Food Allergy Prevention 101 with Tina Sindher, MD

Katie Ferraro (0s):

Have, you ever tried to crack your own coconut? I remember the first time I tried to make coconut for my baby twins, I had no clue what I was doing. It involved a coconut, a screwdriver, a hammer. There were safety goggles. Since that time I've learned a lot about making foods safe for babies and, spoiler alert, there are way easier ways to get your baby to safely try coconut. This week I'm actually making coconut as one of the five new foods that I'm making for my friend's baby Ezra. So I'm cooking all of his hundred First Foods and we're on week 10, meaning we're almost halfway there. He is gonna be trying foods number 46 to 50 this week. He's just past eight months of age now and the five new foods we're trying this week, our coconut for the new fruit of the week. Green beans are his new vegetable.

Katie Ferraro (40s):

The whole grain starchy food we're doing is bulgur. One of my favorite plant proteins, kidney beans. I'm making this amazing kidney bean pie. It's his new plant protein, and then we're also gonna be doing ricotta cheese as another way to introduce the potentially allergenic food cow's milk protein. So if you are just getting started with solid foods, if you're interested in learning more about how to make foods safe for baby-led weaning without having to wear safety goggles, the best place to get started is my free online video workshop. It's called Baby-Led Weaning For Beginners I just redid this whole training. There are so many good visuals of how to prep foods safely and ideas what to feed for the first few weeks of baby-led weaning, plus a whole section on making allergenic foods like the ricotta.

Katie Ferraro (1m 23s):

We're gonna make our own ricotta. You can definitely buy your own too, but it's super easy to make and to make it safely for your baby to eat. Everybody on this free workshop gets a copy of my original hundred First Foods list so you'll never run out of ideas that your baby can eat. You can sign up for this workshop if you go to workshop.babyledweaning.co , you can register and take it right now or you can take it later today or like if your baby's taking a nap or sleeping and you can also do it tomorrow. Really, whatever works for your schedule. If you've got a little bit of time to learn about baby-led weaning, I'd love to see you on this free workshop. Again, that signup is at workshop.babyledweaning.co and happy feeding.

Katie Ferraro (3m 11s):

Hey there! I'm Katie Ferraro, Registered Dietitian, college nutrition professor, and mom of seven specializing in baby-led weaning. Here on the Baby-Led Weaning Made Easy podcast I help you strip out all of the noise and nonsense about feeding, leading you with the confidence and knowledge you need to give your baby a safe start to solid foods using baby-led weaning. Offering and having your baby eat a food is really the only way to know if your baby is allergic to it. But that doesn't mean it's not scary. Tina Sindher is a pediatrician and a food allergy research and she's my guest today. She's a clinical associate professor of medicine and pediatrics at Stanford and she's also the director of Clinical Translational Research at Stanford's Sean N.

Katie Ferraro (3m 58s):

Parker Center for Allergy and Asthma Research. So Dr. Sindher is also the mom of two small children and she has that really unique blend of real life clinical experience. Like she is in the clinic working every day with families who are living with food allergy and she's also conducting research. So she looks into factors, for example, that increase the risk of food allergy like eczema in babies or even how does mom's diet during pregnancy affect food allergy outcomes in babies. And today Dr. Sindher is going to teach some basic tips for introducing allergenic foods as a means to help reduce the risk of food allergy, talking more about the theory behind it and why we wanna do this and what the research is saying or is not saying. Now, there is a part in the interview where she mentions the LEAP study.

Katie Ferraro (4m 39s):

So that's the learning early about peanut allergy, the landmark clinical trial that really shifted the entirety of what we know about Introducing allergenic foods. And the study found that the early introduction of peanut actually helps prevent peanut allergy down the road. In that answer, that response, she mentions Bamba. So if you're not familiar with them, Bamba is a peanut based snack that is common in the diets of young children in Israel, which is where a cohort of the LEAP study took place. So I didn't want to interrupt her to ask her to explain what Bamba is, but just a heads up, it's a peanut puff that babies eat routinely in Israel and other parts of the world was kind of key in that study to showing that early introduction of peanut foods helps to lower peanut risks. So with no further ado, I wanna bring on Dr.

