Richard: Hello, this is Richard Jacobs with the finding genius podcast over Carla McGuire Davis. She’s an associate professor of pediatrics, also the section of immunology, allergy and retrovirology. She’s the director of the Texas Children’s Hospital Food Allergy Program. She has a chair in Immunology and HIV AIDS at Baylor College of Medicine. But there’s a lot that she works on. But today we’re going to focus on food allergies and some gastrointestinal problems that affect children. So, Carla, thanks for coming.
Carla: My pleasure to be here.
Richard: If you would tell me what got you interested in the food allergies or working with children, the gastrointestinal issues in the first place?
Carla: Wow, that’s a great question. I was a training doctor. I was a pediatrician, and I was training to be an allergist-immunologist and I kept seeing children who were pretty highly impacted by their allergic skin disease and their food allergies. I noticed that there was a little bit of research happening, but not too much with regard to the immunology of these children, as well as the best way to figure out what foods they were and weren’t allergic to. So I became really interested in this. There were two cases in particular that that really pushed me towards this field. One was a little girl who had severe atopic dermatitis, always had skin infections, and was anaphylaxis or having severe allergic reactions to things like milk, wheat, things that everybody eats because he could not stay in daycare. His mother, who was in school for nursing, quit her job and had to stay home and I could see she was quite impacted and affected by that and that was the first time I really realized how big of an impact severe food allergy can make in someone’s life.
Richard: Everyone’s worried about their children and me certain child’s like that. You’re constantly worried about their diet. So I’m sure that it’s a big drain on the whole family’s energy.
Carla: Absolutely and then the second case was actually an adult. He came into the clinic and he was really emaciated, thin as a rail. I thought he had cancer or tuberculosis or HIV disease and then I asked him what he had and he said food allergies and to make a long story short, he actually didn’t have the food allergy he thought he had and in my quest to figure out whether he truly had a food allergy or not, because he had positive tests and in his prior doctor told him to stay away from all foods that had any trace of his food in it, which was pretty much everything he ate. So he said he didn’t know what to eat and he lost like 40 pounds and so I realized that the only way I was going to be able to let him know or to figure out whether he truly had food allergy was to give him a food challenge in my particular office at the time, didn’t allow food challenges because it’s a relatively risky procedure that has to be done in an office and I called around to every single office, every person I knew in the greater Houston area, and I could not find anybody who would do this procedure.
Richard: What is a food challenge?
Carla: Well, that’s a great question. Yes. So in order to figure out if a person has food allergies, we have to do what’s called a food challenge because the blood tests are skin tests. Can’t really tell us with 100 percent certainty when a person does or doesn’t have a food allergy. So it’s a procedure. The food challenge is a procedure where a person in an office or in a hospital setting is given very small amounts of the food and then so let’s say one-hundredth of serving size, monitored for 15 minutes and then given a little bit more and then 15 minutes and has about seven or eight of these doses to see if the person actually reacts to a serving size of the food.
Richard: Can this procedure kill them?
Carla: Well, because they’re in an office and or a hospital, it could I mean, I guess technically, if you react, you could die. But because you’re getting medical care immediately, it’s exceedingly rare that this happens. So and allergies is what’s called the gold standard and we only do this test in children or adults that we at least think they have a 50 percent chance of passing the challenge and those people are less likely to have severe disease that would kill them and so because I couldn’t find anybody, I did it myself but I recognize there was this need right in my area to be able to tell people whether they did or did not have a food allergy and it causes so much disruption to people’s lives. I felt strongly that that service needed to be there.
Richard: I have heard with peanut allergies there’s now a protocol for people like a minute, like a thousandth of a peanut continuously over a period of weeks and slowly increase it, they can even get resistance or a combination or whatever you want to call it, to severe, severe allergies like that?
