Episode transcript
Time stamps
0:00 Intro
1:19 Clemens von Perkett Award Winner
2:47 Grocery Store Factors and Food Allergy Labeling
4:49 Food Allergy and Psychology
6:45 Latex-Related Food Allergies and Climate Change
8:52 Prenatal Fatty Acid Supplementation and Food Allergy
10:29 The Impact of COVID-19 On Food Allergy Patients
12:06 Peanut Allergen Components and Oral Immunotherapy
13:35 Allergic Rhinitis and Mental Health
16:35 Help-Seeking Behaviors and Allergic Rhinitis
18:36 Conclusion
Transcript:
Announcer:
ImmunoCAST is brought to you by Thermo Fisher Scientific, creators of ImmunoCAP™ Specific IgE diagnostics, and Phadia™ Laboratory Systems.
Gary Falcetano [00:00:13]: I'm Gary Falcetano, a licensed and board certified PA with over 12 years experience in allergy and immunology.
Luke Lemons [00:00:19]: And I'm Luke lemons, with over 6 years experience writing for healthcare providers and educating on allergies. You're listening to ImmunoCAST, your source for medically and scientifically backed allergy insights.
Hello, welcome to ImmunoCAST. Gary and I are on location here at the American College of Allergy, Asthma and Immunology. We're actually excited today because in this episode we're going to be going over some of the interesting research abstracts that were revealed during this conference. This is a two part episode, so again we're going to be talking about the research abstracts in this one. In our next episode we're going to be looking at medically challenging case studies and so we're really excited to share some of this breaking research and some really interesting bits of science related to allergies.
Gary Falcetano [00:01:01]: Yeah, there's literally hundreds of abstracts so it was a bit challenging actually picking the ones that, that we could talk about today. We'll leave it up to you to see if we, if we did it right.
Luke Lemons [00:01:11]: Yeah, we sat down and we, we, we went over all of them and so these, we're boiling it down for you, but why don't we start. Gary, you have an interesting one to start off with.
Gary Falcetano [00:01:19]: Yeah. So our first abstract I'd like to talk about, Luke is, is Clemens von Perkett award winner, so third place award here in college. And this is from our friends at the University of Virginia and the lead investigator is Charlene Dunaway, title of it is food allergy and a pediatric cohort from Honduras. The relevance of cross reactive carbohydrate determinants or ccd. Or ccd. Right. I think our listeners will remember that from our component.
Luke Lemons [00:01:45]: Oh yes.
Gary Falcetano [00:01:46]: So this we know food allergy prevalence is a lot higher in western populations, certainly here in the US and North America and actually quite a bit lower in other populations such as this Honduras, Honduras cohort. And what they endeavored to study was kind of, they, they had really pretty in depth clinical history on all the patients included in this study and in addition did a wide variety of assessment of their sensitizations. And what they found was, yeah, they confirmed again a low prevalence of true clinical food allergy but a high level of sensitization to these CCDs or cross reactive carbohydrate determinants. And that's really interesting because we don't see that in other cohorts. And so I think now I had a chance to speak the to the lead author yesterday and she was actually saying that they think there might be something in their diet that's protective, that's actually causing this elevation of CCD sensitizations. And they're going to do some further research and more.
Luke Lemons [00:02:42]: Very interesting. Interested to see how that that pans out.
Gary Falcetano [00:02:46]: Yeah, for sure.
Luke Lemons [00:02:47]: And related to food allergy, there's another interesting study that we uncovered and it's titled Examining the association between Grocery store factors and Food Allergy Labeling Compliance. And this is a really interesting study in my opinion because they looked at large grocery stores and at the small grocery stores and they tried to see how accurate food labeling was in both settings. They found that 31% of large stores, and I don't want to name any names, but I'm pretty sure we all know large food stores, 31% of them had food labels incorrectly labeled for food allergens. In small stores it was more, it was 38%. But that 31% is still pretty big number for a large store.
Gary Falcetano [00:03:27]: So that's almost a third.
Luke Lemons [00:03:29]: Right.
Gary Falcetano [00:03:29]: Of these stores. And I think what we're talking about here specifically isn't the pre packaged products that are coming from manufacturers. We're talking about store made products and whether they're accurately labeled or not. And over half of the small stores had incorrectly labeled products.