Katie Ferraro (5m 19s):

Tina Sindher to talk about Food Allergy Prevention 101.

Dr. Tina Sindher (5m 25s):

Hi Katie and thank you for having me.

Katie Ferraro (5m 28s):

I am so excited to chat with you because I've been familiar with your work for a long time and it was, I was, I'm glad we could finally get something on the books. I know you're a very busy practitioner, researcher, clinician, mom of two. Tell our audience how did you become interested in both this kind of intersection of pediatrics and allergies?

Dr. Tina Sindher (5m 46s):

That's a great question and I, I, you know, when I talk to medical students and residents, they, they ask me this question sometimes. When I first started medical school, I feel like I loved all of it. Every, every rotation I did, I was like, oh yes, this is, this is it. I I would love to do this. And so OBGYN was pretty high on my list at one point. I even thought I wanted to be a surgeon until I, you know, one week into my pediatrics rotation. I knew that was for me, I just loved being in the environment. I just loved working with children and at that time I didn't have children of my own. And so that kind of pushed me towards going into pediatric residency.

Dr. Tina Sindher (6m 29s):

But I found pretty early on that I loved learning about the immune system. I, I just loved where all our little cells do their job and you know, how things kind of pan out when they're not working and what you can do about it and how you can identify it. So all things immune system related, I, it really excited me and I enjoyed it and I, allergy was almost accidental. It was one of our rotations and it wasn't my top choice. I wanted to do oncology as a rotation first, but what I loved about allergy is I felt like I was treating the whole family. You, you, you know, you address the quality of life and it's not just the child.

Dr. Tina Sindher (7m 13s):

It impacts the whole family. And I, I loved that connection where I got to see them often know, you know, where they're going on vacation or what new foods they've tried and just the excitement surrounding it all. I, I just felt like I was making a difference and, and you know, one patient at a time including in their family's lives. So that's, that's where I got into food allergy specifically. But allergies in general.

Katie Ferraro (7m 38s):

I've never thought of food allergy treatment as treating the whole family, but of course you are, right? Ultimately the goal is that the family is able to eat, enjoy foods together and that the one or however many people in the family that have the food allergy should be allowed to participate fully in the mealtime. So it, it is that kind of holistic approach. And I know in Food Allergy a lot has changed in the world of introducing allergenic foods that personally when I was studying to be a dietician over 20 years ago, it was, you know, we learn no dairy until age one, no eggs until age two and hold on peanuts tree nuts and fish until three at real high level. What is different today versus those recommendations from 20 years ago when it comes to Introducing allergenic foods to our babies?

Dr. Tina Sindher (8m 17s):

I think part of the reason there there has been so much change is because truthfully we don't completely understand our immune system. There are a lot of redundancies and when we think we understand it and we make these guidelines and you try it out and you realize you've done the opposite and have not really helped in the way you'd hoped to do So, we have seen this real change in the guidelines which really just reflects how much more we still need to learn about our immune system and how we develop food allergies. But our latest guidelines are really based on this instrumental study called the LEAP study performed in the UK where they found kind of children who were deemed to be high risk or already sensitized and one group of patients they gave peanut containing foods, specifically Bamba is what they gave children and another group, they didn't give them the Bamba and in the cohort that had peanut introduction early had a much lower rate of food allergy down the line.

Dr. Tina Sindher (9m 22s):

And I was just at a meeting where one of the investigators who was in the original study was telling us about their follow-up studies and just continuing to follow these patients long-term. So it, that study has been so crucial in just changing our mindset about food allergies and that it led to other studies such as the EAT study where it wasn't just peanut but multiple other allergens to see if early introduction to many allergens can have the same impact. And that study too was very promising and based on these guidelines and across Europe, across Australia, and Canada, we have it in the US now as well where we recommend early introduction with peanut and even though it's not explicitly stated, allergists are recommended to encourage early introduction for all foods, not just peanut.