Carla: Yeah, that’s that is a really exciting development in the field of food allergy. It is the first FDA approved treatment for any kind of food allergy, and it’s peanut oral immunotherapy and each peanut has about two hundred and fifty milligrams of peanut protein in it and this particular therapy starts with one milligram. So kind of a two hundred and fifty. It’s a peanut and in this oral immunotherapy, the process is where this peanut flour that’s in a small capsule is essentially placed. The capsules unscrewed and opened in the flour that’s inside is placed on food that the person takes every single day and they do that for two weeks and then every two weeks, the dose is increased. But when the dose is increased, they come into the office to have a food challenge to the next higher dose and what the body does is it becomes more desensitized or more tolerant to the peanut when it’s introduced in that manner in a very slow fashion, starting very, very low and then increasing to three hundred milligrams of peanut, which gives protection against accidental exposure to trace amounts of peanut and so what it does is give it kind of removes that fear and anxiety that peanut-allergic people have when they go to a restaurant or to a friend’s house where they never try to eat peanut-containing food but sometimes cross-contamination occurs, which is when a very trace amount of peanut will get into food just because of the sharing of utensils or pots and so this therapy protects people from accidental exposure reactions. So people who are treated have to continue to avoid peanut. They can’t just go and eat peanut butter and jelly sandwich.
Richard: Even if they’ve been of this protocol, they’re getting slightly more and more peanuts over time. They still can’t have peanuts normally, correct?
Carla: Well, and no one of our studies that we’re is being reviewed right now for publication, we actually did what’s called a high dose oral immunotherapy protocol. We call it high dose because we gave the patients around four thousand milligrams of peanut and that’s anywhere from peanuts are kind of different sizes. I said two hundred and fifty milligrams, but peanuts are a little bit different sizes. So it was around 15 to 20 peanuts at the end and in those patients actually could eat a peanut butter and jelly sandwich after they finished. But it’s kind of an interesting thing with peanut-allergic patients. They don’t all like the taste or the smell of peanut even after having the oral immunotherapy treatment. So it is difficult to daily take that much peanut for many of the patients who participated in our study.
Richard: So you’re getting my new batch of peanuts. Why is it even given to these people? Is it to prevent them from having a big reaction? But they still can’t go to peanuts, but at least they won’t die if they actually have let’s say like a peanut curry. What’s the point of it if it doesn’t really cure them?
Carla: You’re right. There’s no cure. What contributes to the anxiety and fear and low quality of life, people with a peanut allergy is the fact. That most of them have an experience at one point or another where they think they’re eating safe food and like you said, peanut curry, if they just have a curry sauce, they may ask, does this have curry in it and the person who’s giving it to them, serving it to them doesn’t even know. So they say no and then they have yeah, definitely reaction. It puts them in the hospital. Some of them end up in the intensive care unit. So in order to prevent those kinds of episodes and to have peace of mind, that one doesn’t have to constantly worry and be vigilant all the time is actually something that can really increase the quality of life of peanut-allergic patients.
Richard: What are the most predominant allergies that you see in children and adults? Are they different? Are they changing? What are they today?
Carla: Yeah. Over the last 15 years, we’ve actually seen an increase in the prevalence of food allergies and there are eight foods that cause about 90 percent of food allergies in adults and children. Those are milk, egg, wheat, soy, peanut tree, nut fish. That’s like flatfish, like salmon and shellfish, like shrimp, and in certain of these eight food groups that children have more are an increased incidence of the milk and soy and wheat allergies and adults have more prevalence of the peanut shellfish and fish allergies. So and interestingly, the foods that are the food allergies that are outgrowing the foods that are typically tolerated as children get older are milk, egg, wheat, and soy. Typically, anywhere from 85 to 90 percent of children will outgrow those allergies by the time they get to be 18 to 21 years of age. The peanut tree nuts, shellfish, and fish allergies are typically not outgrowing. They typically, even if they develop in childhood, are lifelong. I’ll give you an example. There was a large study done with peanut allergy and it found out one in five children who have peanut allergy outgrow their peanut allergy and for tree nuts, only one in 10 children will outgrow that peanut allergy. We are wanting to do a shellfish natural history study, but it takes a very long time. So we’re going to try to treat it and have a study to use oral immunotherapy to treat shellfish allergy. It is a significant concern and problem for adults and actually, shellfish allergy is the number one allergy in adults.
Richard: Has anyone figured out why you will get allergies there? I mean, how do you characterize or categorize the different types of reactions you could have to the same allergies?
