← The Peter Attia Drive

#277 ‒ Food allergies: causes, prevention, and treatment with immunotherapy | Kari Nadeau, M.D., Ph.D.

Oct 30, 2023 1h 45m 26 insights
<p><a href="https://peterattiamd.com/karinadeau/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=231030-pod-karinadeau&amp;utm_content=231030-pod-karinadeau-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=231030-pod-karinadeau&amp;utm_content=231030-pod-karinadeau-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=231030-pod-karinadeau&amp;utm_content=231030-pod-karinadeau-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>Kari Nadeau is a physician scientist with expertise in treating food allergies. In this episode, Kari first explains the fascinating workings of the immune system, exploring how it adeptly defends against bacteria and viruses but how the same system can lead to food allergies. She proceeds to explore the complexities of food allergies, detailing their typical developmental patterns, underscoring the significance of preventative approaches like early exposure, and highlighting the potentially life-threatening nature of severe food allergies. Kari illuminates the latest advancements in immunotherapies that not only mitigate allergy severity but also hold the potential to completely cure the patient. Additionally, Kari shares her concerns about the increasing levels of air pollution, elucidating its adverse effects on health while providing valuable suggestions for reducing exposure.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>Kari's motivation to study food allergies [4:00];</li> <li>Overview of the immune system and the family of immunoglobulins [9:00];</li> <li>How our immune system fights viruses, bacteria, or fungi, and some exceptions to the rule [13:00];</li> <li>Why our immune system is generally better at fighting viruses than bacterial infections [18:45];</li> <li>Differentiating a food sensitivity from a food allergy, and a discussion about celiac disease [25:30];</li> <li>How food allergies develop, why they can be lethal, and factors contributing to the uptrend in food allergies [35:45];</li> <li>The role of environmental factors in the onset of food allergies and strategies for prevention [50:15];</li> <li>How immunotherapy helps to overcome, and even cure, food allergies [1:04:15];</li> <li>Can immunotherapy work for environmental allergens like pollen? [1:24:00];</li> <li>Air pollution: impact on health and tips for reducing your risk [1:25:30];</li> <li>Resources for those wanting to learn more or find clinical trials related to food allergies [1:40:45]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights

1. Daily Oral Immunotherapy for Allergies

If undergoing food allergy immunotherapy, take small, increasing doses of the specific allergen orally every day under medical supervision to retrain the immune system and build tolerance. This regimen aims to switch the immune response from IgE-mediated reactions to protective IgG molecules over time.

2. Master Epinephrine Use

Educate yourself on the proper use of injectable epinephrine devices and carry them if you or your child has a food allergy, as this is the only thing that can prevent fatal reactions. Know how to use it within a minute and administer a second dose immediately if symptoms don’t improve.

3. Diversify Infant Diet Early

Introduce diverse foods like tree nuts, fish, milk, egg, and peanut in small, regular amounts to children early and often (between four to six months of age) to help prevent the development of food allergies. The gut immune system is meant to tolerize to antigens, unlike the skin.

4. Monitor and Filter Indoor Air

Use an indoor PM2.5 monitor (e.g., Purple Air) to assess your home’s air quality, especially in areas with wildfire smoke or high pollution. If levels are bad, install MERV 13 or higher filters in your HVAC system or use stand-alone HEPA filters to reduce exposure, as 90% of life is spent indoors.

5. Protect Skin Barrier Health

Maintain a healthy skin barrier, especially in infants, as dry skin with microscopic holes can allow food proteins to enter and trigger an allergic response. This skin exposure can initiate the allergic pathway, as the body reacts to food through the skin as if it were a parasite.

6. Update EpiPens, Re-test Allergies

Regularly renew and update your injectable epinephrine devices, ensuring they are not expired and are the correct dosage for the individual’s current weight. Re-test allergies with a doctor, as assumptions about outgrowing allergies can be dangerous and lead to tragic outcomes.

7. Sustain Daily Allergen Intake

After completing food allergy immunotherapy with a doctor, continue to consume a maintenance dose (e.g., one to two nuts) daily. This regular exposure is crucial to sustain the immune system’s tolerance and protection, as stopping therapy can revert the immune system to its original allergic pathway.