Luke Lemons [00:03:45]: Yeah, I don't want to say it's understandable, but small stores, of course, if a patient has food allergies, you're going to probably recommend that they stick to foods that are labeled by manufacturers instead of going to a deli or a bodega. But what's really interesting was the food allergens that were labeled incorrectly were actually some big allergens. So in the large stores, 6.8% of egg allergy was incorrectly labeled.
Gary Falcetano [00:04:11]: Yeah. And 15% in small stores.
Luke Lemons [00:04:15]: But interestingly enough is in the big stores, 3% of peanut allergy was labeled incorrectly. However, in smaller stores it was only 0.9%. Which means that smaller stores actually labeled peanut allergy more accurately than the bigger stores.
Gary Falcetano [00:04:32]: And I wonder if that's just because of greater awareness of peanut allergy. People are more attentive. I mean, who knows, right?
Luke Lemons [00:04:38]: Yeah. But again, really interesting study here. And sticking into the food allergy theme, there was another paper that came out related to food allergy and psychology.
Gary Falcetano [00:04:49]: So referrals to mental health colleagues once the food allergy diagnosis is made. And this was at a large tertiary center. So this was from Clumps, Ohio. Lead author was Lamentia. And they looked at referrals for a big period, I think 10 year period.
Luke Lemons [00:05:06]: Yeah, right.
Gary Falcetano [00:05:06]: From this, from this tertiary center. And what did they find?
Luke Lemons [00:05:09]: So they found that about 88% of the children that they looked at were referred to a psychologist with food allergy concerns. And this was a big increase in 10 years. It's an 11 fold increase in psychology or psych referrals for children who have food allergies.
Gary Falcetano [00:05:27]: I don't think this says, right. That mental health for people or children with food allergies is getting worse. I think this is, this is more. The providers being more aware of potential impacts, which is great.
Luke Lemons [00:05:38]: Which is great. I mean, especially we talk all the time on our podcast about the effects of food allergy and how it may emotionally impact a child. And so this increase is a good thing. But I think it also speaks to the fact that we need to be having these conversations about mental wellness. When it comes to food allergy. 53% of the children who were referred were. It was due to the fact that they had suffered anaphylaxis at some point. And then 69% of a smaller group had food allergy anxiety. It's just great to see this. And I think that if our listeners have a patient who comes in with food allergy and we have that conversation with the parent, it's a joint decision if it's affecting the child in this sort of way, if they've been diagnosed correctly, and making sure that they're getting the mental health care they need.
Gary Falcetano [00:06:26]: Yeah, no. And with 69% having food allergy anxiety, it's a spectrum. Right. I don't know how if you're diagnosed with a food allergy, you can have at least some level of anxiety.
Luke Lemons [00:06:36]: Yeah, right. Yeah.
Gary Falcetano [00:06:37]: So it explains why that that number is so high.
Luke Lemons [00:06:40]: Exactly. And you, you have another article on food allergy, I believe.
Gary Falcetano [00:06:45]: Yeah. So this is actually an increase in latex related food allergies. So we know that there's this cross reactivity between latex proteins and food proteins in certain foods. So this is something that we've seen actually decrease through the 80s. Latex allergy used to be a lot larger problem, especially in healthcare workers and in patients that were exposed to a lot of latex during medical procedures. But we made big efforts to get latex out of the medical care kind of stream back in the 80s after it increased with increased using of gloves, actually, for. Because of AIDS and hiv. Since we've moved those out of the healthcare stream, latexology went down, but in this study we actually see it going up.
Luke Lemons [00:07:30]: Yeah, yeah. We see the rise of increasing almost more than tenfold in 10 years. And we also see an increase more than fivefold of fruit allergy. And there's a relationship between latex and fruit allergy.
Gary Falcetano [00:07:43]: Right. And the typical fruit allergies that are related to latex are things like avocado, banana, kiwi. These are all kind of the common culprits when we're talking about latex sensitization causing a food allergy.
