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Kari Nadeau: Science takes on food allergies

Once avoidance was the only answer, but a leading allergist says that advances in desensitizing allergies are challenging common convention.

Common foods that cause allergic reactions are peanut, milk, eggs, tree nuts, wheat, soy, fish and sesame

Common foods that cause allergic reactions are peanut, milk, eggs, tree nuts, wheat, soy, fish and sesame. | Illustration by Kevin Craft

Food allergy expert Kari Nadeau, MD, PhD, says that as many as one in ten adults in the U.S. has a food allergy, many without knowing it.

With consequences that range from mild to serious (including lethal anaphylaxis), it is imperative that medical scientists become better adept at spotting food allergies and ultimately at helping patients cope with allergies.

Nadeau notes that while a cure remains elusive, it’s a "moonshot issue" worthy of pursuit. She has seen positive results with incremental desensitization therapies that build a patient's tolerance for foods that cause allergic reactions. In addition, new gene therapies are just emerging that are offering a glimmer of promise for those whose diets and lifestyles have been impacted by food allergies.

Join host Russ Altman — once allergic to seafood but now able to indulge in lobster thanks to desensitization therapy — and allergist Kari Nadeau for a look ahead at the hopeful future for people with severe food allergies. You can listen to The Future of Everything on Sirius XM Insight Channel 121iTunesGoogle PlaySoundCloudSpotifyStitcher or via Stanford Engineering Magazine.

Full Transcript

Russ Altman: Today on The Future of Everything, the future of allergies. I’m gonna start with a little bit of a personal story here today, a little unusual for me.

I grew up in New York and we spent lots of time out on Long Island in a little town called East Quogue, where there was abundant seafood. Clams, mussels, lobsters, shrimp, crab, and I have extremely fond memories of my grandfather buying lobsters for everyone. We would put newspaper on the table, get bowls of butter melted, and dip lobster, and dip seafood in the butter and eat it. It was wonderful. And we had shrimp around the house all the time and my mother loved it an cooked it and I just loved seafood.

When I was 24 years old, or so, I was traveling, I was on a trip to Boston, and I went out to dinner to some seafood restaurant, and I returned to my hotel and I had a runny nose, I had watery eyes. My face was obviously red. And I was wheezing, I had asthma. I was having trouble breathing. I didn’t feel like I needed to go to the hospital but this was a big enough deal that when I thought about it, I said, “You know what? The last couple of times when I’ve been to seafood restaurants, I’ve had this kind of reaction.”

It was obvious I needed to be evaluated.

So I went to the doctor and they pricked, they sent me for an allergy test and back then, and maybe now too, they had me lay down on my stomach and in 60 different spots on my back, they poked me with a little needle and put in a little challenge, like, leaves from different trees and extracts from different animals.

And they did 60 of these and at the end they said, “Well, we did 60 different food and plant and other challenges and you had a reaction to 58 of them, including big reactions to shrimp, crab, and lobster. And in fact, the only two things you didn’t react to were horses and rabbits.” And they said to me, “Have you ever been anywhere near a horse or a rabbit?”

I said, “No, I’m from New York, I don’t know what rabbits look like, I don’t know what horses look like.”

And they said “Yeah, So, if you ever do come in contact with them, you probably will be allergic eventually, but you’ve never seen them before, so you’re not.” Then he said, “No more shrimp, crab, or lobster.”

In fact, clams, mussels, oysters, were okay, but those other three were not. And I was profoundly sad, and for the next thirty years, I stayed away from those foods, It became actually, a part of my self-image, ’cause, I always had to fill this out. You know, when you go to a meal, they say, "Do you have any food limitations," and I always listed it. It really becomes part of my self-identity.

And then I met Dr. Kari Nadeau, who we’ll be speaking with in a moment, but first I want to finish my story. And I described this, I said "Oh, you’re an allergy person, "let me tell you about my allergy "because it’s a bummer" and I used to say, "What I might do is have my final meal. You know, I’ll be old, I’ll have some terrible disease. I will just have a big plate of lobster and that’ll be it." That was kind of what I was thinking. And Kari said, "No, no, no, I may be able to help. And then, we’ll make this story shorter, and we’ll maybe talk about it more later.