Carla: That’s a good question. There are two questions. One, the first question is why have allergies been increasing? And we think it has something to do with, it’s faster than we would expect with any kind of mutations or genetic drift. Things that Charles Darwin would talk about and with selection methods, we think it has more to do with the environment and the fact that we live in a more clean society. By clean, I mean, we don’t play in the dirt like we used to. We don’t really live on farms and in the industrialized countries, in first world countries, as you would call them, we live inside buildings. We don’t have exposures to things that our immune system, especially the allergy part of our immune system, is really designed to fight against. So the allergies immune system really fights against parasitic diseases. It is influenced by good bacteria to become in our body and so because we live in buildings, don’t have exposures to things like parasites or other bacteria that might occupy any part of our immune system that reacts to in an allergic way, we now have the immune system is kind of redirected to react to things that used to be tolerated, so this is called actually the hygiene hypothesis, and it’s been validated that when we use a lot of antibacterials and our entire microbial system in our body called the microbiome is altered. We’re at an increased risk of developing all kinds of allergic diseases in these allergic diseases, including asthma, allergic rhinitis, atopic dermatitis or eczema, and food allergy.
Richard: Does anyone know the mechanism by which someone becomes allergic or shows an allergic reaction to something other different mechanisms? What’s the study looked like there?
Carla: Yeah. So there are definitely different kinds of ways the immune system can react to food. There are really what I would say are four different ways. The first way is through an allergy antibody called immunoglobulin e this allergy antibody combined to foods or pollen or dust things that causes allergy and then activate the allergy cells in our body and caused the release of histamine that then can cause anaphylaxis or a deathly allergic reaction. And this is, I would say, is a rapid response and it can be fatal. If there’s a mild allergy antibody response, then it could cause hives and that’s why we use antihistamines for hives. The best treatment for deathly allergic reactions called anaphylaxis is actually injectable epinephrine. So that’s one way the immune system reacts to food. The second way the immune system reacts to food is by cells being reactive. Cells called T cells can react, but they do it in a more slow way. They have to be exposed to it over time and they become more reactive and they can cause chronic diseases, chronic inflammation that can affect the skin and the gastrointestinal tract. So that could cause vomiting, diarrhea, pain. That would be chronic and allergic inflammation of the gastrointestinal tract to food. The other thing that can happen is the cells in the skin can cause itching and the sensation of wanting to scratch, which can then cause some inflammation in the skin or atopic dermatitis. So that’s a second way the immune system can react. The third way the immune system can react to food, which is really uncommon. Those first two of the most common are antibody antibodies that are normally kind of normally produced by the body can link up and form complexes and then they can set down in joints and skin and cause inflammation and it can happen in the lung and that is a more chronic disease. But again, that’s very, very rare and then finally, I would say there are what we call intolerances. But the fourth way that people can react to food is due to something that’s not related to the immune system. It may be a part of the composition of the food. So it could be something like caffeine causing a jittery response, fast heart rate flushing and it could also be something like lactose intolerance, where the person doesn’t have the enzyme to break down lactose in milk called lactase because they don’t have that whenever they take something that is like milk that has that sugar lactose, they can’t break it down. So it causes them to have diarrhea or gas. So there are several ways the body responds to food. But the two most important, I would say, is the immediate immunoglobulin E-type one allergy antibody mechanism that causes anaphylaxis and the second is through T cells that can make more chronic inflammatory responses.
Richard: So there is research starting with working on allergies. Is it in many directions? Is it more towards dampening down people’s reactions to the allergens or acculturating them to them somehow? Where do you see the advances?
Carla: Well, the advances are really geared towards trying to identify what is the trigger of an allergic reaction and trying to dampen whatever that trigger is. There are new medications that are being used to treat eczema and atopic dermatitis and asthma that can kind of stop the immune system early in the process. One of the medications is that blocks the function of during the body called a cytokine, which triggers the immune system to make the allergy antibody and so that actually has been FDA approved for a type of dermatitis, but not for food out. So studies are ongoing to see if patients who are food allergic could actually eat food if they are given this medication to prevent their reaction before they even eat the food. The other thing that’s happening is with the oral immunotherapy process, many of those patients who are treated well actually develop an accidental reaction. I shouldn’t say accidental, like a side effect of a reaction to the treatment. 