Hello and welcome to UNC REX Health Talk Live brought to you by UNC REX Health or UNC REX Healthcare. I’m Sharon Delaney and we’re coming to you live from UNC Medical Center in Chapel Hill. Tonight our topic is Food Allergies 101, so start sending your questions in right now. Whatever your food allergy question might be, we have an expert here to answer your questions. Joining me is . Dr. Edwin Kim and I’m going to have to pick up my paper because you’re all your things, your introductions are very long! Now, I don’t want to make you feel uncomfortable, but check this out: Director of UNC Food Allergy Initiative, Director of the UNC Allergy and Immunology Fellowship Training Program, as well as Assistant Professor at the UNC Division of Rheumatology Allergy and Immunology and faculty at the UNC Thurston Arthritis Research Center. Do you ever sleep? I try! That’s a lot going on! But really, one of your specialties Dr. Kim, is food allergy. That’s right. And not only as a professional, but as a father too, tell me about your child. Yeah, so actually I’ve got three kids and so my middle son Elliot, who’s now about four and a half, he actually has peanut allergy as well and interestingly he developed his allergy, while I was in the middle of doing all the research that I do now – it was sort of, it was a real big game-changer for me because I had always sort of seen it from the physician, the clinician, researcher point of view and suddenly this became real for me, it’s all of a sudden you know, ah, he was about nine months old and we had introduced him to peanuts, just like he was being advised these days early on, but sure enough, shortly after eating a peanut he started developing redness all around his mouth, so similar stories other people told me, he started scratching everywhere and me being an allergist of course I knew what we were dealing with and actually as it turned out, I had Benadryl sitting right there on the counter and so we treated him, but over the next hour really started developing all the symptoms that we worry about so… The bad ones, like? Oh yeah. Oh wow. And so, he a, shortly afterwards started having vomiting, he developed a rash that eventually became head to toe rash and even had coughing, which is a sign of potentially having trouble breathing. Oh goodness! And at nine months of age he couldn’t tell you…exactly, he couldn’t, he couldn’t, and so it was frightening and so eventually, we ah, we got him to the medical center and he got his epinephrine just like a lot of other kids have had to do with their reaction – and he got better, and sure enough we had testing shortly afterwards that confirmed what we knew, that he was allergic to peanuts, and so from that day on, again the research I’ve continued to do research but I’ve definitely seen it in a very different light because a lot of again the things that these families have been going through we’re sort of living it at the exact same time. You really probably have a lot of empathy for your patients, because that you can’t say well let me try to understand, you really do understand what they are going through. (Exactly.) I”m sure they love that, that they have a sympathetic partner, in treating their kids! Yeah, I mean I wish there was an easier way to kind of get there. Yeah, I’m sorry that that is the case.. Yeah, it really is the case and even the simplest things, of how do you deal with situations like going to school or going to restaurants, I mean these things that families with food allergies have to deal with every single day. You know I tried my best before Elliott, to sort of get on that same level with them, but it’s not until you live it that you really understand. That you know it. Now you are leading some research, that is being done right here at UNC and you’re doing a three year study, we featured a sweet little family in getting ready for this show, we got to meet this nice family, with little Jane, who’s four, getting ready to start school next year and her parents are understandably quite nervous about letting their little one go off and they can’t watch every morsel going into her mouth. Tell us about this research and the trial that she’s in. Sure and so the overall concept of all of these trials are something to call immunotherapy and immunotherapy what that is essentially giving small amounts of what the person might be allergic to, with the idea of building it up and essentially retraining the immune system. Trying to make it again be able to tolerate the food or foods that they may be allergic to – we’re trying to do this in a bunch of different ways. So the way that we initially had tried to do this was actually an injection in shots and this is many years ago probably 20-30 years ago and unfortunately there we saw a lot of side effects, we as researchers and that one sort of got put on hold, but since then, we’ve started to look at trying to do it in a form that’s eaten – so flower forms and in her case, actually trying to do them in liquid drops. Little drops, yeah and she’s a great little patient and she’s following the instructions and after the end of the three years you’re hoping you can do it like a challenge to see how much she could tolerate? That’s right and so on the first day of this study what happened was we did her challenge as well, which is a very frightening day because she hadn’t