Luke Lemons [00:07:56]: In this study, again, the name is the possible linkage between increased increases of. In latex fruit allergies and global temperatures. And so that. Global temperatures, this is another interesting part of this article is they believe that it is because of this enzyme that is used to break down chitin. There's an enzyme in plants that is increasing to break that down. And they think that this enzyme is associated with climate change. They think that because of climate change, there's more of it in.
Gary Falcetano [00:08:21]: There's more of this. Of this chitinase.
Luke Lemons [00:08:23]: Yes, in this.
Gary Falcetano [00:08:24]: In the plant. And that's causing greater exposure to chitin.
Luke Lemons [00:08:28]: Yes, right. Yeah. And. Yeah, it is. And I think that for our listeners, this is just a takeaway for this is you may be seeing patients more and more who have a fruit allergy and that if a patient does have a fruit allergy, to consider also maybe a latex allergy and vice versa. If a patient has latex and they've reacted to fruit in some sort of way, it may be worth exploring deeper into that.
Gary Falcetano [00:08:50]: Yeah, for sure.
Luke Lemons [00:08:52]: So keeping the same realm of food allergies, another great abstract that came out during the college, and this is what we call the American College of Allergy, Asthma, Immunology. The college was called Protective Effects of Prenatal Fatty Acid Supplementation Against Food Allergies in black Children. And this is an important paper, I think, because there's research that, that suggests that in white children that fatty acids reduce atopic diseases. But there hasn't been a lot of research for black children, so.
Gary Falcetano [00:09:18]: Exactly. So they were trying to replicate. Right.
Luke Lemons [00:09:20]: Those.
Gary Falcetano [00:09:20]: Those studies that were done in white children to see if did have that same effect with prenatal supplementation of mothers in these black children.
Luke Lemons [00:09:28]: Yeah. And it's important because we see also that in black children, they're. They're at an increased risk of food allergies. So. So this sort of research is, is really important. And they found that when women, black women were, were eating dha, which is in fish oil, they found that there was a decrease of food allergy in black children.
Gary Falcetano [00:09:46]: Yeah.
Luke Lemons [00:09:46]: Which would.
Gary Falcetano [00:09:47]: And atopic diseases generally. Yeah, yeah. So they, I think they're intending to really expand the number in this cohort and publish additional studies. I did have a chance to talk to the researchers.
Luke Lemons [00:09:58]: Oh, I did not know that. Yeah. Yeah.
Gary Falcetano [00:09:59]: In this abstract as well. And they intend to really expand the number of patients and see if they see, continue to see this signal of protection.
Luke Lemons [00:10:08]: Oh yeah, that's great. I can't wait to hear how it continues down and how we can better understand that. So in the future we can say maybe take fish oil or not, but who knows?
Gary Falcetano [00:10:17]: Especially it's something that's fairly benign.
Luke Lemons [00:10:19]: Yes. Yeah, it's exactly.
Gary Falcetano [00:10:22]: So, Luke, this next abstract actually talks about emergency department visits during COVID 19. Why don't you tell us a little bit about that?
Luke Lemons [00:10:29]: Yeah, so this is, this is called emergency department visits for pediatric food allergies during the COVID 19 pandemic. And what's interesting about this abstract is that they looked at a pretty big population size. They looked at 332 patients and they found that children with emerging food allergies during COVID 19 were at a high risk of food allergy related emergency department visits.
Gary Falcetano [00:10:53]: That's probably because they didn't have access to proper evaluation.
Luke Lemons [00:10:57]: Exactly. And so that they go into that in this abstract and they believe that there was insufficient diagnostic clarity in management. Because if we remember going back into that time, medicine, there was a lot of virtual counseling. There wasn't a lot of opportunity for testing because hospitals were overflooded and it was for children who were starting to develop food allergies. There really wasn't a lot there to help support, diagnose, manage. And so we see more emergency department visits.
Gary Falcetano [00:11:24]: So totally makes sense.
Luke Lemons [00:11:25]: And I think the takeaway here is for any provider who's listening, if you do have a patient who was that age when food allergies start to take effect during COVID maybe consider talking to them about case history even more if they haven't been officially diagnosed and really understanding because there was a gap in care during that time and that gap.
Gary Falcetano [00:11:44]: Could still be persistent.
Luke Lemons [00:11:45]: Yeah.
Gary Falcetano [00:11:45]: So we really need to address that and get them to the, to the clearest diagnosis.