Katie Ferraro (10m 16s):

So. we recently had Dr. Gupta on the podcast, Dr. Ruchi Gupta and she was talking about why doctors are still, for the most part, not really talking about Introducing allergenic foods early. A recent paper refers found that only 13% of parents and caregivers are aware of the recommendations to introduce peanuts to babies early and often. Do you think this is a problem as well or I mean you are a parent and I love having researchers on who are actually practitioners as well. So you see what the recommendations are are supposed to be, but then you're in the clinic and you're like, are parents actually getting the message they trickling down from the research? Do you think parents are starting to hear this message more about new updated guidelines regarding early and often introduction of allergenic foods?

Dr. Tina Sindher (10m 54s):

That's a really good point and I, I just saw Ruchi a few months ago at a global Food Allergy Prevention summit where we all just kind of talked about ways to, you know, prevent food Allergy in the first place. Yes and I, I think one of the discussions we had is that our allergy experts and allergists, we are just maybe not doing a good enough job disseminating the information we need to make it easy for the pediatrician and the primary provider to be able to just disseminate the information and not have to, you know, figure out the how often and the how much and the when and So I. I do think some of that comes from not very explicitly stated clear guidelines from the allergy community.

Dr. Tina Sindher (11m 40s):

So I. I feel strongly that we should be putting out statements to help guide pediatricians and what kind of information to provide the families and patients. And the way I come across this is we have some studies where we are enrolling pregnant moms to understand the development or you know, lack of development of food Allergy in those babies at three years of age as well as we're recruiting infants less than two months of age and seeing, you know, the connection between eczema and dry skin and developing development of food Allergy So, we are fielding this early introduction, the how to the how much often and we're also getting asked by pediatricians themselves where they're at a loss of what exact guidelines to give to families.

Dr. Tina Sindher (12m 27s):

So yes, I do think the information is a little piecemeal and haphazard and is not being consistently disseminated and that's where the allergy societies and groups can truly play a role.

Katie Ferraro (12m 39s):

Hey, we're gonna take a quick break but I'll be right back. One thing I'm noticing you're talking about the kind of confusion is on the other end of the discussion it's in some cases not that the parents are waiting too long to introduce the allergenic foods or not doing them at all, some of them are wanting to do it too early. So four and five months of age which is before babies are safe to eat foods other than infant milk. So outside of that small subset of the population of babies who are deemed to be at high risk for peanut allergy, so those who already have an egg Allergy and or severe eczema, is there any compelling reason to introduce allergenic foods at four or five months of age versus waiting until six months?

Dr. Tina Sindher (13m 23s):

What I typically tell my families is to really see if your child is developmentally ready. Like are they really what's key? And I feel like food allergy treatment for those who have developed food Allergy but in general kind of eating of Foods in general, just kind of following the cues of your baby to see like are they gumming, are they putting things in their mouth, are they showing an interest in food? Do they want to be eating? And to really kind of look at these cues from the baby before we all try to jump in and start feeding them allergens at four months of age. For instance, for my own children, my second born, she's eight years old now was showing interest in food much earlier than my 10 year old now where if he could, he would just probably be drinking milk forever.

Dr. Tina Sindher (14m 14s):

So they just had a very different approach to food and you have to kind of tweak your parenting a little bit based on what your child's needs are. So, I, I tend to be less prescriptive about the exact time. That being said, some of the data has been done in children as young as four months of age. So if you have a four month old who is showing interest in food it, it's not gonna harm the child if you start giving them small amounts just to taste and put it around their mouth or not around their mouth but on their lip.

Katie Ferraro (14m 45s):

So early introduction of allergenic foods, we know it's the one thing, it's like that one risk factor that parents and caregivers have some impact on, right? We can't do anything to lower the risk of you know, existing food allergy in the family or history of allergic disease. But parents know okay I have this job and I wanna introduce the allergenic foods. I think you know, we as a feeding and research community have good data for this on peanut. Right. You mentioned the LEAP study, fairly good data on this for egg and milk, you mentioned the EAT study but what about the other kind of less common Allergenic FOODS? What research is being done right now? 'cause they always say you know, more research is needed. Sometimes I think researchers say that for like freaking job security. I'm like you guys are always saying that like you're the researcher, why don't you do it? But like what about the other allergenic foods, right?