50 to 80 percent of people will actually have highs after they take a dose and the reason is that our immune system and the maintenance of tolerance are not static. It actually changes with different conditions and those conditions might be stress. So a person who had a peanut allergy, who’s able to tolerate 300 milligrams of peanut, if they get really stressed, if they take that same three hundred milligrams, they might have a reaction because the immune system is augmented with stress. It’s also augmented with a fever infection. It’s augmented with exercise, augmented with hot showers and so with oral immunotherapy, there is a waiting period after taking the dose to ensure that there these factors don’t cause reactions. The other thing that can cause reactions to flu that were formerly tolerated is lack of sleep and so this, as you can imagine, is also a significant limitation of oral immunotherapy. So trying to get methods to dampen those side effects and maybe a combination of medications during the oral therapy process is that that’s another area of research. The third area of research I would highlight is, is actually prevention. So there was a large study done about five years ago now called the Sleep Study Learning Early about Peanut and it was done in six hundred and fifty infants in England. Those 650 infants were split into two groups. One group introduced Peanut into the diet very early in life before six months of age, and the other group avoided peanut for four, actually just avoided it and at five years of age, the children who actually introduced peanuts were compared to those who avoided it to see what was the percentage of those infants in both groups that developed peanut allergy and so the children who avoided the peanut had 80 percent more prevalence of peanut allergy than those who introduced the peanut before six months of age. So that was a huge eye-opener that is actually really beneficial for children to eat food early because their immune system is developing and it would prevent them from actually developing the food allergy in the first place. So a lot of studies are geared towards doing very large scale studies, introducing food early into infant’s diets. That’s the recommendation now and in determining what are the factors that are contributing to the development of food allergy and eczema and actually there’s a study that’s about to be started, really the first birth cohort study for a topic, dermatitis, and food allergy. It’s called the Sunbeam Study. That study where we’re going to recruit pregnant women and follow their infants to give them the best, absolute best care for allergies and asthma, and we’re going to take samples to test the microbiome and then follow to see when the children develop eczema and when they develop food allergies to really determine what are the factors that are contributing to the development of food allergy because really, we understand it is difficult to treat food allergy. It’s very tricky and if we could prevent it in the first place, that would be much more desirable.
Richard: Well, you said that stress can affect the response of sleep, food, and other foods, not just solely the allergen. So it seems like when you try to treat someone, the treatment can be very slippery. It works that it stops working or doesn’t work for some unknown reason and it just seems like if you’re going to treat someone with a food allergy, you need to know everything that’s going on with them when they really need like diarrhea or an accounting of what they’re doing every day with their eating and sleeping and otherwise, how would you apply the right treatment or know that it’s effective or that some other factors that are causing them to go off the rails?
Carla: So interestingly, from most of the children who were in the studies for that peanut oral immunotherapy trial at the end of the trial, they all were challenged, had a food challenge to the three hundred milligrams in and so all of them or almost all of them actually passed that challenge. So we know it’s effective and as long as the dose is not taken around circumstances that could cause a reaction. So everyone’s counseled not to go out and exercise after they take a dose and not to exercise before they take the test. If there’s travel that’s happening in the sleep-wake cycle is messed up, then we say just hold the dose for the day. If a person is sick, then they hold the dose and so we know that is effective if it’s utilized and because of the different side effects, we counsel to avoid taking the dose during those times where there are studies that are ongoing to determine if the dose has to be taken every single day or could it be taken every other day or three times a week or once a week. Their studies are going to look at that and of course, there are studies looking at egg allergy and other allergenic foods. I should mention there are other research studies going on with using a patch that has peanut powder and I didn’t think it was going to work when I first heard about it. But in children ages four to 11 years, this peanut patch actually does alter the immune system so that a little bit more peanut is tolerated at the end of the trial, but we know it works much more slowly than oral immunotherapy, oral immunotherapy can work in like six months.
Richard: If you’re eating small amounts of peanuts. I would think your microbiome, you’ve got microbiome would slowly change and there would be bacteria there that would like to eat the peanut, even if it’s a minimal amount. So I would see how if you escalate that slowly over a long period of time, that that would make more sense. If it’s just a patch, then I guess you rely just on our somatic cell immune system and maybe the microbiome doesn’t get involved. Maybe the response isn’t as good.
Carla: Yes, we don’t really know. We know the doses. So the dose that you can get on the patch is like a thousandth of the dose that you can take by mouth. So that is kind of the prevailing thought. Maybe we’re just not giving enough of it in the patch. But that’s it’s a good point that maybe the microbiome really hasn’t changed as much or some other factor that we don’t know about. But we do know one to three years, it slowly works, slowly works. So all of those are things that are in the works.
Richard: You mentioned you also work on gastrointestinal issues in your kids. What kind of issues comes up there? What are the main ones? And I’m sure they’re intimately tied to allergies too.
