Dr. Nana Mireku, allergist at Aspire Allergy & Sinus, discusses the rising diagnoses of food allergies in children.
Bill Klaproth: There's a growing prevalence of food allergies among children today. One in 13 have food allergies. So why is this problem growing and what options do parents have when it comes to response and prevention of food allergy? Well, let's learn more with Dr. Nana Mireku and allergist at Aspire Allergy and Sinus. This is Achoo! The podcast for people with allergies and sinus issues from Aspire, Allergy and Sinus. I'm Bill Klaproth, Dr. Mireku, thank you so much for your time. So first off, what is the prevalence of food allergies in children?
Dr. Mireku: Yes. Well, thank you for having me here. The current prevalence of food allergy currently is that we have one in 13 children who have food allergies and essentially we are in a food allergy epidemic.
Host: A food allergy epidemic. Well that certainly frames the conversation today and really explains why this is such a problem. So what are the foods that children are most allergic to?
Dr. Mireku: There are many foods that children are allergic to. In fact, children can be allergic to any food. However, we are very well aware of the most common foods that cause an allergic reactions such as milk, egg, wheat, soy, peanuts, and tree nuts. And most recently Sesame seed allergy has been coming more of an issue.
Host: That's a pretty big list and a lot of common ingredients that food are made out of milk, egg, wheat, soy, peanuts, tree nuts. And now you say Sesame seed allergy is becoming a problem. And so what are the main options parents have available to them? I know two of the bigger ones are food, oral immunotherapy, and also the food allergy drops. Can you explain those to us?
Dr. Mireku: So with food allergy drops, the goal is to protect against accidental exposure and to provide what I call bite size protection. In the event that child should accidentally ingest what they're allergic to. The nice part about this is that this therapy can be done daily at home and these food allergy drops are placed under the tongue. It takes roughly about 42 weeks to get to their maintenance dose. And then they need to continue the food allergy drops daily in order to maintain that bite size level of protection. Some of these children are even able to ingest items that have cross contaminate levels. They do need to continue to read labels throughout this therapy as they are not going to freely ingest a protein and they do need to carry their EpiPen as a precaution. This difference from oral immunotherapy or OIT in the sense that the goal in OIT is for these children to freely ingest their allergic food.
So these patients have more than a bite size protection level. For example, a peanut allergic child will be able to ingest approximately 24 peanuts or more once they complete the therapy. Another difference is that an OIT, these patients come to the allergist's office regularly to increase their dose in a clinical setting that is supervised by the allergist. The therapy's about eight to 10 months long as well, and they also need to carry their EpiPen when they've completed their therapy. So the main thing is that we have options for our patients. We really like to take the time at Aspire Allergy to get to know our patients, understand the goals of the family, and really direct them to the best therapy.
Host: Well, both of those sound like powerful solutions. So how does a family decide which one to choose? How does that work?
Dr. Mireku: That's a very good question. And as a physician, I usually just spend the time to talk with the patients and really find out what the family's goals are. For example, if I'm discussing this with a family whose goal is simply to provide some level of protection for their child, then we will discuss more in depth about food, sublingual immunotherapy or food slit. And the reason for this is because this therapy provides bite size protection levels. If the parent wants to freely ingest an allergic foods such as peanuts and they want their child to ingest it anytime they please, then that would be oral immunotherapy. And that's because those patients are basically able to tolerate 24 peanuts at the end of their therapy, for example.
Host: Really interesting. So understanding the goals of the family helps you decide what is the best treatment method. So when it comes to both of these options, how are each of these administered? Obviously the food allergy drops are drops, but are they given daily or weekly? How do both of these work?
Dr. Mireku: That's another good question. So for food allergy drops, those are administered daily and they are administered under the tongue on a daily basis at home. The therapy usually is roughly about 42 weeks to get to their maintenance dose. And then once they get to the full maintenance dose they are required to continue giving the drops daily to maintain that bite size protection level. Whereas an oral immunotherapy, the patient needs to take the food every single day, however they need to start off in the allergist office and return to the allergist's office in weekly visits or biweekly visits for up dosing.
Host: So just so I understand this a little better. Food oral immunotherapy provides long lasting protection, so the treatments are a little bit more intense upfront, but then the child is covered for a long time and you don't have to worry about daily drops. The food allergy drops provides less protection because constantly you've got to give the daily dosing every day. Do I kind of have that correct? So your options are long lasting protection, you don't have to worry about it, but the food allergy drops every day you got to be given that child the drop.
Dr. Mireku: That's right. So if with food allergy drops, your goal is to have bite size protection. If the child should accidently, for example, if they're allergic to peanuts and they were accidentally, you know, bit into a peanut butter cookie, the goal is that they're less likely to have a severe allergic reaction. However, when they're done with the therapy, they still need to continue the drops to maintain that threshold. With oral immunotherapy, the goal is for you to freely ingest any level of peanut protein that you would like at the end of the therapy. So we challenge, for example, with peanuts, we challenge our patients with 24 peanuts and then they maintain their minimal peanut dose and they can freely ingest above that dose when they're done with the therapy. These patients still need to carry an EpiPen when they're done with their therapy, they often don't need it, but as a precaution they still need to carry their EpiPen when they're done with the therapy.
Host: So it sounds like the main point that we need parents to understand is there are options and two really good options that we've been discussing. No one has to tip toe around food allergies and be left out of living their best life. Is that correct?
Dr. Mireku: We're happy to say that they don't have to live a life of restriction. If they want protection levels, they can consider food sublingual immunotherapy if they want their child to freely ingest the food. Oral immunotherapy is a consideration and oftentimes sometimes we have some parents who are concerned about jumping right into oral immunotherapy. So sometimes we can start with food sublingual immunotherapy, increase the child's threshold to bite size protection and then they transition beautifully into oral immunotherapy where they can tolerate larger doses at the end of therapy.
Host: I love it. So then for a parent listening to this right now who has a child with food allergies and they're kind of going, I don't know what to do, what's their next step? Make an appointment with you at Aspire Allergy and see an allergist and kind of drill down and then talk about those different treatment options?
Dr. Mireku: Absolutely. So the next step is to see us at Aspire Allergy and we will take a comprehensive history to understand the child's food allergies. We will do testing, we will also possibly do challenges to figure out what the threshold level is and we will discuss all of the options and really try to find the right solution for the problem that the family is comfortable with.
Host: And that's what everybody is looking for. And then being able to have those options and then make a choice on the proper treatment for their child. Dr. Mireku, thank you so much. This has really been informative and interesting. Thank you for your time.
Dr. Mireku: Thank you for having me. I appreciate it.
Host: That's Dr. Nana, Mireku an allergists at Aspire Allergy and Sinus. To learn more or to book a visit, please visit aspireallergy.com, that's aspireallergy.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Achoo! The podcast for people with allergies and sinus issues. I'm Bill Klaproth. Thanks for listening.
As an allergy sufferer herself and being the parent of a food-allergic child, Dr. Mireku is passionate about providing relief for her allergic patients. She believes in empowering her patients and their families through education of their diseases.