Katie Ferraro (15m 26s):

Which think about the, the list of the big nine, right fish and shellfish, tree nuts, soy, wheat, sesame. Should we also be doing those early and often? 'cause you kind of said before like there's no real definitive data but we also know there's like no real benefit to withholding the introduction of those foods, right? Like it is this huge gray area.

Dr. Tina Sindher (15m 41s):

That you are absolutely right. So the way I have internalized all the available data out there is to encompass that diversity of diet is important. So really as much for variety as you get in there as many different foods that you get in there is only gonna help and it's not going to hurt and the data is promising but the problem is the data is only as good as the study that was conducted. And performing these kind of studies as you can imagine is really, really difficult to really kind of, you know, capture the exact amount and how much food are they doing it, you know, five times a week.

Dr. Tina Sindher (16m 21s):

And so adherence rates and just the ability of families to continue with these studies is very difficult and that's where the data is. It's hard to say definitively like this is the amount, this is how frequently because it all kind of falls apart over time. But that being said, in the the data we do have, we've seen that this is feasible and there's no harm to the Babies and we have data showing diversity of diet is important.

Katie Ferraro (16m 48s):

And I love that concept of diet diversity. I teach a hundred First Foods program so we help parents introduce their babies to a hundred foods before turning one. And I'm very close as a friend and but also professionally with Carina Venter and she's a big advocate for diet diversity and this whole idea of like the more exposure and experience that babies can have with foods like parents are so scared to try this but if we show them how to do it safely and I think Carina also being a dietician, that's where we come in showing parents how to do this safely. 'cause as you know, you can't just shove a spoon of peanut butter in a four month old's mouth. They are going to choke on that. So we have to modify these foods to make them safe. And I appreciate what you're saying from the research standpoint that it is hard to design these studies. They are incredibly expensive. And where I take issue is like if you look at, look at LEAP for example, right?

Katie Ferraro (17m 31s):

They that particular research design, they did six grams of peanut protein per week equivalent to close, you know, to three teaspoons of peanut butter. And then you get brands that are like, well we put the exact amount of peanut protein into this product that they use in the LEAP study. It's like, well there's nothing to say that if the researchers had designed it with any more or any less protein, that would've been more or less protective. Like we just don't know that so I think researchers do need to be hesitant to put out these very stringent guidelines for pediatricians give your baby three teaspoons of peanut butter because that may or may not necessarily quote unquote solve the problem. But we know that waiting until two to do peanut is not the answer either. Right? So it's somewhere in between there.

Dr. Tina Sindher (18m 5s):

Thats right. In fact some data pilot study, so they're not as large as something like leap, but some data does show that amounts as small as 2.5 milligrams, which is tiny. One peanut is 300 milligrams of protein. So 2.5 milligrams of protein may be enough to give you the protection of staving off food allergy. So very small amounts may be good enough.

Katie Ferraro (18m 31s):

And parents ask that question, well how much does it count? How much counts? You know at the beginning your baby's not actually eating that much. So there are times where you offer it where they might not even interact with that protein. That's, that's why we need to do it early and often. And I know that recommendation is frustrating to parents because it's not very specific. Well how early, we kind of covered that earlier, but the how often part could you speak to that like repeated exposure to the protein and that it that these allergic reactions might not occur on the first exposure? 'cause I think that message sometimes parents are like, oh we did shellfish once so he is not allergic. It's like no it doesn't work like that.

Dr. Tina Sindher (19m 2s):

No, no you're exactly right. And to that point, sometimes you know, babies probably are wearing the food more than they've actually ingested it. So what I like to say, and again it it really is dependent on what works for the family. But I like in my head I like to think of it as to feel confident that you are not allergic to it. Maybe in the first two weeks if you're able to give it like three times a week and you've introduced it where you feel that even a small amount has been ingested and the child has been doing okay, in my mind I feel like that is very good evidence that you are not allergic. But at the same time for the highly allergenic Foods, if there's a question or concern, there's strong family history, the child has a lot of eczema that puts them at high risk for food Allergy or they're already food allergic to another allergen.

