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Dr. Sandra Hong is the Chair of the Allergy and Immunology Department at Cleveland Clinic. She joins this episode of the Butts and Guts podcast to discuss food allergies and the digestive system. Listen to learn more about the differences between food allergies and food intolerance, as well as the advancements being made to help people living with food allergies.

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Food Allergies and the Digestive System

Podcast Transcript

Dr. Scott Steele: Butts and Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Dr. Scott Steele: Hi again everyone, and welcome to another episode of Butts and Guts. I'm your host, Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. And today, I'm super excited to have Dr. Sandra Hong, the Chair of the Allergy and Immunology Department here at Cleveland Clinic. And we're going to talk about something that we have not talked about in the past, and that's food allergies and the digestive system. Dr. Hong, thanks so much for joining us.

Dr. Sandra Hong: Thank you so much for inviting me. I'm so excited to be here today to talk about food allergies on Butts and Guts.

Dr. Scott Steele: That's awesome. And so, for all of our guests, we want to first start off by getting to know you a little bit better. So, tell us where you're from, where'd you train, and how did it come to the point that you're here at the Cleveland Clinic.

Dr. Sandra Hong: So, I have been here at the Cleveland Clinic for 18 years, and I actually was born and raised in beautiful Cleveland, Ohio. So, it just made sense for me to come back home after training at Mass General in Boston. And it's been fabulous.

Dr. Scott Steele: Well, we're very excited to have you here and very lucky to have you here. So today, as you said, we're going to talk a little bit about food allergies, and specifically as it relates to the digestive system. So, let's start at a very high level. Can you explain a little bit more about what a food allergy is?

Dr. Sandra Hong: So, food allergies are basically when our bodies for some reason decide that it really doesn't want to accept any sort of food proteins. So, most people have heard about peanut allergies. It's basically when your body decides that it's kind of a foreign object, doesn't want to come in contact with it. And when you eat this product, pretty much immediately up to four hours later, you'll end up with reactions to it. And a lot of times they can be mild, but it can be severe and life-threatening.

Dr. Scott Steele: So, I could eat pepperoni, my sister can't, somebody has this, somebody has that. How are things a food allergy, or what's a food intolerance?

Dr. Sandra Hong: So that's a great question. So, food intolerances will not be life-threatening. They are typically times when your body basically doesn't really respond to certain foods in the way that you want them to. So, for instance, one very common intolerance causes lactose intolerance. So, people actually just don't have the right enzyme to break down the cow's milk protein. And so, without that enzyme, it just kind of rushes through the body and it can give you diarrhea, it could give you bloating, it can give you indigestion. But it wouldn't kill you. Other types of things that can happen are irritable bowel syndrome, where basically coming in contact with certain things will give you cramping, constipation, diarrhea, stress can also kind of play a role in times like that, or sensitivities to foods where someone with a history of migraine headaches. And if they get caffeine in their diet, if they don't get caffeine in their diet, if they have basically sulfites or anything that could cause them to have more symptoms, those can trigger migraine headaches in them. And a totally different way of the body kind of reacting to the food, and again, won't be life-threatening. But with these others, they typically, with food allergies, they'll occur immediately. And, again, it can be extremely difficult because it can hit multiple different organs.

The ones most interesting to this group would be the gut and the way that it hits the gut is very frequently people will have cramping, they'll have diarrhea, they can vomit immediately. But what happens is that it comes with other symptoms usually. So, people can be covered in hives. So, an itchy, really itchy rash or flushing where they feel hot. And then a lot of times they can have other things happen where they feel like they're going to pass out. They feel really dizzy because we're just not getting enough blood flow to the brain. And then people can be short of breath. So, they can feel like they can't catch their breath or they're wheezing, and it all can come together immediately with taking a bite of something that their body just doesn't like.

Dr. Scott Steele: So, you mentioned peanuts a little bit earlier, and that's all over the national news and they announce it on airplanes and all sorts of things like that. So, what are the most common types of food allergies?

Dr. Sandra Hong: So, the top eight would be peanuts and tree nuts, cow's milk, egg, wheat, seafood and shellfish, and soy. Those are the top ones. Growing in popularity and growing in prevalence would be some of the seeds. So, sesame seeds are starting to really rise, but those top eight are typically the ones that bother us the most.