been treated yet, but what we try to do is establish…confirm that they are allergic and then establish what that baseline is, how much does it actually take to get sick, to have a reaction and then we do our treatment and then do it again to try to show that yes, we have provided a level of protection that the children have and to give those families some level confidence, when they actually go out there into schools, into restaurants or wherever it may be, that there is a level of protection. Sure ok, if you’re just joining us on Facebook Live we are coming to you from UNC Medical Center here in Chapel Hill and our topic tonight on UNC REX Health Talk is Food Allergies 101. We want you to send us your comments and questions now, we already have a couple of people who sent in some questions ahead of time, let’s see, we want to say hello to Alana and Katie and Alana is asking “we just found out my son has a peanut and an egg allergy, I’m also afraid to try tree nuts how likely is it that he would have an allergy to those as well?” Yeah and so that’s a really, really good question and so what we do know is kids who have peanut allergy and even egg allergy but especially peanut allergy seem to be at higher risk of allergies to tree nuts, so in this situation definitely would make sense to go to an allergist and be evaluated to confirm this, whether or not they actually have the allergy and that may mean skin testing or blood testing, but unfortunately there’s up to a thirty percent chance that there could be an overlap where someone with a peanut allergy has a tree nut allergy as well. Ok, all right Beth would like to know, ah, she wants to know about new – some insights into new research regarding tree nut immunology or therapy like you were discussing without peanuts, do you have a similar sort of clinical trial going for tree nuts? Right, and so at this point those are in development, so for the last bunch of years, we’ve really focused on peanut to try to optimize what we’re doing and we have seen a lot of good preliminary data and now I think we’re starting to take those same ideas and shift it over to tree nuts, so I wouldn’t be surprised in the next couple years to start to see more of these studies start to come out and one interesting thing with tree nuts is there is a hope that that there is an overlap between the different tree nut.s For example, I mean if you’re allergic to walnuts, perhaps if we can treat the walnut part, maybe the cashew allergy would get better or the pistachio or something else like that. So that would be a really nice thing that we could discover in this as well for tree nuts. Ok, we had a question come in from Jessica, why does it seem that there are so many more people with food allergies than before? I know when I was growing up, I don’t think I knew a single person who had a food allergy and now it seems to be quite common. Is that just perception? Oh no, so that’s the thing, so I mean everyone, every family, parent or anyone else that I meet, they all have that same question – and all of us say the same thing we knew nobody or maybe we knew one person, so clearly there’s a tremendous increase. A couple things we know, so one piece is we know there is a genetic component, so there is some family history that probably sets people up for it, but not everybody has a family history and so what we also know there’s got to be an environmental component to it and that’s where we get stumped is you know a lot of folks are worried about is it the way that our food is being produced or processed, is it other exposures that are out there as far as antibiotics or is it exposure to the sun, is it you know other things that could be happy to infections or otherwise and to be honest at this point we we just don’t know and a lot of the research that we’re doing in the background is trying to understand why people are becoming allergic so what is changing in the immune system and not only trying to get those patients better the ones that we’re studying, but also through them learn more about them. Ok, all right this is a really interesting one and we brought a plate of the meat to illustrate it, it’s not a laughing matter actually, but Michelle is asking, “I’ve been diagnosed with alpha-gal. I’m allergic to beef, pork and lamb. What are researchers doing to potentially either get rid of this or treat it?” And that’s – that’s a really odd one. Tell people what alpha-gal is because a lot of people haven’t even heard of it. Yeah and so alpha-gal is a sort of a nickname for a new allergy that’s really started to become a problem we started to notice more in the last probably five to ten years. And specifically here in North Carolina and in the southeast? Right yeah, so Virginia and North Carolina or major hotbeds for this and one of the reasons is different than most of the food allergies you think of it seems to be actually related to being bit by a tick and this tick happens to live in the southern states, ah, including Virginia and North Carolina. And it seems that the tick somehow, again we don’t understand how, is setting people up to develop this allergy. Once they have it, it’s not an allergy to one food like maybe in the case of peanut, but it’s an allergy to all these different meats. So basically all meats that come from mammals, such as beef and pork and lamb. You can stretch it