Over the next six months she treated me in a certain way with certain new medications that we can talk about. But the bottom line is that over that six month period, I was desensitized and I was able to take my first shrimp and then my first crab, and then my first lobster in more then 30 years.

And actually, there was an emotional aspect to this, because I was able to eat these foods that I had eaten with my grandfather and with my family as a young boy, it was a big deal. And in fact, there’s been two or three years since then and I’ve had paella, the famous Spanish dish filled with seafood. I’ve had that on my birthday, every time now, since then, and I’m pretty sure that for the rest of my life I’m gonna be having paella on my birthday as a celebration. And in fact, I believe, I liked to believe, that I was instructed to make sure that I ate a certain amount of crab, shrimp, and lobster on a regular basis, and I have never been so happy to obey a doctors order, then to tell my friends “I’m sorry, but I simply must have lobster this week, because it’s doctors orders.” Okay, that’s my story.

Now, Dr. Kari Nadeau is a professor of pediatrics, pediatric food allergy, immunology, and asthma at Stanford University. She is an expert on food allergies, their prevention, obviously their treatment, and the ways in which climate change may be impacting both the food supply and the allergies that result from it.

Let’s start out with basics Kari. What is a food allergy and are they increasing in the population?

Kari Nadeau: Yeah, thanks for asking that and thank you for inviting me here today, it’s really wonderful.

Russ Altman: It’s our pleasure.

Kari Nadeau: And, it’s great to hear your story and make sure we can deliver on hope and promise and make sure people get to eat lots of lobster in the future without fear.

Russ Altman: Because of that story I would take a bullet for you.

Kari Nadeau: Well, it’s a team approach for sure and there’s lots of science behind what you’re able to do and it’s really all you Russ, and I appreciate the fact that you can talk about it today. So, what is a food allergy? We like to describe that as a disease, it’s a disabling disease as you suffered from. It’s a disease in which you have to eat a food, and when you do, you have these reactions, like you did. You have itchy eyes, itchy nose, congestion, you can wheeze with it, you’d get a lot of mucous and this can all happen within six minutes.

Russ Altman: Yes.

Kari Nadeau: In fact 80 percent of the time, you mostly have just hives on skin, but about 20 percent of the time, you can have abdominal pain, vomiting, as well as blood pressure changes, and then wheezing, so we take it really seriously.

Russ Altman: And that was part of what they warned me about, and why I needed to stop, because I had had this increasingly brisk response, and they were worried that the next one could be a big bad one.

Kari Nadeau: Exactly. So that at any point in time, someone that has a doctor’s diagnosis of food allergy, has a 25 percent chance of having a severe reaction. And that, the typical food allergy patient, about 60 percent of their reactions at some point in their life will be severe. It accumulates as you move forward in life, so I’m really glad that you didn’t have to suffer. But importantly we took care of you with therapy.

Russ Altman: Yes.

Kari Nadeau: That we need to make sure lasts. But contrast food allergy to food sensitivity.

Russ Altman: Okay, good, so that’s another thing that’s in the air, a lot of discussion on social media.

Kari Nadeau: Exactly, and we like to differentiate food sensitivity versus food allergy because with food allergy we know that’s a molecule called IgE. I call that the match that lights the fire behind allergies, and specifically food allergies, it can be quite dangerous. It’s not the only molecule that we like to look at in food allergy, but that’s the molecule that we know, if you have a food allergy, that’s gonna be positive, and we need to watch that. Because any amount of dose can affect you. You might say, "Well, last night I ate a whole pot of lobster." But in fact another night, you could actually eat just a small amount and have the same similar reaction.

Russ Altman: And this is called IgE. It’s an immunoglobulin, I believe.

Kari Nadeau: Exactly.

Russ Altman: And it’s Type E.