Luke Lemons [00:11:50]: Yeah, yeah. And we're just going to keep going down this food allergy. There's a lot of good food allergy research abstracts and this, this next one is called Patients with high peanut IgE component levels less likely to Complete Peanut Oral Immunotherapy up dosing.
Gary Falcetano [00:12:06]: And this is from some researchers at University of Chicago. And just as a background for our primary care listeners, we haven't really talked about immunotherapy for foods.
Luke Lemons [00:12:16]: Right.
Gary Falcetano [00:12:16]: We know there's, there's one FDA cleared immunotherapy for foods, oral immunotherapy for foods. But there's a lot of allergists that are actually doing their own oral immunotherapy for various foods. The one that's approved is for peanut. In this case, they were doing a different oral immunotherapy for foods and they wanted to see if they could predict who would be a good responder. So someone who the immunotherapy worked for and they were able to achieve tolerance or if they could predict someone who would be a non responder. So someone who would fail the oral immunotherapy, basically. And what they saw was people with super high levels of Rh2 and Rh6. And remember, those are the storage proteins, the 2s albumins in the peanut. They were very predictive of not being successful with oral immunotherapy. So I think we need to see additional research in this area. But we really, it just, it just shows that using biomarkers can really help to guide our therapy in the future.
Luke Lemons [00:13:10]: Yeah. So you're saying that because of the high levels of these components that it was predictive on whether immunotherapy was going to be successful.
Gary Falcetano [00:13:17]: Exactly. And the higher the level of 2 or 6, RH 2 or 6, the less effective the immunotherapy would be.
Luke Lemons [00:13:23]: Interesting. I love talking about food allergy. It's a very interesting subject. But I think we've talked to our listeners enough about literally their ear off. Well, maybe not literally. Hopefully not their ear off.
Gary Falcetano [00:13:34]: So should we move to snot?
Luke Lemons [00:13:35]: Yeah, yeah. Let's go into allergic rhinitis. There was a study or an abstract put out here at the college titled Allergic Rhinitis and Mental Health Allergy Medications are Not Enough. So the results of this study found that there's a significant association between poor allergic rhinitis control and increased levels of depressive and anxiety symptoms regardless of the medications used. So if a patient has uncontrolled allergic rhinitis and even if they're taking over the counter medicines, it still can affect their emotional wellbeing.
Gary Falcetano [00:14:12]: Yeah, no, absolutely. So, I mean, we discussed this, I think a little bit with Dr. Benninger, back in our sexual performance or sexual encounters, I think.
Luke Lemons [00:14:22]: Yeah, yeah, yeah, yeah.
Gary Falcetano [00:14:23]: And rhinitis.
Luke Lemons [00:14:24]: Right.
Gary Falcetano [00:14:24]: And we talked about the effect of allergic rhinitis on sexuality.
Luke Lemons [00:14:28]: Yeah.
Gary Falcetano [00:14:29]: But we also talked about mental health at that time as well. And I think the real take home from this. Right. Is that as clinicians we tend to downplay the significance of allergic redness. You see it so much. You know, we tend to just minimize, try to treat it, come back if you have any issues. But there really are a lot of people out there, especially with persistent allergic rhinitis, that have a lot of other issues that are not just related to snot.
Luke Lemons [00:14:55]: Yeah. And it speaks to the importance of testing these patients. Allergic rhinitis. And we've talked about this, Gary, not even we've talked about on the podcast, but in general that allergic rhinitis isn't really taken as seriously as it should. And I think that this is just another example that if a patient comes in with these symptoms, which we deem as hay fever or we write off as better to say we should take this seriously, let's make sure that, number one, is it allergic rhinitis, because there is a possibility it could be something non allergic. And all these medications are taking, aren't working.
Gary Falcetano [00:15:26]: And I believe we talked with Dr. Benninger that allergic rhinitis actually has more impact on those other things like mental health than non allergic Rhino.
Luke Lemons [00:15:35]: Yeah. And so first figuring that out and then working through management, where can we reduce exposure to these, these allergens that may be impacting patients?
Gary Falcetano [00:15:44]: Going beyond medications.
Luke Lemons [00:15:45]: Right, exactly.