Dr. Tina Sindher (19m 53s):

In those cases I will go as far as to say after you've established that they're not allergic, keep it in some form in the diet at least once a week just so they're, you know, they're getting used to the food, they're getting used to the texture and you're not at risk for limiting exposure over time.

Katie Ferraro (20m 11s):

Are there any benefits to withholding the introduction of allergenic Foods

Dr. Tina Sindher (20m 16s):

At this time? Not that I'm aware of. That being said, depending on the medical condition and what other health issues might be ongoing, there are some patients where we may actually ask them to withhold introduction of foods in general, especially if there's any feeding disorders or if there were, you know, any swallowing dysfunction and things like that.

Katie Ferraro (20m 38s):

Okay. But for a typically developing population

Dr. Tina Sindher (20m 40s):

A typical developing child, no, not that. And if anything, if some of my families they're so because of family history they, they have an older child that's already food allergic, you're so nervous about the introduction of foods in their younger child. And from the safety standpoint, we have found that those early infant allergic reactions tend to be very mild. We do not see very severe, severe, severe symptoms with those. So if, if you are able, if you are giving a food and they do end up having an allergic reaction, it almost is helping us identify it early so we can do something about it and help support the family. So I, I cannot think of a compelling reason not to do early introduction in a typically developing child.

Katie Ferraro (21m 27s):

Hey, we're gonna take a quick break but I'll be right back, And I know you're working on like talking points for pediatricians. That one is huge short of saying your baby is not going to die from anaphylaxis, from a food Allergy reaction. You're actually hard pressed to find even in the literature a case of that happening. Not to say that it couldn't happen, but anaphylactic reactions from food allergy are much more severe the older the child gets. So if we need any more impetus to encourage parents to do this earlier, it's actually safer to do it earlier. Now as a dietician, I have problems with the four and the five month olds. Like if parents are not educated about this, the risk of choking when your baby does not have the trunk support and the head and the neck control to facilitate a safe swallow.

Katie Ferraro (22m 15s):

Like if there is not hard and fast data to show that this is safer to do at four and five months than it is to six, then I feel we should be waiting until six months of age. Especially when we're talking about exclusive breastfeeding, right? The World Health Organization, American Academy of Pediatrics, they recommend exclusive breastfeeding until six months of age. If you're telling mom to introduce solid foods, and I know you guys are saying like, oh just play around with it and put it on the lips. But what they hear is, oh, now they're starting to eat. So now I'm breastfeeding less and I maintain that that's an anti breastfeeding message because we should be promoting breastfeeding and then starting solid foods when as you said, the baby is developmentally ready. Now obviously pediatricians and dietitians oftentimes disagree on what developmentally ready is. So it's, it is this ongoing conversation that to be honest, our parents had the same conversation.

Katie Ferraro (22m 57s):

if you look back at, you know, recommendations for introducing solid foods, it's fluctuated all over the place. But I do think pediatricians need to be careful when they give blanket statements saying four to six months because four month old babies can't sit relatively on independently, you know, and we know that. So I think if there's, kind of leads me into my next question. I wanted to know what your thoughts were on this kind of overmedicalization of the introduction of allergenic foods like this marketing to parents' fears. They're, you are so scared to feed your baby real food. So now we're trying, you've got all these companies and supplement companies trying to push expensive supplements, subscription models with powders that they mix into bottle and traditional baby foods versus just making safe versions of those foods for the babies to try, not to talk to any particular brand.

Katie Ferraro (23m 39s):

But what do you think about this kind of shift in the conversation about introducing Allergenic foods where it's less about food and it's more about supplements?

Dr. Tina Sindher (23m 46s):

When I speak to my families, I try to kind of work through what their fears are and what is feasible and you know, for my children, I, and this was before the availability of all these kind of allergens, but I, I wasn't, I remember I, I had just started allergy fellowship. My son was six months old and I, I bought myself a bottle of Benadryl and like the allergy clinic is down the way. I'm going to introduce these foods and the way I did it, I would, I would just blend in all the peanut tree nuts, whatever I needed into the applesauce and just turn it into a little applesauce puree and feed it that way. And having, you know, speaking to parents, you know, if that, based on what I'm hearing from them, if they feel more comfortable buying a product and it takes the stress out of the how much, then I will support that as long as I, you know, I'm present if they have any reactions or questions, but at the same time I try to highlight that you don't need that product either.