out the deer and bison and whatever other kinds of meat. Really, the way I try to describe it to patients is that really the state meets are more poultry and fish but everything else sort of beware. My goodness and how do it we spend time outdoors, you hear about ticks all the time in the summer and does it take a while to realize what’s going on? Do you have the allergic reaction right away after getting bitten by the tick or does it take some time? Right and so even there we’re trying to trying to understand that because some tick bites we’re well aware that we got many of them we don’t and it could have been that it happened years before whatever else. Some studies have shown again immediately after tick bites that there are changes in your immune system so very well could be sort of a next-day type of a situation what’s going on, but another piece that’s really interesting with this meat allergy that shows that is potentially a different type of allergy is that most food allergies when we’re thinking about same milk or egg or peanuts, those usually happen within minutes of eating the food and in the case of these meats, for whatever reason, it takes an extended period of time. So maybe four or five six hours after the first person eats the food that they actually have these symptoms and that could be difficult in that there might be the scenario where you go out and have a wonderful anniversary dinner, you have a nice steak dinner, you go home and you think everything’s fine, you go to bed and then the next thing you know you wake up at two in the morning covered in rash or maybe even feeling like you need to vomit or something like that. And so there are definitely aspects of this allergy that are that are very different and that we’re trying to use, as best we can, to learn more out how all allergy works through this different type, this strange different allergy. And what’s interesting to note too, is UNC is one of the leading institutions in this research and partly because of our proximity to it. Right, so you know again we have many, many, many patients in the region that have had this, and we’ve also recruited experts from the Virginia area that also have brought a lot of patients as well and so it’s just been a you know again a great place to be to try to learn this and we have patients that are basically you know banging down our doors to try to come in and and volunteer to help us learn more about this. My goodness Michelle, I hope that helps to answer your question – at this point it’s just in the research phase, there’s no real treatment except avoid all those meats? Unfortunately, at this point yeah, it is really about understanding again, why this was happening, how is this different from the other allergies we know about and hopefully, really quickly after that we can turn it into what can we do to treat them. Okay, all right – Grace wants to know why are so many people unwilling to take food allergies seriously and what can be done to better educate the general public about this? Sure and I think there’s a couple things going on there, one of them is exactly that idea we talked about before that many of us growing up never saw anyone with allergies and so all of a sudden why is there so much more and so I think there’s first of all that, that perception that you know again is there something made up? Also there is again one until you’ve actually seen someone with an anaphylactic reaction, somehow it’s not real and I so I think there’s a couple of those different things that sort of make it difficult. Another piece to it and again i’m sorry that is multi prong but it really is is that the testing that we have available is also imperfect, so unfortunately there probably are some folks out there that are worried that they’re allergic, that maybe is not so there might be a small level of overdiagnosis, but I think a lot of a really has to do more with just, this is not something that we used to deal with and all of a sudden the last 10-20 years, there’s so much more out there and we can’t tell anyone why at this point. Hmm, I’m sure there’s a lot of theories (oh yeah) that could be a whole other show! Let’s talk about some of the more common allergies, which I would imagine are the dairy ones, so milk, eggs… So when we think of sort of your classic kind of anaphylaxis potentially life-threatening allergies, really there are eight sets of foods that are going to be most common and that’s going to be milk, egg and peanuts of course, but then also your tree nuts and then you have your shellfish and your fish and wheat and soy fall into that category too and we think of those eight groups of foods as a basically accounting for 85, almost 90% of all food allergies that are out there and again clarifying that this is sort of the anaphylactic, life-threatening allergy that we’re talking about. Ok, all right ,if you’re just joining us this is UNC REX Health Talk, we’re live from UNC Medical Center in Chapel Hill and we’re taking your questions tonight about anything to do with food allergies. Dr. Edwin Kim is a researcher and professor here at the Food Allergy Center and he has a son who also has a food allergy, so he’s the expert on all things right now. We’re taking your questions, ah, we’d like to say hello to Ashley and Lindsay. Misty would like to know where can we do oral immunotherapy? Right, so