Dr. Scott Steele: So, "Truth or Myth?" Truth or myth: food allergies can occur at any age.

Dr. Sandra Hong: Yes. Truth. So, it could be the first time your baby takes a bite of food. So, four to six months from when you start feeding them. They can have their first signs of it, or someone could absolutely be in their 80s or 90s, and they've done just fine and then they decide to go get shrimp or crab legs and automatically they feel really terrible. So absolutely, it can occur anytime.

Dr. Scott Steele: What are the symptoms? You mentioned some of them before, but just too kind of home in on them, of food allergies. Does it always have to be a deathly illness, or can it mimic even that of food intolerance?

Dr. Sandra Hong: This is probably "TMI," but I actually have a shellfish allergy. And prior to actually being an allergist, I had just thought I did really poorly with shellfish and seafood. So, every time I had lobster, I would just have stomach upset and loose stools. But basically, it ended up being a food allergy. So, they can be very mild, they can be one system, it could be just a rash for babies around their face and they can get just really itchy, but then it can progress to more and hit more of these other organ systems. So breathing, you think digestive, you think skin, and then it can be kind of like heart and vasculature, meaning that they get dizzy, they feel like they're going to pass out.

Dr. Scott Steele: Is it possible that a patient could have exposure to that and then subsequently develop a food allergy after that? Or is it you had it the first time and that triggers something in you? Or from the moment you first try something that food allergy is there?

Dr. Sandra Hong: So, I would say for the vast majority, they've tolerated it previously. And especially as we get older, they've tolerated going out and getting clam chowder forever. And then, all of a sudden, one time they've noticed they didn't feel well. And then every time they eat clam chowder, they don't feel well. So very frequently your body kind of sees it first and then decides that it just doesn't like it. And we developed something called IgE antibodies, but basically it triggers this whole cascade of allergic reactions from that.

But can children, babies for the first time actually get it and have it for good? Yeah. So, peanut allergies, when a child has a peanut allergy, they can actually have it, eight out of 10 children will continue to have a food allergy for the rest of their life if we actually don't do some of the treatments that we've started most recently over the last couple of years.

So, if you left someone with a peanut allergy, they would continue to be allergic, probably lifelong in eight out of 10. In children with tree nuts and those are things like almonds and cashews and walnuts and pecans - those types of foods - if you eat those, only one in 10 will grow out of that food allergy if you don't intervene early on. So, they could be absolutely lifelong. But then there's interestingly foods like cow's milk and eggs, eight out of 10 will grow out of those, and it's just the way that it works for those individuals. But they can grow out of them very frequently.

Dr. Scott Steele: So, when should you call a doctor about a potential allergy?

Dr. Sandra Hong: So, I would absolutely call an allergist if your baby happened to have allergy symptoms. If you start noticing every time they eat peanuts, they get a rash around their face or they vomit, those are two of the most likely reactions to happen in a baby. There are not many organizations or institutions or allergists that are doing early oral immunotherapy. But we have started doing that and we're finding nine out of 10, 10 out of 10 children are actually tolerating the foods with early introduction and doing something called early oral immunotherapy.

Dr. Scott Steele: So, how is a food allergy diagnosed?

Dr. Sandra Hong: So, the first part of it really has history, having a great history. Every time they eat it within four hours, they're having reactions. And then after that, an allergist can actually do two forms of testing. One is actually skin testing, where we take the protein that we think you're allergic to and do tiny little scratches on the skin, and it will basically look like a mosquito bite within 15 minutes if you possibly have an allergy. The other way that we can do it is through some blood work, and the blood work can actually pick up these antibodies that are specific to the foods that we're worried about you having an allergic reaction. The way that we're able to tell for sure is actually we can do oral challenges where we monitor, and we give you tiny amounts of it and slowly increase it to see if you develop an allergy to it.

Dr. Scott Steele: So, you told us a little bit earlier about the ability for some of these food allergies to go away. But if you were to kind of, go big, high level, what is the prognosis of someone who has a food allergy?