Gary Falcetano [00:15:46]: Going from a, from a preventative standpoint, figuring out what's causing the symptoms, addressing those, and then using medications in a complimentary manner.
Luke Lemons [00:15:54]: Yeah, yeah. And they used, again, just to call back on that episode that we had, they used the, in this abstract, the sino sinonasal outcome test 22. Or as some creative researcher deemed SN, not 22, which is why I've been.
Gary Falcetano [00:16:08]: Referring it to it.
Luke Lemons [00:16:08]: Right, yeah, yeah, yeah, yeah, yeah, for sure.
Gary Falcetano [00:16:11]: And you know what, incorporating that, perhaps especially more. We know that our otolaryn go up ent.
Luke Lemons [00:16:17]: Yeah.
Gary Falcetano [00:16:18]: Colleagues use that quite a bit. Some allergists use it as well. But perhaps, maybe we should look at using those validated assessment questionnaires in primary care to really assess the impact, because you really should be asking that question for anybody with chronic symptoms. Does it affect other areas of your life?
Luke Lemons [00:16:35]: Definitely. So moving on to another study on allergic rhinitis, we have impact of help seeking behaviors on allergic rhinitis. In mental health. A longitudinal study.
Gary Falcetano [00:16:48]: Yeah. So this is kind of a good follow up to that previous. Right. The abstract that we just discussed, there were a couple of take homes from this. Right. That number one, what are health seeking behaviors? And I think we had this conversation earlier. Right. What does that mean? Well, they were referring to both medical health seeking. So in other words, you have allergic rhinitis symptoms and you actually seek medical care, not self medicate. Right. So that's the first health seeking behavior they were looking at. And then they were also looking at if you did identify some emotional or mental health issues that you also sought help for that counseling or whatever.
Luke Lemons [00:17:21]: Yeah. And they found that in this study that patients who did these health seeking behaviors for wellbeing and allergies, they significantly improved allergic rhinitis and mental health outcomes. So it's just interesting that these patients who are seeking well being, they're actually becoming more emotionally healthy.
Gary Falcetano [00:17:40]: So imagine that if you seek the appropriate help, you actually have a better outcome.
Luke Lemons [00:17:45]: Yeah. And some patients might not know to do that. And so this podcast is for providers and I think that it's that the learning here is that you might need to help a patient realize they should be seeking helpful advice. And so a patient who maybe is suffering with allergic rhinitis is help them get to the point.
Gary Falcetano [00:18:04]: And again, assessing for potential mental health issues right along with it. There was an incidental finding here too, right. With decongestant.
Luke Lemons [00:18:12]: Yeah. They found that decongestants, the use of them, may negatively affect mental health, particularly anxiety. And they don't go into exactly why that may be, but it's just interesting that they found it. Yeah.
Gary Falcetano [00:18:26]: Well, there's sympathomimetics. We know that the decongestants will kind of upregulate.
Luke Lemons [00:18:30]: Right.
Gary Falcetano [00:18:31]: Your nervous system. So, you know, I could definitely see how that could especially affect anxiety.
Luke Lemons [00:18:36]: Yeah. Well, these are all the research abstracts that we found really interesting. And there's a ton more. We wish we could get through all of them, but luckily we will be linking to an article that has a.
Gary Falcetano [00:18:48]: Yeah, the full publication.
Luke Lemons [00:18:49]: Yeah, yeah. They'll be able.
Gary Falcetano [00:18:50]: From the college.
Luke Lemons [00:18:51]: Yeah. That you can be able to scroll through. And if you want to read more about one of the ones that we talked today, check that out. If you go to this episode's link in the description, you'll be able to find all that information. Again, this is a part one episode. So the next episode that we're going to be putting out is actually around the medically challenging case studies. Yeah. And these are going to be more specific because we're talking about one type.
Gary Falcetano [00:19:15]: Of patient, individual patient, case studies. I'm excited to get there.
Luke Lemons [00:19:18]: Yeah, yeah. There's a lot of interesting ones. So tune in for the next ImmunoCAST and live or on location from the American College of Allergy, Asthma and Immunology, thanks so much. Thank you.
Gary Falcetano [00:19:29]: We'll see you next time.
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