again that idea of the immunotherapy being small increasing amounts of what you’re allergic to so oral typically is going to be taking flower forms of the food you might be allergic to, so in the case of peanut flour, milk flour, egg flour or something else like that, at this point it really is something that’s still in research. It is something that we’ve seen a lot of good preliminary data and we are very hopeful in the next couple years that this will be available to the public approved through the FDA. There are some practices that are trying to start providing or are trying to provide this as a service at this stage, but you know we are somewhat hesitant on that, because we do feel like there are still some major safety and efficacy questions that are out there at this point. So we do think of this is purely a research center. So it’s still in research, but if you are local could they apply to be in one of your trials? That’s right and so we are constantly involved in different trials again trying to understand the different aspects of the allergy and the treatment and so on our website we actually have a place where folks can actually sign in and really tell us a little bit about the allergy they’re dealing with so that we can quickly be able to respond to them when the appropriate trial comes up. Ok, Dallas asks, “I hear a lot of discrepancy about the best age to test infants and children for allergies. What is your recommendation? Yeah and so there um, you know again, we kind of joke with our trainees, that for the skin testing that we do as long as they have skin we can kind of test them, but in all seriousness really it comes down to when the right time is really when that family is going to do something different about it so testing someone who’s never going to eat that food for the next three or four or five years probably doesn’t make sense, but if they’re at a stage where for example they’re about to go to school and they want to know is my child allergic to peanut and are they going to be exposed at school, for that for that family that would be the right time. Or, for perhaps the kid who’s been having formula is about to switch over to some sort of soy or milk or something else – and so really that would be probably the right timing. So that’s usually going to be discussion within the family, potentially the family with the pediatrician and they ultimately with the allergist as well. Ok, Amy would like to know, “she’d like to get both of her children tested for food allergies adding that she wants a large panel done, but apparently her pediatricians office doesn’t offer a large panel, so what would be a resource for her? Yeah and so you know that I’m glad that that question got brought up because I think that is a place where a lot of education could be helpful, is unfortunately the testing that we have available so our blood and our skin testing, although it’s good, it’s far from being perfect and there is sort of a there’s a higher than we would like chance that people could have a false positive reaction, meaning the test says that you’re allergic, but you actually are not – and when you do broad panels of food meaning many – 50, 60, 100 foods you run that that risk gets higher and higher and higher and for any family that’s actually actively trying to avoid food I mean they could easily tell you how difficult is avoid one food and to potentially to avoid many foods and theoretically, for you know when they’re not even allergic, could just be terrible and so we really do discourage sort of doing many, many foods and really try to focus in on what are the foods that that person, that child is eating at the moment, what are the foods that are causing the problems and try to hone in on those instead of doing everything. Ok. All right, Aaron hello to you and hello to Ashley and Shelly would like to know, she’s a dietician ‘her clients often ask her the difference between blood tests and skin tests for food allergies. What is the difference and is there an accuracy difference as well with these tests blood vs skin? So that’s a really, really good question as well – so both tests, the skin and the blood, try to tell us the same thing. They’re really trying to show us, is there that part of the immune system that can cause allergic reactions, so when you talk strict numbers, they’re pretty much equivalent – skin tests have slight added benefit there is it actually shows you not only do you have that component of your immune system but it actually causes a reaction a little itchy bum that’s on your skin and so gives us a slight increase confidence in there, but in reality both that should be near equivalent, now I will add in there that for a lot of patients who are allergic, checking the the antibody level checking this immune level is a way that we can track whether they are trying to outgrow it and a blood test seems to be a slightly easier way, I think, to actually track trends and so the way I usually approach it is very often when I’m first trying to diagnose someone I’ll lean towards the skin test but then over time as I’m tracking and I made you a blood test, but each practitioner might be slightly different in that. Now I discovered something recently and when I first met you I told you about it, I’m not even going to touch it, (don’t go there!) because I have mango