Kari Nadeau: That’s right. It’s Type E, it’s one of the lowest frequent immunoglobulins in our body. But we think it was meant to probably fight against parasites, not meant to fight against food, but it has this maldirected, in some patients, this maldirected attack on foods and also pollens and other allergies that people can have. One third of the whole planet has allergies. And about 8–10% of people have food allergies. We need to think about how much this IgE does its damage, and it is serious. The food sensitivities don’t have IgE.

Russ Altman: Okay.

Kari Nadeau: And food sensitivities are, for example, when you bite into an onion, and you start to cry. Or you bite into something and it starts to giving you bloating, like milk with bloating.

Russ Altman: Yes.

Kari Nadeau: Or, you eat something, and it gives you a headache.

Russ Altman: Yes.

Kari Nadeau: Like some people have that with migraines. Those are food sensitivities, those are not allergies. No one can anaphalax and have a near fatal or fatal reaction to this.

Russ Altman: And we’re not saying that this is in their head, this is a real.

Kari Nadeau: This is real.

Russ Altman: A physical reaction.

Kari Nadeau: Absolutely.

Russ Altman: But it’s not immediated by this IgE molecule, it has other mechanisms.

Kari Nadeau: Exactly, and what we’re learning is there is a strong mind-body connection, and what we’re understanding now is people that have certain taste receptors, and certain abilities to know that the food bothers them, they should avoid those foods. Your body’s telling you not to eat those foods.

Russ Altman: This is The Future of Everything. I’m Russ Altman, I’m speaking with Dr. Kari Nadeau about allergies, both allergy, food allergies, and food sensitivity. You said food sensitivity has these other mechanisms, perhaps related to taste. Are they all coming to you, or do you send certain groups away, and welcome other groups to your practice? How do you think about all of these as a physician?

Kari Nadeau: Yeah, I think as a physician, as well as a scientist, when you think about trying to discern those items that are associated with allergy, you always need to understand what’s the other. And test what we call the null hypothesis, right? And be able to understand these discriminatory features between who really has an allergy, and who doesn’t. And how do we help the sensitivities as well? And are those perhaps related to immunology, but in a different pathway? What we’ve been doing is taking all comers, and we really want to also have people that don’t have any allergies or sensitivities, because we also need people that have no…

Russ Altman: Yeah, what’s different? There must be a difference.

Kari Nadeau: Quote unquote, disease or what we call controls. And then, I do see patients in clinic with all of the above. I like to take care of families, from kids to pregnant moms, all the way to people that are 100 years old. I think what’s important to relay our knowledge and help families and all ages. Because all ages have food sensitivities and food allergies. What we’re very careful about is with Celiac disease, for example.

Russ Altman: Big issue.

Kari Nadeau: That’s an inflammatory disorder, that’s very different from a food allergy, but that relates two different arms of the immune system. And those people can have chronic conditions, but that’s more related to diarrhea and other issues. And those people I would refer to GI specialists, because that’s their specialty.

Russ Altman: Let’s just take a moment on that, because as I understand it, gluten is one of the big… Problems, with Celiac disease, but gluten has had a bad decade. Can you talk to me from your perspective about what is a reasonable thing to say about gluten, as a cause of Celiac disease, and then gluten, I guess maybe we would say, sensitivity. How do you think about that, and what’s the advice to people who are worried about this?

Kari Nadeau: Yeah, it’s really fascinating. I think that in all of our society, and all around the globe, we’ve been looking at gluten. Gluten is a protein. It’s in wheat. It’s 1 of 33 different wheat proteins in existence now. And when we evolve, we evolve with the wheat plant. But now the wheat plant’s kind of different. Our gut, necessarily for some people, when it eats a lot of gluten, it has an inflammatory reaction to it. Now for other people, they don’t. It’s important to know whether or not you really have a gluten sensitivity or you don’t, and that’s where you need to talk to your doctor. Because you shouldn’t just avoid gluten. There’s a lot of great things about gluten products, like fibers, that really help you.

Russ Altman: It makes my bagels that I make every Sunday, extremely chewy.

Kari Nadeau: Exactly.

Russ Altman: And I always worry about, because I’m adding gluten back into the, you know, it’s wheat plus extra gluten. And then people say "Oh Russ, it’s so chewy." And I’m like, "Yeah, there’s a secret ingredient."