Dr. Tina Sindher (24m 46s):

It's, it's also important to kind of just, you know, for the child to have a, have a sense of the smell and the taste and the texture of course, you know, in a form that's developmentally appropriate for the child. 'cause they're still, you know, nuts and certain forms can still be a choking hazard. So I, I'm a big fan of using food equivalences like things like the real food product if you can. But at the same time if this makes a parent's life easier, then I'm all about kind of what works for them. But so I tend to be open to kind of what works for each person. But I guess for myself, I, I did the former which is I, I just bought the real foods and found a way to introduce it.

Katie Ferraro (25m 33s):

You had mentioned something interesting and I don't know If, you did it on purpose but mix nut butter with peanut butter together in applesauce. If your baby had had an allergic reaction to that, how would you have known if it was peanut or cashew or walnut or almond or why would you combine them together?

Dr. Tina Sindher (25m 47s):

You know, at first I did them individually.

Katie Ferraro (25m 50s):

Okay so you're not advocating for mixing up all the allergenic foods together. Okay.

Dr. Tina Sindher (25m 53s):

And then, so after I did a few by itself I was, you know, in fellowship my husband traveled a lot. I was like I cannot do this. I'm just putting it all together and we'll run that way.

Katie Ferraro (26m 6s):

And 94% of infants are not going to have an allergic reaction and you wouldn't have known that had you not fed that to your baby. And I think that's an important message for parents and caregivers is the only way to know if your child is allergic to a food is to feed it to them. And by not feeding it to them, you could potentially be increasing the risk of food allergy. Not to blame anyone, this is, this is scary stuff but at the end of the day most of your babies are not going to have a reaction. And if they do have a reaction then thankfully there's wonderful resources like your clinic where you do a variety of things. I was, before the interview we were just kind of chatting, you do an OIT clinic, an EOE clinic. Do you always work with families after they've had had a diagnosis of food allergy and can you talk a little bit about the diagnosis process?

Katie Ferraro (26m 48s):

'cause we've also had experts on telling us, you know, gosh 50% of positive food Allergy test results are false positives. These parents wanna go in and just test for everything, but it doesn't work like that. So anything you can share about the process of diagnosing a food allergy?

Dr. Tina Sindher (26m 60s):

Yes, so with the diagnosis of food allergy, it's a tricky spot because you, you said it perfectly 50% of the time there's a false positive rate. So it's really hard to tease out a true clinical reactivity versus sensitization, especially if there's no history of actual ingestion. 'cause that is the gold standard. Gold standard is If, you've eaten the food and you've reacted to it. The labs are just there to kind of help support or, you know, provide guidance down the line. So if I have a, a child, well and this actually, you know, we, we were talking about all the foods at the same time in introductions and we've seen that with these allergen packets where all the allergens are together and the child has a reaction And then you know, generally these children tend to be allergic, meaning they have eczema, they have a high IgE values.

Dr. Tina Sindher (27m 47s):

And so every food you've tested is now positive but you're like it, it's not that all those foods are triggering the allergic reaction. There's gotta be a few in there. So, we go through this long road of doing food challenges where we introduce the foods in our clinics under observation and see whether they have an allergic reaction or not. 'cause their labs are positive to these foods. So if they don't have an allergic reaction then we strongly encourage that they put it into their diet because they're already sensitized. We recommend strongly that it's a minimum of three times a week that they have it in their diet, keep it in their regular exposure because if you avoid it again over a period of time you can become resensitized and become allergic to the food down the line.

Dr. Tina Sindher (28m 35s):

So some of these patients we've had to do that where we've done the food challenges in clinic series of challenges to see what we can safely reintroduce back into the diet. And that brings us back to, you know, when I see an initial visit where there is a either, so two scenarios. One is the child had an allergic reaction, we have strong suspicion of what the food is, if the parent requests blanket testing. I, I'm all about shared decision making and I, I would love to support families in any way they can. But I really highlight that these tests can be misleading and we really need to encourage that they eat the food. So, I do try not to do labs for foods that I, they have not ingested yet.