8. Avoid Outdoor Exercise in Poor Air

Refrain from exercising outdoors when the Air Quality Index is greater than 50, as even short exposures to polluted air can negatively impact your immune system for a full day. This is because PM2.5 particles can penetrate lungs and affect the body systemically.

9. Check Daily Air Quality Index

Regularly check your local Air Quality Index (AQI) on websites like AirNow or NOAA to understand PM2.5 levels in your region. This knowledge enables informed decisions about outdoor activities and protective measures, as air pollution has significant health impacts.

10. Wear N95 in Yellow AQI

Wear an N95 mask when the Air Quality Index is in the yellow zone or higher to reduce the risk of PM2.5 exposure to your lungs. While not perfect, these masks significantly reduce the inhalation of small particulate matter, especially for children and the elderly.

11. Boost Immune System Naturally

Improve your immune system’s health by prioritizing better sleep, eating a healthy diet, and engaging in regular exercise. These lifestyle factors were shown to make the immune system healthier, better equipped to fight viruses and microbes.

12. Regular Allergist Consultations

Be vigilant about taking yourself or your child to an allergist for ongoing management and diagnosis of food allergies. This ensures proper care and understanding of the disease, which is crucial given the increasing prevalence of food allergies.

13. Embrace “Dirt” for Immunity

Increase exposure to diverse microbes, such as by growing up on farms or with animals like dogs, as this can help reduce the likelihood of developing food allergies. This aligns with the “dirt hypothesis” suggesting early microbial exposure aids immune development.

14. Optimize Vitamin D Levels

Maintain sufficient vitamin D levels in your blood, as adequate vitamin D appears to decrease the risk of developing food allergies. This is a simple, yet impactful, preventative measure.

15. Minimize Detergent, Pollution Exposure

Reduce exposure to harsh detergents, air pollution, and tobacco smoke, as these can cause dry skin and itchiness, potentially contributing to the development of food allergies. These environmental factors can compromise the skin barrier and activate allergic pathways.

16. Choose Natural Skin Emollients

When improving your skin barrier, opt for emollients with natural lipids like ceramides, and avoid petroleum-based products (e.g., Vaseline). Petroleum products can increase skin bacteria and worsen inflammation, making natural lipids a better choice for skin health.

17. Eat Nuts During Pregnancy

Pregnant women without existing nut allergies should consume peanuts and tree nuts, as it is safe and can be healthier due to omega-3s. This practice is now recommended to help prevent food allergies in children.

18. Breastfeed for Immune System

Breastfeed infants if possible, as it contributes to overall gut health and a healthy immune system. While not definitively proven to prevent food allergies, it is very helpful for general immune development.

19. Find Food Allergy Specialists

Search clinicaltrials.gov for ongoing food allergy therapy trials or find specialized food allergy clinics online, such as Latitude, if your current healthcare provider cannot adequately answer your questions. This allows access to pioneering therapies and expert care.

20. Adjust Immunotherapy for Side Effects

If experiencing significant side effects like abdominal pain, hives, or worsening asthma during immunotherapy, work with your doctor to decrease and personalize the dose. This ensures patient comfort and adherence, as some side effects might make continuing the therapy too difficult.

21. Ventilate Home, Check Gas Stoves

Ventilate your home regularly to prevent the accumulation of indoor toxins, and be aware that gas or wood stoves can produce compounds contributing to indoor air pollution. Monitoring indoor air quality can help identify and address these sources.

22. Test for Food Sensitivity

If you experience symptoms like bloating, headaches, or rashes after eating certain foods, get yourself tested by a doctor to rule out a true food allergy. This helps identify potential food sensitivities that affect quality of life.

23. Manage Food Sensitivities by Avoidance

If diagnosed with a food sensitivity, avoid the specific food causing symptoms, as there are currently no cures or therapies other than elimination. This strategy helps alleviate symptoms like bloating, headaches, and rashes.

24. Confirm Celiac with Specialist

Seek a specific diagnosis from a gastroenterology or celiac specialist if you suspect celiac disease, as it requires professional confirmation. If confirmed, ensure family members are tested and you receive proper medical care due to its long-term gut implications.

25. Opt for Eco-Friendly Detergents

Select ecologically friendly detergents for washing clothes and dishes, as they tend to be better for your body. These choices align with reducing exposure to harsh chemicals that can negatively impact skin and overall health.

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