Kari Nadeau: Yes. Right. And gluten is this wonderful protein that we evolve with, and for people that think they have a gluten sensitivity, go check it out with your doctor first. Now for people with Celiac disease, it’s a maladaptive response to one of the specific peptides in the gluten molecule, that actually then creates the Celiac disease, but that’s mostly genetically predisposed.

Russ Altman: And that’s not what we’re calling an IgE mediated…

Kari Nadeau: No.

Russ Altman: Let’s go back, so, I love this, I mean I could talk, we will talk about this, but… It took me probably five to ten meals to put together that this food eating was causing problems. And I really only knew seafood. I didn’t know what it was gonna be when I went to… Tell me about the detective work that you have to do in figuring out what is causing these reactions.

Kari Nadeau: That’s right. I think, like what you went through, with all pricks in your back, that seems rather draconian. And we still use those metal pricks, for example.

Russ Altman: You do. I was wondering about that.

Kari Nadeau: And you think, well why are you doing something that’s been in existence for 100 years, well right now it’s the best that we have. We take the skin, and we can infer from the skin, what your body might do inside. But it really is only skin deep, because you have these little cells called mast cells, that stay in the skin, they don’t go into your blood. And they can last up to nine years in your skin. And basically when you prick your skin with that specific protein or allergen, then your mast cell will pick it up and have a reaction to it, via IgE. And so…

Russ Altman: So it’s actually a very relevant test?

Kari Nadeau: It’s very relevant. It’s relevant also for the physician and very practical, because you can do it within ten minutes in the office. So that’s nice. And if you have the right person doing it, it’s very standardized, so we do that in our clinical research at Stanford, as well as many other people use it as a tool. When it’s negative, it’s 99.9% negative.

Russ Altman: Wow. So if I didn’t get any swelling, then they say “Russ, maybe it’s time to go see your therapist.” Let me ask, those 60, are they the most common allergens that you see empirically, like we have enough experience to know hay fever, shrimp, whatever? I felt lucky that the things I was worried about were listed on the list of 60. Who comes up with the big, let’s call it the Big 60?

Kari Nadeau: Right, so what doctors usually do, is you come into their office and they try to decide, okay, what are you allergic to? And they try to get that from your clinical history, and then they design their skin test accordingly. But importantly is when you don’t know, like you didn’t know, and like you’re saying, you bite into a meal and you’re confused, because maybe you could’ve eaten those foods previously, but now all of the sudden you have a reaction. And for adults with food allergies, that’s 50% of adults with food allergies now.

We just published a big paper showing that 10% of adults in the U.S. now, and probably around the globe, has food allergy, and they don’t know about it, until they’re an adult. Now, about 300,000 kids in California, for example, learned that they have food allergies for the first time, when they’re at school.

Russ Altman: Yep.

Kari Nadeau: Wating foods, and understanding that we’re trying to get better at prediction. Right now, with Stanford and many other institutions around the world, we’re getting better at prediction. We shouldn’t have to do skin tests forever, so we’re looking at blood markers, to be able to understand even before someone develops an allergy, what they might develop it to.

Russ Altman: Yes. And it sounds like you also know there are genetic familial connections. This is The Future of Everything, I’m Russ Altman, I’m speaking with Kari Nadeau about allergies, and you mentioned kids.

Tell me about prevention. I know new moms are getting a lot of information different from even what we got when our kids were little. And presumably it’s based in science. What is the current advice? What is our ability to prevent allergies looking like these days?

Kari Nadeau: I think over the past five years, around the globe, there’ve been a lot of randomized clinical trials now, and we actually have the knowledge to be able to think about how to prevent. Which is fantastic. When I was doing this, and when I had allergies when I was growing up, no one was talking about prevention. Everyone was talking about therapy.

Russ Altman: Right.

