord even in couples, because one thing I learned in one of our studies early on is moms and I'm not trying to, make, generalizations, but a lot of moms feel very protective, right, and want to take the food out of the house and protect your kid wherever they go, and get very frustrated maybe at their partners for not being as vigilant. And it could go the other way too, but one parent may be very vigilant, one not so vigilant. And so, one thing I'll recommend with this, because even personally, when my daughter, I was that protective mom, and then I saw my daughter having more anxiety around being around her food allergen, and being very scared when I wasn't with her. So, empower your kids. So, one, I remember she would always hand me everything to read the label. And I would start pretending not to read it right, right? And then hand it to her, and this is obviously when they're older and able to read. And then she would look at it and she'd be like, Mom, oh my God. This has peanut in it, and obviously I wasn't going let her ingest it, but empowering your kid, like we'd go to restaurants and she'd expect me to ask or say, so get your kids to start feeling good about advocating for themselves, be right there as they learn, but that'll really bode well for them as they continue their journey, because eventually, they're going to be like my daughter, 17, and have to advocate for herself and doesn't want me around with her at the parties and the dinners anymore.

[00:31:28] Rob Sanchez, MD: Yeah, absolutely.

[00:31:30] Ruchi S. Gupta, MD, MPH: So I'd say those things. And then, like I said, I'll give you our website, it's cfar. northwestern. edu but we have a lot of free resources. So do other advocacy groups, and I'm happy to share all of those. Don't reinvent the wheel, use all the great work that's been done and let it help you and your family. And then my last thing, last thing, I promise, is, I do want to put a plug in for all these great kids with food allergies because we did a study a couple things we found were, like I said, having friends really helps them, who support them. But then we asked them also what positive has come out of your food allergy, anything, and the couple things they said were that first thing that I mentioned, advocating for themselves, for themselves and for others. And then the second one was empathy. They said they really better understand what other people are going through and support them. And then the third, which is always good, is they eat healthier because they have to read every label and they know what they're putting in their mouth. So it's not all bad. Your child can thrive with a food allergy.

[00:32:35] Rob Sanchez, MD: That perspective is so key. I mean, we start off the conversation, hey, this is a serious chronic condition, but to also have that perspective that this is also something that builds resilience and empathy and self advocacy. That's so key as a pediatrician, as a parent, and how we communicate to our families. I love that insight, and thank you so much for sharing that with us. I want to ask one more thing, and this is a little bit of a selfish thing too, but I know parents might think about it as well. It's kind of how we can be a good partner as well. How can we be supportive of children with food allergies? So if our children as parents don't have food allergies, but they're in a class or a team or friends with kids with food allergies, how can we help those friends be safe? How can we be a good ally in that friend group? Love to hear your insights on that.

[00:33:20] Ruchi S. Gupta, MD, MPH: I think it is the most important thing. When I would get an invitation for a birthday party, say, for your child, and they would actually put on there, please let me know if your child has any food allergies. Oh my God, that meant so much to me, because you're not the one having to say, hey, by the way. So things like that, like just putting it out there that you're aware of it and you're supporting, by asking if you're having an event if a child is coming over, ask, you know, what can I do? What's safe for them to eat? It feels so good not to be the one to have to bring it up. And what I love is now when we go to restaurants, I'm always so grateful when the server comes and asks, right? Like, are there any food allergies I should be aware of? And it's happening more and more. And I, every time I'm like, Oh my God, thank you so much. Because it changes your life. You're not like, oh, and by the way... They're proactive. So I think being a proactive parent with your friends who have kids with food allergies, I remember my daughter used to sit at the allergy table and there weren't that many other kids in her class. And so her friend's parents reached out to me and said, Hey, can my kid sit with your kid? Tell me what to send food wise with them that will be safe. And oh my God, it changed our lives. I mean, I'm going to get teary.

[00:34:33] Rob Sanchez, MD: That's so powerful.

[00:34:34] Ruchi S. Gupta, MD, MPH: Yeah, The fact that parents were willing to have their child join my child and pack safe foods, things like that. Yeah, really, really have such a great impact on families.

[00:34:45] Rob Sanchez, MD: That's so great to hear. And thank you. Thank you for sharing. Dr. Ruchi Gupta, thank you so much for sharing all of your knowledge, your experience as a parent and as a researcher. Thank you so much for taking the time today.

[00:34:56] Ruchi S. Gupta, MD, MPH: Oh my goodness. My pleasure. Thank you for having me. This has been great.

[00:35:00] Rob Sanchez, MD: Thanks for listening to Kids' Wellness Matters. For more information on this episode and all things kids wellness, please visit LurieChildrens. org