mouth! Right. It sounds crazy, my lips blow up when I eat mango, if i get the skin of the mango too close to my mouth. What is that? Yeah and so it’s just a fascinating part and a lot of folks who study plants probably could tell us this, but i discovered this as well my own training, is that as it turns out in mango in the peel, there is the same oil that’s contained in poison ivy and poison oak. So that again just by touching it you can get that same kind of rash and I I’m sure you could tell me all about it that crazy itching sensation that you probably had from it. Well, here’s the crazy thing, is I… have, ah, I said this at work the other day like why were you rolling around in poison ivy? That sounds insane! I was camping (right) and was in the poison ivy and didn’t realize it, until someone said you’re all in or you’re inside the poison ivy. I am not allergic to poison ivy, but yet that makes me go “la la”! Right well so that, well now, you know well we’re gonna probably have to figure that out for you then! Yeah the typical scenario I would think it would be related to that but it’s possible that there’s a whole other scenario that’s going on for you, and I’m guessing that that’s why you’re going to ask me about these other fruits. Well, that’s the thing too I thought that was very interesting that certain people also have and what are we calling it? An oral (that’s right) allergy syndrome, so is that to certain kinds of fruit and what is that? Yeah and so ah, you know we’re actually outdoors in the exact time of year that’s perfect for that and so oral allergy syndrome is something where and actually I suffer from it as well so looking at this fruit to makes me itchy already (oh gosh!) but as it turns out now folks who have allergies to pollen they have this part of the immune system that is specifically looking for that pollen to cause allergic symptoms and what we’ve discovered is that there are proteins that are in these different fruit that are here so the pear and the peach and the plum, that look very, very similar to your immune system to that same pollen, it can over overlap and cause a tremendous amount of itching in the mouth, in the tongue, even in the back of the throat and a lot of the patients you come and see me who have this symptom, they worry oh there must be something, a pesticide or something that’s going on with these fruit, but as it turns out there’s a lot more of that protein in the skin and so for a lot of patients peeling that off will somehow make it better for them, but especially during that season, so in my case during the spring season when that part of my immune system is really fired up, that same allergy to those fruits is a unbearable. So I’m going to avoid those! So it makes you all a itchy and is very uncomfortable. Ok, let’s see, Kim asks, “I’ve had an onset of tree allergies as an adult, is it likely this will fade or go away?” Yeah so tree nut, kind of like peanut, unfortunately, as an allergy where most people do not outgrow it. We estimate maybe 20% of people outgrow both of these allergies peanuts and tree nuts, but even there most of people that are going to do it, they do it as a child – and so most adults who have those allergies, unfortunately, the bad news is they’ll probably hang on to it. Ok, similar question Linda is asking, “I became allergic to shrimp at age 32, I’m now 59.” What are the chances that she may have outgrown this and how would she find out without eating and swelling? Yeah, so unfortunately there’s bad news here too, so for shellfish and fish, we think of it very similar to peanuts and tree nuts, so we think it’s very likely, especially as a grown adult, that this will probably stay with her (okay) for most of her life. o there’s not a way to reverse that sort of thing? Not at this point, again we are slowly starting to think about are the same treatments that we’re thinking about for milk and egg, can we transition those over into seafood, because it does affect the tremendous amount of adults that are out there, we’re just not there yet. But unfortunately, other than trying to eat it and seeing what happens, it really comes down to the same types of tests – the skin set and blood tests to try to help predict whether that person is outgrowing it or not. Ok, hi Christian, hi Marie! Thanks for joining us on UNC REX Health Talk! Angela asks, “my son is highly allergic to fish, including salmon, tuna and cod. We carry an Epipen for it – and can he possibly eat scallops and mussels and is there a safe way to find out? Yeah and so there I think there’s a couple things we’ll talk about there, so one of them is we do think your immune system is very specific to the particular food that you’re allergic to, so those antibodies are allergic to salmon should not be reacting the mussel – so it’s possible that they’re, that person is allergic to mussel, but again it wouldn’t be sort of those same antibodies, but I think another piece that’s important to think about though is not only sort of what’s going on in your immune system, but what’s actually going on at the fish counter at the restaurant. So unfortunately, if you think about most restaurants, they’re not separating out mussels and salmon and tuna. Oh, they might all be prepared for the same counter? The same counter, the same fridge. the same knife, whatever may be – so even in cases