Carla: Yes. So one of the largest problems for us is that gastrointestinal problems for children with food allergies are another disease called eosinophilic esophagitis or eosinophilic gastrointestinal disease. Eosinophils are allergy cells and in children who have food allergies and also adults that have food allergies and some who don’t have food allergies but have general allergies to things in the environment, they develop inflammation of the esophagus, the eosinophilic infiltrate the esophagus, cause inflammation and cause symptoms like pain, vomiting, choking, heartburn and difficulty swallowing, which we call dysphagia. Sometimes food can get stuck in the upper part of the chest and cause chest pain and so these kinds of symptoms are all due to the allergy cells moving into the esophagus. Also, there can be enough formation in the stomach or small intestine, large intestine as well that causes diarrhea and protein losses. But in that allergy or the allergic population, the eosinophilic esophagitis is the most common which develop an intestinal disease. So we look at treatment for that and in are doing studies with novel medications to try to treat it.
Richard: So eosinophilic esophagitis pile up in the esophagus, right?
Carla: Yes, it causes inflammation, and also the muscles around the esophagus kind of tighten with certain triggers and certain foods. So we try to help patients with this disorder, with their treatment and there are three ways to treat it. One way is with a medicine called proton pump inhibitor, which is a reflex medicine that can have a dual effect of decreasing the stomach acid and then also decreasing the inflammation slightly in the esophagus. The second treatment is actually an avoidance of food. So we know that if people avoid those food groups that I mentioned, about 80-85 percent of them have a decrease in the inflammation yourself, focus improvement in symptoms, and then the third treatment is actually a topical steroid medication where an inhaler with a steroid in it that might be used for asthma, would actually not be inhaled, but just swallowed so swallowed steroid, which we consider as a kind of a topical coating for the esophagus, is another treatment. Sometimes if this disease goes untreated for a long time, then the esophagus can scar and people won’t eat. They just can’t eat. So they have to get what’s called a dilation or a surgery to kind of stretch their esophagus open so they can eat. We don’t see that so much in children. So I try to treat children so that they don’t develop those complications.
Richard: Well, you got me thinking about asthma for a second, I wonder if it would be better if I did something that could eat a pill that some kind of an allergy and they eat in a capsule in addition to the inhalers. It probably would work better because maybe what I’m having is like a patch. I’m not eating the inhaled stuff essentially and it’s kind of staying locally resident in my throat and lungs and it might be better for me long term if I was able to eat something. I wonder if that’s being worked on.
Carla: Well, the concept that what you are allergic to, that you can actually take it in order to help your body become more tolerant, is actually in a form we do that, but it’s in the form with asthma of subcutaneous immunotherapy. So in asthma, if a person’s allergic to pollen or dust or mold, what we can do is allergies is actually use a liquid colored extract that has the proteins from that allergen and give it a set. These are allergy and allergy shots make a huge difference with asthma and we know allergy shots don’t work well with food because the reactions can be too strong. So early studies with subcutaneous allergy shots to food, specifically peanut cause actually death in one of the studies and so it’s been deemed really too dangerous to do that for food, but for what we call androgens or allergies that works really well for not only asthma but allergic rhinitis. So that concept that you’re thinking about that I’ve had asthma for a while, I wonder if I should take what I’m allergic to, that that’s definitely being used and is an effective therapy.
Richard: I think asthma and allergies are just two completely separate things. I didn’t realize that allergy shots might have an impact on asthma. Do you think they may?
Carla: Yes, absolutely. So asthma that is linked to allergies is really treated well with allergy shots and I did want to say if a person eats food and has wheezing or coughing or asthma symptoms right afterward, and that is actually one of the definitions of anaphylaxis to have an allergic reaction to the food and sometimes it’s actually difficult for us to figure out, is this asthma or is this reactivity to food? I had a patient, a little girl who had horrible asthma, and her pulmonologist said that she referred the patient to me for allergy testing. Well, it turns out she was allergic to peanuts and she was eating peanuts almost every day and she would because after eating peanut and I said, you’re allergic to peanuts. Stop that and miraculously, her asthma went away.
Richard: That’s weird, though. We talked about giving people a minute amount of peanut so they could tolerate it more. But then now you’re saying, OK, well, those cases make sense, obviously, if you know something’s giving you allergies, stop having it. But so when do you go from one end to the other and how do you know what to do? It is one way to stop something work in one case and then adding something and working on another case.
