Fredericksburg Parent

www.FredericksburgParent.NET 19 Join us for the live conversation on Stay tuned in March for a video interview that will explore more about allergies with Dr. Irina Dawson on the Fredericksburg Parent & Family Facebook and YouTube channels. Facebook: @fredericksburgparent • Twitter: @FredParent • Instagram: @fredparentmagazine a sk t h e e x p e rt Sponsored Material Q: What else do we know about the prevalence of food allergies and what might casuse it? The emergence of food allergies in the last two decades has a lot to do with the immune system not being active enough. There is something called the "hygiene hypoth- esis," which stipulates that extremely clean environments in the post-natal period fail to provide necessary expo- sure to germs required to educate the immune system. Decreasing incidence of infections has led to increase in allergic diseases and autoimmunity. In fact, developed countries with low rates of parasitic infections have much higher rates of food allergies and autoimmune dis- eases when compared to developing countries. Having a child exposed to his or her environment in safe ways, and not always being in a completely germ-free environ- ment, provides important opportunities for the immune system to act and develop appropriately. In other words—playing in the dirt isn't always a bad thing. Q: How do you work with families to help them figure out what is causing what may look like an allergic reaction in their child? My approach starts with a thorough history. Sometimes what a parent might think is a food allergy can be something entirely different. There are a lot of adverse food reactions which can mimic food allergy. I often see children undergoing extensive food allergy testing with lots of positive results to various foods. They are told to avoid these foods even though they were previously eating them with any issues. This can lead to nutritional deficiencies and unnecessary anxiety around eating, so we really want to narrow it down to the specific foods that are causing a reaction. The important thing to know about food allergy is that it is consistent and reproduc- ible—every time you eat that food, you are going to see a reaction. Food allergy testing, whether it is bloodwork or skin testing, can lead to false positive results. That's why it's so important to do a thorough history and talk about each reaction including timing, symptoms, and the foods involved. A complete history combined with food allergy testing are needed for a precise diagnosis. Q: How do you work with families to help them figure out what is caus- ing what may look like an allergic reaction in their child? My approach starts with a thorough history. Sometimes what a parent might think is a food allergy can be something entirely different.For allergies in gen- eral—whether they be food or seasonal allergies—are they consistent over a person's lifetime, or can they develop later in childhood, or even adulthood? Food allergies are more common in children. Milk, egg and wheat allergy tend to develop early in life with majority outgrowing these allergies by school age or teenage years. Allergies to peanuts, tree-nuts and shellfish tend to be more lifelong. Shellfish is an allergen that tends to develop later in life, even in adult- hood. It's definitely not as common to develop food allergies at an older age, but shellfish is the exception. For seasonal allergies and allergies to things like pet dander, these are a product of a person's environment, and often we see can see new allergies develop with different environmental exposure. The classic example is a college student who goes away to college, comes back for winter break and all of a sudden cannot be around the family cat or dog, even though it was never a problem before. Often it happens when you have a change in your environment that the aller- gies become more pronounced. When we stay in the same environment, we become desensitized to it. Upon re-exposure allergy symptoms can suddenly develop. Q: What is exciting to you about working in the Allergy Partners practice? For many years, the treatment for food allergy was considered avoid- ance. Once you were labelled allergic, you just avoided the food. Now, we are seeing oral immunotherapy becoming a tool that we can use to try to alter the immune response. It's similar to allergy shots. We take the allergic food and start giving it to the child in tiny doses, hoping they can build up their tolerance to that food. This is a fairly new treatment. At Allergy Partners of Fredericksburg, Dr. Nicholas Klaiber is currently conducting oral immunothera- py, and I hope to begin doing it as well. It is definitely the future. If we start this process early enough, we can even change the outcome of the food allergy, to where the child can even outgrow it. Q: Many parents avoid peanut butter with their infants not only because of previous advice about allergies, but also because pea- nut butter can be a choking hazard. Are there safer ways to introduce it? There is a snack called Bamba puffs that almost look like cheese puffs, but have peanut in them. These puffs were popular among children in Israel when the LEAP study was conducted. Researchers found that Israeli children who had been consuming Bamba puffs had a much lower prevalence of peanut allergy than children in the U.K., who had avoided peanuts as infants. You can also add a very small amount of peanut butter to formula or breast milk to safely intro- duce it at this age.

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