where patients may not be allergic to all the different seafood, there’s always going to be that chance of cross-contamination, so for many families or many patients, the safest way to go is to try to avoid them. Or if you’re really wanting to try and do it at home where you control the environment that you’re preparing and cooking in. Ok, let’s see, Shelly asks, “my son is tree and peanut allergic, how does a doctor determine if a child’s numbers qualify for oral immunotherapy?” Sure, so again what they’re talking about there is going to be how much of that allergic antibodies you have in your system, so whether the blood test is a big, big number or the skin test is really large and at this point really we’ve taken all comers for our studies, we’ve taken people with numbers that are in single digits and then even ones that are sort of higher than the machine can even detect and we’ve seen benefits really for everybody. There is sort of a hint with some of our research that the lower you start the better, but again we’ve taken all comers and we’ve seen benefit at all levels, so I think that’s one of those where it really is going to be important to go to the allergist and have that discussion and see if it’s appropriate for other reasons, but I don’t know that that blood test itself would be a reason not to. OK, Melisha says, “my son out grew tree nuts at age 12, he still has dairy and peanut allergy, so she hasn’t given any tree nuts. Just in case he’s now 15, I feel like I shouldn’t let him try tree nuts unless he outgrows the peanuts as well,” now what you said before there’s a crossover right? Right, so there I’m going to qualify that a little bit in that one good thing that’s come with the increase in food allergies there seems to be a lot more sort of just a general awareness of it and one of the things that comes with that, is labeling of foods is better than it was and so in the world of peanuts and tree nuts, I feel like there is better labeling to the point where you might be able to discriminate that more and so we do have more patients out there now who have peanut allergy that do feel safe and confident eating tree nuts again reading off of labels (sure) as well again not really the case for fish and shellfish at this point, because it’s not typically packaged, but for peanuts and tree nut it is something that may be more realistic than it was say 10 years ago. Ok, Alicia has a follow-up question, she’s heard that “coconut is separate from tree nut allergy – is a coconut a nut?” Exactly, so that’s well… So we think of it as a fruit and not a nut, it has the word nut in it and it’s gotten really confusing, but there have been a lot of small studies that try to prove the fact that it doesn’t overlap and so that I would think of that as a totally separate type of thing and unless that person is really eating coconut and had a problem, it would be fine. Are there people who are allergic to coconut? There are, unfortunately, there are, but it’s usually not going to be something that’s overlapping at all with the other tree nuts. Ok, Linda asks or Lisa rather, she “had a reaction to oysters at 19 and has not eaten any seafood since” and she’s now 59, do you think she could try to eat shrimp? Yeah, so I think again, this is something that if it’s important to her to have shrimp and it’s absolutely worthwhile to go to that allergist and get that testing done (just be safe) yeah and for two levels, one of them is that it’s a different food we are talking about shrimp versus oyster and also with that amount of time, although not a lot of people outgrow it, some do and so it would be helpful for finding find that answer out. I wanted to go back and ask about the alpha-gal (sure) because you were describing how it’s different than sort of the peanut and some of these other ones where there’s almost an immediate reaction, there could be hours after you’ve eaten this nice steak dinner that you’re all of a sudden getting up in the middle of the night very ill. Do people think that that’s actually food poisoning? Like they may go to their doctor thinking they’ve gotten food poisoning? Yes, that’s exactly right and it’s hard to- it’s hard to tell the difference, because food poisoning can of course cause throwing up, horrible stomach ache as well and so usually one of the first things folks will do is, if they’ve gone to dinner with other folks, ask who else got it? Because anyone else who’s had the same dish, you expect should have that problem as well or at the restaurant, maybe restaurants may not be willing to share that information, but someone else may have ordered that same dish and it’s you know other people at the restaurant have that problem, that could be one way to answer it as well, but unfortunately, a lot of things especially with the alpha-gal, what you find out happening is people are going to have multiple reactions and then they came here and they put two and two together. I actually have a friend who I believe she is an environmental scientist is her career and during her thesis she spent a lot of time in wetlands and she got bitten by the tick and it took six months to figure out that she had alpha-gal (right) it was like the craziest thing, she was sick and then well, because she never put two and two together that it was always after she ate some kind of red meat, but then sickness