Dr. Atkins from National Jewish Health in Denver
Dr. Dan Atkins is a pediatric allergist at National Jewish Health here in Denver. He is very well known and has quite a following with parents of food allergic kiddos. He was kind enough to come to a MOSAIC (Mother’s of Severely Allergic Infants and Children) support group meeting this week to speak with parents. Dr. Atkins blows me away every time I meet with him. He has a great bedside manner with the kids and is amazingly smart. Being a father himself, I trust that he is giving me advice that he would take if it was his child who was ill. He has so much knowledge and I appreciate having him on our side!
Below are some rough notes I took from our meeting with Dr. Atkins that I hope you will find helpful. Please keep in mind that I am not a doctor and did the best I could at taking notes on this fascinating talk. If you find any glaring errors, please let me know and I will do my best to correct it.
Food Allergies with Dr. Dan Atkins
November 2, 2009
What is a Food Allergy?
Patients can have an adverse reaction to food or a toxic reaction to food.
Food aversions
- Food allergic – oral symptoms. Mouth tingle, burn, metallic taste
- Esophagitis – Reflux. Esophagus gets stretched out and it hurts. These kids only want to eat soft foods
- Poor swallow – these kids aspirate. They cough, choke when eat.
- Oral tactile – Don’t like soft, mushy foods, have problems with texture.
- Behavioral – have certain food preferences, don’t like green foods, etc…
Food Intolerance – Immune system plays NO role.
Metabolic intolerance – lactose intolerant
Pharmacologic – Coffee keeps you awake at night so you don’t want to drink it.
Idiosyncratic – react to dyes
IgE and Non-IgE Reactions
Food Allergy – Immune system DOES play a role.
- IgE response
- Non IgE response
- Both IgE and non-IgE response
IgE Response
Non IgE Response – Celiac
- Gastro problems
- Skin system
Timing
- IgE – react in minutes, hours
- Non-IgE – reaction can take hours or days
If it’s IgE – Skin test can detect it.
If it’s not IgE – Skin test will be negative.
We all have IgE antibodies in our bodies but food allergic individuals make more IgE than non-food allergic people. Cells tell body that an intruder is in the system and the body attacks by releasing histamines first. Leukotrienes get released over hours.
Our mass cells contain histamines and IgE triggers them to go off when an intruder is in the body. Mass cells have receptors and IgE sticks.
Blood test results on food allergic kids:
What does it mean when Cap Rast numbers go up? Our numbers are classified by classes 1-6, 1 being the lowest likelihood a child will react to that food. A class 6 is a higher likelihood that a child will react to that food. This does not tell us how severe the reaction will be, only likelihood of a reaction to that food.
Food Allergy Treatments
When reacting to food:
Does Benadryl work? Benadryl won’t kick in for an hour. It can help with skin itching and mouth tingles. So, we often think Benadryl is working and making food allergic child better but it may be simply because the reaction has run its course.
Epinephrine works the quickest. Blood pressure level peak time is 8 minutes. Epinephrine works to decrease muscle spasms and multiple levels of reactions. Epi-pen injection can not hurt someone reacting! If in doubt, give it.
3 things that lead to death in food allergic situation:
1. Asphyxiation
2. Asthma death
3. Blood pressure drop – 50% of pressure drops in 10 minutes.
If you wait too long to give epi-pen, epinephrine won’t enter system fast enough. Don’t let blood pressure drop too far or it won’t work. Need to act swiftly.
Possible Food Allergy Treatments
Oral Immunotherapy – give small doses of allergic food under doctor’s care.
Sublingual Immunotherapy – drops of food under the tongue. Either put drops in for a timed period and spit out or put drops in and swallow.
We need to learn more about both methods.
Food Allergy Theories
Do genetically modified foods cause more food allergies? We can insert things into foods quicker now than we could before. A worry is that we can now take an allergen (brazil nut) and put it into a food. People can react to it not knowing that an allergen has been added to the food. Can choose to avoid GMO foods but some argue we need GMO foods to feed our large population. Not enough space/land to grow enough food to feed everybody.
Do antibiotics/hygene theory contribute to food allergies? If give anti-biotics to kids, it changes gut. These changes in bacteria can make a difference.
Watch out for pro-biotics. Not all pro-biotics are of the same strain. We need to watch this area still.
A C-section can increase chance for food allergic child if already predisposed. When baby travels through Mom’s birth canal, it gets her bacteria and that is healthy.
LEAP Study – Learning Early About Peanut Allergy. A clinical trial being done by Gideon Lack to determine if eating peanuts during infancy makes the immune system tolerant or sensitive to peanuts consumed later on. Does one approach work better than the other in preventing peanut allergy in children? Won’t see results for a few years.
Food allergic kids don’t get flu worse than other kids.
How to treat kids that do get the flu:
Keep fluids in them
Monitor fever
If child has asthma, begin asthma treatments
If child is not responding to asthma medications, go to emergency room.