Carla: Yeah, there’s just a huge spectrum of disease in food allergy and there are some people who are so allergic to a peanut that they wouldn’t even tolerate one milligram. They would react to it. So there’s just a large spectrum. Some people are mildly allergic and some people are really, really allergic and the treatment is oral immunotherapy works for people in the middle, people who are not super mild and might grow out of it, and not people who are super allergic, but the people in the middle who can tolerate one milligram initially and won’t have a lot of reactions but where the treatment is actually helpful because they would have reactions if they came in contact with peanut. So you’re so right. That’s why it’s important to have an allergist assess kind of where you lie on that spectrum.
Richard: Well, sounds like a missing set of correlations. I mean, for instance, is anyone looking at the microbiome of people with lots of allergy spectrum for a given allergen, let’s say peanuts, is there any way to ascertain maybe there’s a microbiome component?
Carla: Yes and that’s actually we’re doing that study here to look at through the oral immunotherapy process. Does the microbiome change? And it’s clear that there are some bacteria studies that have been done that show in fact Kathy Nagler did this study where she actually showed that there are certain microbes that were associated with tolerance to peanut food and there are certain microbes that were associated with allergy. But we don’t really know if the oral therapy process changes the microbiome. We do know that the oral therapy process decreases the level overtime of the allergy antibody to peanuts and there’s also a blocking antibody and it actually is a marker of tolerance and it actually blocks that allergy antibody from causing the reaction. So we know that the blocking antibody increases and the algae antibody decrease when people are treated with oral immunotherapy. But we don’t really know yet if the microbiome changes.
Richard: And I know it’s redundant and it would be hard to tease out which microbes are set of microbes is responsible for modulating the immune response to the response to certain substances.
Carla: So, yeah, it is very, very interesting and it is very complicated and we’re just trying to tease it out. People ask me if taking a probiotic would help their allergies, and I just normally tell them I don’t think it would hurt. But we don’t really have evidence that it would help enough to be a cure or a true treatment for this.
Richard: I’ve learned that supposedly all the bananas we eat just one kind of banana. It’s very narrow and therefore bananas may go extinct if a certain creature attacks them like a fungus or whatever, but like peanuts, the average person, do they only eat one kind of peanut and only anyone looked at? all these kinds of peanuts seem to be much worse for allergies than other ones and the method of cooking them dry roasted versus raw versus et cetera, like, is anyone looking into that difference?
Carla: Yeah, they have roasting causes an increase in allergenicity of the peanut protein, and it causes the bringing together of specific protein types in the peanut that is recognized by the immune system as being more allergic and so in the US and in the UK, we eat is roasted peanuts. But in Asia, China, are boiled and we know that the peanut allergy comes out in the water so that the boiled peanuts have less of the allergenic protein in them and there’s much less peanut allergy in Asia than there is in the United States or the U.K. So they have been assessed and the other thing that’s been tried now, there hasn’t been, no one has noticed that there are different types of peanut that cause different immune reactions, no one has noticed that. But what’s being investigated now is the use of a peanut that actually doesn’t have the protein that we call the major allergen. So there are some allergen-free peanuts that are being developed and so we’ll be able to see if you actually take the most allergy-prone protein from the peanut if people with peanut allergy can eat it. So that’s an ongoing study. For shrimp, it does make a difference if people can be allergic to Gulf shrimp, but not Asian shrimp or vice versa. So it is very interesting.
Richard: What about wild-caught versus farm-raised? So I think it’ll be a very different there to the reaction.
Carla: Yet studies have not been done to really see if there’s a difference in allergenicity and farm-raised and wild-caught in terms of people eating the two to see if they have different reactions. So that would be a very important study, I think, to do so.
Richard: What’s the best way for people to find out more if their child has a problem.
Carla: So if they Google the Texas Children’s Hospital food allergy program, we have a website there and it shows and also the research that we’re doing, it shows we have an educational outreach and a food allergy family network where we educate about foods and we have kind of four goals of our program to offer patient-centered, wonderful care access to the state of the art food allergy desensitization protocols, which are the oral immunotherapy protocols. We are the third kind of aim is to improve the methods of diagnosis and treatment of using it for like esophagitis in the last year to do educational outreach and inform the community and help community members support each other. So, yes, you can see all of that on our website.
Richard: That’s great. Thanks for what you do and a good call and sounds like I need to go see an allergist there, maybe for shots in there. Yeah. Thanks for coming. I appreciate it.
Carla: My pleasure. Thanks so much.
Subscribe to Our Newsletter
Get The Latest Finding Genius Podcast News Delivered To Your Inbox