Dr. Tina Sindher (29m 19s):

And I try to prepare them in terms of how to do the introduction safely. You know, making sure that you know, both caregivers or multiple caregivers are around in a controlled environment. You have whatever emergency medications you have ready if needed, you have access to emergency care if needed. But really the gold standard is eating the food. So one group is, you know, they have a specific reaction, we do the testing and we go that way. Then another group of patients I see is that it's a little more, the picture's a little more murky. We don't know what the trigger was. They've had an allergic reaction, blanket testing was done and multiple foods are positive and those are the kiddos where they're now avoiding all these FOODS and we we're really putting them at risk for developing food allergies for to some of those safe Foods.

Dr. Tina Sindher (30m 7s):

So it is those patients that we try to work so closely with and get them into clinic, you know, as much as we can to get the the foods into their systems early. 'cause time is of the essence. We, I mean one thing we know from the research is our immune systems are malleable when they're young. So the sooner we address this the better the long-term outcomes.

Katie Ferraro (30m 29s):

Dr. Sindher, which study related to infant or pediatric food allergy that you and your team are working on right now are you most excited about and why?

Dr. Tina Sindher (30m 36s):

How about this? I'll bring up two different favorites. So my favorite in the infant setting is our seal study, which is really looking at Food, Allergy, Prevention. And that to me, if we can get good information is going to be such a huge contribution to the literature, to the field and could have the possibility of making kind of a global impact. So in this study we're enrolling babies with dry skin or eczema and then treating them aggressively with emollient as well as low potency steroids for the eczema to see if we control the eczema aggressively versus if we just did standard of care and just let the pediatrician kind of manage the eczema and the family manage the eczema.

Dr. Tina Sindher (31m 22s):

How the child does down the line. So, we don't have early data yet but I can't wait to see what the data ends up showing and whether there is a benefit to kind of helping manage the skin early. The other study that's one of my favorites is it's called a combined study and this is for children four years all the way up to 55 years of age and we are doing multiple food Oral Immunotherapy. So these are kids in adults who already develop food allergy and we're doing multi food OIT with two different biologic injections that can actually, you know, soak up your IgE floating around in your body and it one drug does that and the other drug helps kind of minimize the allergic cells from migrating into tissues.

Dr. Tina Sindher (32m 11s):

So with the combination of those drugs plus the OIT, we're hopeful that it can get up to you a maintenance dose quicker, more safely and have just good overall outcomes.

Katie Ferraro (32m 22s):

Hey, we're gonna take a quick break but I'll be right back. I know you said you were just gonna do two but you had previously mentioned a study where you were enrolling pregnant mothers. What is it about pregnancy that you're studying that does or does not determine or predict future food allergy in the infant?

Dr. Tina Sindher (32m 46s):

And that's another cohort of patients that I feel like there's so many questions, right? Like what do you eat during pregnancy and like well what do you eat during breastfeeding that we just don't have a lot of answers to. I mean all the data has now said is, well it won't hurt but the benefits is you know, hasn't been super overwhelming either. So in the study we're actually looking at so many different elements. We're looking at maternal diet, we're looking at medications, other existing conditions. We're also looking at microbiome, both gut microbiome, skin microbiome, mucosal microbiome because there is a connection between our microbial diversity and how our long-term development of food allergy as well.

Dr. Tina Sindher (33m 28s):

And I know this is something that's close to Carina's heart as well. We've collaborated on studies before and on the SEAL study since I mentioned that first Carina was instrumental in its design as well. And once the baby's born we actually see them every six months and then we see 'em again at a year and we, we get skin swabs, we look at you know, epidermal water loss to get a sense of how dry the child's skin is. We're looking at their dietary history, we're looking at the foods they're Introducing at what time. And that study long-term I think has the potential to give us so much information in terms of identifying maybe some, some positive associations that can show us that these things can actually reduce your risk or are protective and that would be so instrumental in our long-term guidance that we give families.