Kari Nadeau: So we need to predict, and then we need to prevent. And with prevention, what’s known now for preventing food allergies, is I call it sort of the Ds: Dry skin, try avoid dry skin. Avoid detergents when you’re an infant, make sure that you use good creams, good emollients to protect any type of dry skin. Because through dry skin, allergens in the air, and there are many, can actually touch the skin, and then the skin reacts in a maladaptive way, and then creates allergies inside your blood.

Russ Altman: Okay.

Kari Nadeau: We now think that the mantra is through the skin, allergies begin. Through the diet, allergies can stay quiet.

The next D is diversification of the diet. If you eat a lot of diverse proteins early and often when you’re an infant, we think that that will also tolerize the gut, and protect you against food allergies as you get older in life.

Russ Altman: This is what I’ve seen. I am pleased to have an 11-month-old grandson, and my daughter is spectacularly disciplined in the introduction of foods in a serial, thoughtful way, that makes my wife and I blush, because you know, it was like, “well here you go, eat this. See how it goes.” She feels like she’s really gotten good information from her pediatrician about when and how, strawberries, peanut butter, all of these things that we know can be associated with allergies.

Kari Nadeau: Right. It used to be thought, in 2000, and guidelines throughout the world were made where people were in a very sort of precautionary reflex, and I think they meant well, because there was this epidemic increasing of food allergy, they suggested oh delay the introduction of peanuts, shrimp, eggs, but in fact, in those countries that actually took up the guidelines, they had the highest rates of food allergy.

Russ Altman: So the avoidance…

Kari Nadeau: Avoidance actually created a higher degree of epidemic. Those countries saw a doubling of tree nut allergies, for example, over ten years. With that now, they’ve thought about the data, randomized clinical trials occurred over the past five years, and now we’re saying diversify the diet early and often. We’re also saying have some good dirt. Eat some good probiotics.

Russ Altman: Is that the third D?

Kari Nadeau: The third D is eat some good dirt. Not bad.

Russ Altman: Oh, I love that.

Kari Nadeau: Make sure that you have good fiber in your diet. We have a great group of people here at Stanford and around the world, looking at microbiota, and how that’s gonna help tolerize our gut better. To understand that our gut shouldn’t be having this maladaptive response to foods.

Russ Altman: The three Ds. This is The Future of Everything, I’m Russ Altman, more with Dr. Kari Nadeau about allergies and sensitivities next on SiriusXM, Insight 121.

Welcome back to The Future of Everything, I’m Russ Altman, I’m speaking with Dr. Kari Nadeau about allergies, and one of the interesting things that you’ve written about and looked into on the research side, is the impacts of climate change. Of all things that I thought we would be talking about with allergies, I wasn’t expecting climate change. Can you link for me, how climate change impacts your life as an allergist?

Kari Nadeau: Absolutely. With climate change, and that means that we’re seeing this 1.5 degree Centigrade increase overall, and that’s due to the carbon dioxide emissions, and with that, that carbon dioxide and all of the particulate matter that are associated with that because of diesel exhaust emissions, that really affects people’s asthma. There’s plenty of studies to show that that small little matter, that you can kind of see in the air when you see that polluted day, and that’s about what we say 2.5 microns, that’s really small, but it gets into the bottom of our lungs, and it creates terrible havoc. Our lungs don’t like that.

Russ Altman: You know I grew up in New York in the 60s, and I remember, in a skyscraper, and I remember looking at the skyline and seeing a little brown layer halfway up the Empire State Building, pretty much every morning, which I was breathing.

Kari Nadeau: Exactly. That brown layer is getting into our lungs and in countries like India, in New Delhi, that’s really more of like a black layer. We need to be careful about what climate change is doing and how what I see in my clinic, for example, is on bad air quality days, I’ll see more asthma in my clinic. In emergency rooms, the increase fold of asthma ER visits is about four fold. But then take that up ten times when we have wildfires. We’re also seeing in California, but all around the globe. In Kenya they had wildfires, we’re seeing reforestation issues in the Amazon. All the time that fires are used, that’s very similar to this particulate matter, but it’s ten times higher in the sky, and so you see people, even that don’t have asthma, come in with wheezing. And we don’t know to the degree by which those types of climate change factors, those extreme weather conditions, even after five days, are increasing people’s visits to the emergency room due to stroke, due to heart attacks, we see all this increase —

Russ Altman: Ripple effects, really, of this air quality?