began. So it actually took a good six months to figure it out, which is probably not that long in the alpha-gal world. That story is very very, very common and again because with the other food, you eat it you get sick within a few minutes, you can make that connection directly, but when it comes to sort of the timing and then even with the alpha-gal again we don’t understand why but there are situations where people can eat small amounts and be okay with it, so it doesn’t necessarily happen to every single time you eat it (wow) and that makes it even more confusing as far as trying to figure this stuff out. Ok, Kristin asks, “my son has an egg and peanut allergy, he also has reflux, which used to be severe before we determined his allergies. Are they related?” Right, so a couple things could be going on here, one of them is there is a whole other disease that looks very much like reflux, that’s called this big word eosinophilic esophagitis, but it’s basically an allergy, (oh my lord, goodness) in the feeding tube (I know…) We call it EOE which is a lot easier (say again) So it’s eosinophilic esophagitis, but EOE is definitely good enough! Wow, we’ll stick with EOE! We will definitely stick with that and so with EOE, very much what the symptoms can look like on the outside is trouble swallowing food, maybe regurgitation, maybe even straight up vomiting – and so for some folks that’s what’s happening. Those foods are triggering this other kind of allergy as well, in other cases, it could just be that they do have bad reflux and began for whatever reason these trigger foods are making that go on, but for someone where there is sort of a direct connection that they see with this food and may be worthwhile again start the conversation with their doctor or their allergist. Ok, another viewer wants to know, “can you get mango mouth with fresh pineapple?” Well, it would be pineapple mouth, right? Right! And so I mean that would be sort of a nice segue way into there are some folks where different types of citrus, can cause what sounds like what you described with mango mouth – and there again, likely what’s going on, is they’re having more of a reaction to the acid, the citric acid, so it could be that not only pineapple but other citrus fruits could do that, or it could be very specific to pineapple as well, but it probably is very similar to what you described and maybe not necessarily related to poison ivy oil or anything else like that. Ok, Elaine asks, “my son is severely allergic to wheat. We discovered his allergy when he started eating solid food as a baby. The doctor predicted he’d outgrow it by age five, he’s 13 and still cannot eat anything with wheat. Are there any food desensitization studies going on here at UNC for wheat allergies?” Yeah, so unfortunately, at this point we’re not involved in any particular studies focused on wheat. There are definitely other major food centers out there that are doing it and the number of folks out there continues to grow every day and so I think done again as we are learning more about peanut allergy. I think that attention is in a good way, spreading out to other foods and so it wouldn’t be surprised if we started studying wheat in the very near future, especially considering other places are doing it at this point. In your field Dr. Kim, are there researchers who are trying to find the source of why there is this uptick in allergies? Yeah and so I think one of the ways that we’re really, really, really hoping to do this, is to try to do essentially sort of what we call birth cohorts or even registries- the idea of finding folks before they’re even allergic and then track them over time and see when do they become allergic and then try to work backwards and see there, were there any differences in their exposures? Was it where they grew up, was It what they drank as a formula, was it you know, whatever else it might be. But as a way of trying to answer that question, because right now sort of working backwards with someone who’s already is already allergic is helping us only to a limited amount, but I think really finding folks before they’re allergic and then tracking them through becoming allergic is going to be probably the way we find this answer out. Yes, and that’s really many, many decades of study involved. Unfortunately, many decades and lots of people. Ok, well questions are still coming in but it’s going to be time for us to wrap it up, but we will answer your questions, just keep them coming, put them in the comments section and the nice folks here at UNC and UNC REX Healthcare will answer those for you. Dr. Kim, thank you so much, (yeah, thank you) I wish you the best of luck with your son and with the rest of your clinical trial work that you’re doing here at UNC. Yeah, I’m grateful for your support, so thank you. Thank you and thanks again for joining us on UNC REX Health Talk! Our next show is May 31st, we’re going to be live from the Rex Open which is happening in Wakefield in North Raleigh, the annual Rex Open, which is a fantastic golfing event. Pro-am day will be on the 31st, we’ll be there live at noon, so you can come by in person and ask your questions or of course start submitting them now, we’re going to be talking about sports injuries and different things you can do for all you weekend warriors out there. Have a great night everybody!