Katie Ferraro (34m 21s):

I didn't know you could study epidural water loss. Like there's an objective measurement for yes determining that because you know parents here eczema and you guys aren't just talking about the run of the male eczema like all babies have when we're talking about like severe eczema, that's so different and parents like how do you know and what if I don't have a dermatologist? Like it would be so cool if parents could know like exactly how dry their baby's skin is. Just one more thing to worry about.

Dr. Tina Sindher (34m 43s):

One more thing to worry about. But what we're finding is some of the kids with dry skin run of the mill, typical baby dry skin sometimes has kind of behaves similar to those with eczema and can be the same risk factor for developing food allergies.

Katie Ferraro (34m 59s):

Oh, my gosh, now all the parents are gonna be freaked out more about two things. That's not the point of the of the interview. What is it that you wish that all new parents of a baby who's just getting ready to transition to solid foods could know about introducing Allergenic foods?

Dr. Tina Sindher (35m 12s):

A mentor once told me is that when I asked him this question was you should live the way your grandparents lived. And so when I had my children I was like, mom, you know, and my mom-in-law like how did you introduce foods to me? Let's just kind of go down that path. And so I was very open-minded and flexible with, and my mantra was diversity, dietary diversity. So I wasn't as focused on the allergens specifically but just like as much that I could get in there is all helping in the long term is how I think of it.

Katie Ferraro (35m 45s):

Where can our audience go to learn more about your work Dr. Sindher?

Dr. Tina Sindher (35m 49s):

I would say that our website, the Sean and Parker Center for Allergy and Asthma Research is our center Food Allergy Center's website that has a listing of all our ongoing studies as well as past publications. So that could be, that could be a good spot.

Katie Ferraro (36m 4s):

Well thank you so much for this conversation. I appreciate all of your insight. I know the questions are kind of all over the board, but we just wanna do like, you know, Prevention 1 0 1 and what's going on right now and I really appreciate your take as someone actually working with families and doing the research because a lot of the researchers, I don't think they've ever fed a baby and a lot of the baby feeding people don't know anything about research. So it's nice to see both sides of the coin 'cause I think it's important that they talk to each other.

Dr. Tina Sindher (36m 27s):

Well thank you so much Katie for asking such insightful questions and really I, I feel like you highlighted the fact that it's not easy and there's a lot of information needed to give very specific guidelines, but at the same time I think whatever feels good right, for a parent and their baby and is safe is is gonna be helpful in the long run.

Katie Ferraro (36m 47s):

Well it feels good to be like this is too much, I'm just gonna skip it and breastfeed forever. And that's also not the right answer, So, we gotta find somewhere right in the middle. Yeah. Thank you again. This was a great conversation.

Dr. Tina Sindher (36m 57s):

Yes, likewise.

Katie Ferraro (36m 58s):

Well I hope you enjoyed that interview with Dr. Tina Sindher kind of talking about a lot of different things as they are happening in the research world or you will be hearing about them in the future 'cause they're conducting the research right now or interpreting previously done research and how that can help families. With the introduction of allergenic Foods, I'm gonna put all of the references, including the different studies that Dr. Sindher was talking about in the Shownotes for this episode, which you can find at BLWpodcast.com/382. Thank you so much for listening to this episode and this podcast and a special thanks to our partners at AirWave Media. if you guys like podcasts that feature food and science and using your brain, check out AirWave Media.

Katie Ferraro (37m 38s):

We're online at BLWpodcast.com. Thanks so much for listening and I'll see you next time. If you are interested in doing baby-led weaning, but you're not exactly sure, like what does that mean? What does it look like? Where do I start? My online program called Baby-Led Weaning with Katie Ferraro has everything you need to give your baby a safe start to solid foods and get them to eat over a hundred foods before they turn one, whether you're terrified of choking or maybe you've started but you feel like you're feeding your baby the same foods over and over 'cause you don't know what to feed next or you're looking for guidance on how to prepare Foods safely for your baby's age and stage.

Katie Ferraro (38m 19s):

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Katie Ferraro (38m 59s):

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