Dr. Sandra Hong: It depends on the food that they're allergic to. Peanuts, tree nuts and shellfish, people typically don't grow out of those. Those are going to be with you lifelong. For some of the others, there's varying degrees of improvement and definitely an allergist can help improve your chances of growing out of it or at least being able to tolerate it in certain amounts so that if by accident you ate it, it wouldn't be life-threatening, and you can have small amounts in cross-contamination.

So, for instance, very frequently families with allergies to peanuts and tree nuts, they're not able to eat bakery, they're not able to go to an ice cream shop. They're not able to eat different things where there can be something called cross-contamination where small amounts of it could get into whatever they're eating. By doing things like oral immunotherapy, these newer forms of therapy, it can get you to a level where it won't cause your immune system to basically go bonkers. And so, we can actually get your body to tolerate those amounts.

Dr. Scott Steele: So, let's delve a little deeper into that last aspect. You mentioned immunotherapy, but here at the Cleveland Clinic, are there advancements on the horizon when it comes to diagnosing or treating food allergies?

Dr. Sandra Hong: So, there are very few organizations that are doing early oral immunotherapy. In my opinion, I think that this is going to be what changes food allergies for us completely. If we're able to have these children tolerate amounts of food that won't trigger an allergic reaction and all they have to do is keep it in their diet regularly so that they don't develop it again, that's life changing. It's life-changing for patients, it's life-changing for their families. And so, doing this - we're one of the few organizations doing this, and I've been doing it for the last eight years - and it's been extremely successful and life-changing.

Dr. Scott Steele: So, now it's time to get to know our guest a little bit better. It's time for some quick hitters. So, first of all, we're talking about food. So, what is your favorite food to make and to eat?

Dr. Sandra Hong: Favorite food to make, I guess curry is the first thing that I would say. And favorite food to eat, pretty much anything Indian.

Dr. Scott Steele: What is your favorite sport to watch and what's your favorite sport to play?

Dr. Sandra Hong: Favorite sport to watch would be basketball. Love our Cavs. And then my favorite sport would be actually swimming. I ended up escaping from Alcatraz a couple of years ago. So, I had heard that people do it when I was at a meeting and then decided, why not? I hadn't been in a pool in 10 years, hadn't really been training for it, but decided if they could do it, why not? So, I trained for a year and survived.

Dr. Scott Steele: That is absolutely fantastic. So, give us a spot in the world that's on your bucket list or maybe someplace that you've gone to that you have to tell the listeners you got to go there.

Dr. Sandra Hong: So, I love Italy. I love Rome. I think bucket list would be to go to, that's tough. We're going to go to Alaska. I'm pretty excited about that. I'll let you know if that was worth it.

Dr. Scott Steele: Fantastic. And then finally, you said you're a Cleveland woman and a Cleveland girl at heart. So, what is something you like about growing up and now living here in Northeast Ohio?

Dr. Sandra Hong: I love the fact that we have it all. We are basically a big city in a livable and wonderful place to be. It's a great place to raise children, and it's a home. And the Cleveland Clinic, I love the Cleveland Clinic.

Dr. Scott Steele: That's great. So, give us a final take home message regarding food allergies in the digestive system.

Dr. Sandra Hong: So, intolerances are not life-threatening food allergies. If you have a food allergy, if you're diagnosed with a food allergy, it's really important to take it seriously because it can be life-threatening. If you think that you've ever had an allergy or you're having a food allergy, you need to go to the emergency room. Seeing an allergist can be life-changing for you. We've got different therapies that were not available three to five years ago, and so we're just going to keep making advancements and hopefully we'll stamp out food allergies.

Dr. Scott Steele: Fantastic advice. And so, to learn more about food allergy care at the Cleveland Clinic, visit our Respiratory Institute's website at clevelandclinic.org/respiratory. That's clevelandclinic.org/respiratory. You can also call us at (216) 444-6503. That's (216) 444-6503. Dr. Hong, thanks so much for joining us here on Butts and Guts.

Dr. Sandra Hong: Thank you for having me.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts and Guts.

Butts & Guts

Butts & Guts

A Cleveland Clinic podcast exploring your digestive and surgical health from end to end. You’ll learn how to have the best digestive health possible from your gall bladder to your liver and more from our host, Colorectal Surgery Chairman Scott Steele, MD.
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