Kari Nadeau: Big ripple effect.

Russ Altman: The connection to asthma really makes perfect sense. Does any of the climate change actually impact on the food, and food allergies? Or is that a different thing?

Kari Nadeau: Right. The one thing about climate change, is of course what people are seeing throughout the world, is that there’s more drought. Or there’s more flooding, and that affects our crops. In addition, because of the fact that we’re having to reuse water supply, and we don’t necessarily rotate our crops like we used to in the past, because of the fact that water is such a commodity now, we have less nutrients in our given foods. When we were growing up, there was a certain amount of zinc, certain amount of calcium, in spinach. Now that’s being depleted, and the typical spinach plant has much less zinc and calcium in it, for example.

Russ Altman: Wow, so spinach ain’t what it used to be.

Kari Nadeau: No, exactly, Popeye would be sad.

Russ Altman: And then that’s easy then to imagine that when food, when that molecular makeup of the food switches, that it might change allergy propensities in one direction or another.

Kari Nadeau: That’s right. That’s the next big question, is whether or not, because we’re having to use waters that might have a slightly higher amount of detergents, because they’re having to be used again, those detergents, even in one parts per billion, for example, can change how proteins are folded. That affects when we eat the food, how those proteins are being digested. All these things are showing up in our immune systems. In the way that we process foods, in the way that we see foods as people. We need to really follow this carefully, as well as look to what degree climate change can be improved, because we do see that, for example, when filters were used in school buses, or when we take away ozone issues, or for example, flourocarbons in the air, we see improvements in asthma. We see improvements in allergies. So we know that by improving it we can —

Russ Altman: That’s great, the game is not lost. We haven’t lost the game yet.

Kari Nadeau: Absolutely.

Russ Altman: Now I do want to move on to cures, because this is one thing that your lab has become famous for. And of course I’m personally grateful. Tell me what is the current landscape for curing allergies, if we are for some reason unsuccessful in preventing them, which of course will happen.

Kari Nadeau: Yeah. I think we always have to have that moonshot as scientists to try to create a cure. Because in the goal of creating the cure, we can actually mitigate it along the way. And that maybe it’s not everyone that we can cure cure, and when I say cure, I mean that I’d like to make sure that when you get to be 100 and over, that you can still eat your lobster without a problem.

Russ Altman: My paella. Paella for my hundredth birthday.

Kari Nadeau: There you go.

Russ Altman: It’s a good goal.

Kari Nadeau: There you go. That’s the goal. And with that goal, we want to make sure that every person that comes into our clinical research unit as well as clinics, we understand what their goals are, and then we can make sure that we can face forward. A lot of people say, “Well, I’d like to eat my food and not have to worry about accidental ingestion.” Or, they can be like you, and say “Well I’d actually like to eat that food, not just worry about accidental ingestion.”

Russ Altman: In large amounts.

Kari Nadeau: In large amounts, we had —

Russ Altman: Not just trace contamination, I’m talking like two lobsters.

Kari Nadeau: Exactly. We had one college student who was very allergic to milk. I mean, put a little milk droplet on his skin and he had a horrible reaction and he wanted to eat a whole pizza. That was his goal, and we used the very same method that we used for you.

Russ Altman: Good, let’s get into it.

Kari Nadeau: What we did was to say, okay, we know that the body, and this has been going on for hundreds of years. If we feed back the body every day, the very same thing that they’re allergic to and this has been going on for pollens, for insect allergies, but what about food? What if we feed you back very small amounts and increase those amounts slowly over time? We train your immune system, just kind of like how we train for races and build our immune system, it’s like building muscles. And so with that, we build up your immune muscles, and over time you adjust and you become desensitized yourself.

It’s the beauty of your own immune system where you readjust and decrease your own allergies to that food. But along the way you can have reactions. And that’s the hard part. 30% of the people while they’re doing this type of therapy can have bad abdominal pain or bad wheezing, and we don’t, that’s scary —

Russ Altman: Or the reaction that led them to come to the doctor in the first place.

