Why are we hearing about so many kids these days with nut allergies? It’s unclear why peanut and tree nut allergy (and, in fact, food allergy in general) has been increasing over the last 15–20 years but recent studies suggest that 3 to 6 percent of children have a food allergy. Recently, researchers have speculated that current GI bacteria (microbiome) as well as the timing of food introduction may be playing a role: There are certain bacteria that produce chemicals that enhance the allergic response; and delaying introduction of certain foods might be missing a critical period in infancy when tolerance to a food allergen is more likely, such as the first year of life.
We hear there’s some exciting research going on in this area regarding peanut allergies. Can you explain? Two exciting newer studies include the use of a peanut protein patch and the use of omalizumab [an antibody designed to reduce sensitivity to allergens] prior to peanut (and other food) desensitization. The peanut patch seems to be quite effective, and has been better tolerated compared to traditional oral desensitization protocols. Omalizumab is used to pretreat patients before desensitization to provide a potentially safer starting point by removing the peanut IgE (allergy antibodies) that could otherwise cause a potentially fatal systemic response.
Managing childhood asthma has changed considerably over the past decade or so. What new treatments can we expect to see in the near future? The fundamental change to managing childhood asthma over the last 20 years has been to approach this as an inflammatory disease, using inhaled corticosteroids for routine controller medication to minimize the daily impact of the disease and to prevent severe acute exacerbations leading to ER visits or hospitalization. Over the last decade, more emphasis has also been placed on diagnosing and treating underlying diseases that lower the threshold for asthma, such as allergic rhinitis and chronic sinusitis.
You’re a Seattle native. What are a few of your favorite local hangouts? My favorite restaurants are Wild Ginger, Il Terrazzo Carmine and the Metropolitan Grill (but my wife and I also love trying new places). Favorite neighborhood spots include: Din Tai Fung, Jak’s Grill, Mioposto and the Ram at University Village. —M.B.