Kari Nadeau: Exactly. It seems rather paradoxical that the treatment is actually causing more frequent reactions that you’re trying to avoid in the end. And over time when you get done with this, your reactions decrease and decrease. However, what we decided to do was people that have more than just one food allergy, and many do. About 70% of people now have more than one food allergy. We said we wanna treat all ages, we wanna help be able to treat multi as well as mono allergies, and we wanna do it safely. And so at the current time, there was a drug that was being used in asthma that had been made by Genentech and a prior company called Tanox, and that was called anti-IgE. And so it basically quenched —

Russ Altman: Which is a good sign, because you said IgE was the problem, so anti-IgE is sounding good.

Kari Nadeau: Exactly, so it quenched that match that lights the fire. But it’s not perfect, and so what happens is we use the anti-IgE as sort of a cover, with that increase in the food at the same time, which is what we did for you.

Russ Altman: And I remember this, yes. You gave me these injections before you ever had me eat anything. I came back a couple of times and you said, “Russ, we’re pretty much wiping out your IgE.”

Kari Nadeau: We’re building it up, and then we start feeding that food to you so that it’s done under that cover, that blanket, of a protective device.

Russ Altman: And that drastically reduces the chance that I’m gonna get the bad reaction, even on my first little tiny bite of shrimp in 30 years.

Kari Nadeau: That’s right.

Russ Altman: Which is what happened. You guys were all around me, they had the crash cart. It was very memorable. Like why is the crash cart here? Well, we think this is gonna work, but we’re not a hundred percent sure. Then I took my little first bite of shrimp in 30 years, everybody watched me, nothing happened, but you did make me stay there for six hours and make sure nothing happened.

Kari Nadeau: Exactly. Because we’re super concerned, we always like to be careful, and for all of the people that we’ve treated with this particular regimen. We call it Xolair, or anti-IgE with the food, we’ve never had any severe or bad reactions, but we always like to be careful. And with that, we can also increase the dose of your food, that you can get done in six months, in nine months. Usually it takes five years, if you don’t use Xolair.

Russ Altman: I believe that when you had me do the shrimp I had a little tiny bite, but in that same session I think I ate two full shrimp. And there was an acceleration.

Kari Nadeau: Exactly. And we wanna do that, because that helps people.

Russ Altman: This is The Future of Everything, I’m Russ Altman with Dr. Kari Nadeau, we’re speaking about allergies and the cures. Is that gonna be the way to cure? Or are other modalities also arising?

Kari Nadeau: Yeah, you know, I think one thing in science is that we always need to think about improving. And that when you look at your data, you always need to look at the data on the edges and say who’s doing really well and who might not be doing well at all? And why is that? Not everyone fits into the Gaussian distribution of data, so we’ve been looking on the edges. We’ve been looking at how to improve and this is very cool. Now a gene therapy has been made. For people that don’t even want to eat the food, because it’s quite anxiety provoking, we now have a plasma that we insert under people’s skin, so the person can become their own peanut plant, as it were. They start making their own peanut protein.

Russ Altman: Oh my goodness.

Kari Nadeau: Very small amounts. In a very measured way. Daily. You can’t do this every week, for example, you need —

Russ Altman: So instead of eating the shrimp, there’s something in my body that’s basically secreting shrimplike compounds so that I can slowly become used to it.

Kari Nadeau: And it’s really neat. That is to me this precision medicine, where you’re taking science, you’re being able to capture that, use it to effectively help someone, and enable them to be desensitized to X, Y, or Z. Gene therapy, I think, is something very exciting and then I think there’s other cures that we’re looking into now that use other biologics that might be safer, and that might treat a lot of different ages, so I’m excited about the future. We’re running about 27 different clinical trials throughout the world in food allergy now.

Russ Altman: So unbelievably good news for those of us with allergies. Thank you for listening to The Future of Everything, I’m Russ Altman. If you missed any of this episode, listen anytime on demand with the SiriusXM app.