A Food Allergy Primer for Parents with Dr. Jaclyn Bjelac

Podcast Transcript

Nada Youssef:   Hi. Thank you for joining us. I'm your host Nada Youssef. Today we're talking about children's food allergies, and with us today we have Associate Staff in the Department of Pediatric Allergy and Clinical Immunology, Dr. Jaclyn Bjelac. Thank you so much for being here today.

Jaclyn Bjelac:     Thank you for having me. I'm excited to be here.

Nada Youssef:   Excellent. Well, I'll give you a few moments to introduce yourself to our viewers.

Jaclyn Bjelac:     I'm a physician at the Cleveland Clinic, as Nada mentioned, in the Department of Pediatric Allergy and Immunology. I actually see adult and pediatric patients. I've been on staff here for about a year and a half. One of my passions is food allergy, so really excited to be in the session today.

Nada Youssef:   Great. Thank you so much. If any of viewers have any questions, please type them in the comment section below and we'll ask them here live. Before we begin, please remember this is for informational purposes only and it's not intended to replace your own physician's advice. I'm going to go ahead and start with, what are food allergies?

Jaclyn Bjelac:     Yeah, so a very important question for the session, of course.

Nada Youssef:   Yes.

Jaclyn Bjelac:     Food allergy is an inappropriate immune response to a food when you're exposed to it. When someone eats a food, for example, like a peanut, your body responds inappropriately. Your immune system says, "This is dangerous," even though we really know that it's not. That sets off a cascade of events in the body that causes symptoms of an allergic reaction and can even result in severe symptoms that we call anaphylaxis.

Nada Youssef:   Okay. What is the difference between a food allergy and a food intolerance?

Jaclyn Bjelac:     That's a really good question. We're learning a lot about what happens to our body when we eat a food. Of course, you can have food allergy, which is what we primarily deal with in the allergy clinic, which are immediate reactions to a food because of the immune system, like we just talked about. Many people can have intolerances to foods like lactose intolerance, for example. There are people who have non-celiac disease gluten intolerance. There are people with celiac disease, which is an autoimmune condition when you eat wheat, for example. You can have lots of different symptoms when you eat a food, but what we focus on in our allergy clinic are food allergies that result because of the immune system's inappropriate response to the food.

Nada Youssef:   Right. Well, per the CDC it seems like there are way more children with food allergies nowadays than ever before. Why is that or why do you think that is?

Jaclyn Bjelac:     Yeah, so it's a really unfortunate trend and one that's being examined really closely. Nobody knows for sure. If I knew the one reason why I'd have a Nobel Prize, so ...

Nada Youssef:   Yes.

Jaclyn Bjelac:     Spoiler alert. I wouldn't be at work today. We think that it's multi-factorial. Lots of different things. We know that genetics probably plays a significant role. A lot of times people with food allergies, their sibling have food allergies or even their parents. It's probably some environmental exposures. Things that are being looked at are antibiotic use and also lack of exposures. The whole hygiene hypothesis probably has a lot of merit, so it's probably a number of different things that sort of created this perfect storm where, unfortunately, a number of us are now suffering from food allergy.

Nada Youssef:   Now, when you say lack of exposure, can you go a little bit in detail?

Jaclyn Bjelac:     Yeah. Really, we're very lucky because in our country and in most places we aren't fighting off parasites or infections that our immune systems used to be kept very busy doing. There's something called the hygiene hypothesis where our immune systems were a little bored so they're inappropriately responding to things that aren't dangerous because they're not being kept busy fighting off infections and diseases as they were before.

Nada Youssef:   Very interesting. Why do some children get severe allergies to food while others don't? Another Nobel Prize question.

Jaclyn Bjelac:     Yeah, so it's probably, like I mentioned, a combination of things. Sometimes we can't find a reason. We want to always reassure parents that we don't think it's anything that you did or didn't do. Sometimes these things happen. The important thing is if you suspect a food allergy to get it checked out so we can keep your kid safe.

Nada Youssef:   Sure. Can we list some of the foods that trigger these most common allergies?

Jaclyn Bjelac:     Yeah.

Nada Youssef:   Peanuts, I know that for sure.

Jaclyn Bjelac:     Yeah. Peanuts. Peanuts are important. Tree nuts are common food allergy triggers. Soy, wheat, fish and shellfish, and then sesame is an emerging concern, particularly in our country, and the FDA has recently had a proposal to now include sesame on food allergy labeling similar to what you see in the grocery store on labels for milk and egg.

Nada Youssef:   Wow.

Jaclyn Bjelac:     Which is great.

Nada Youssef:   Very interesting. I had no idea. What are the symptoms of a food allergy on a child? What to watch for.

Jaclyn Bjelac:     Typically within minutes up to a few hours, so that would be exceedingly rare, after eating a particular food. Food allergy symptoms vary person to person, but they can be things like mouth itching, a child telling you that their throat really hurts or itches, stomach upset, vomiting, diarrhea, hives. We get very concerned with trouble breathing, a change in a child's voice. Those sorts of things can indicate more serious reactions. Very rarely, but potentially, you can experience a drop in blood pressure and potentially food allergy reactions can be fatal, but that's, luckily, very, very rare.

Nada Youssef:   Okay. What to do when you first notice a food allergy like you just mentioned?

Jaclyn Bjelac:     Yeah, so food allergy reactions are always very concerning and parents tell me just how scared they were the first time it happened. That's so understandable because even when we expect it in the allergy clinic it still is disconcerting. We respect food allergy reactions and take them seriously. If you have reason to suspect that your child is having a food allergy reaction, take a deep breath. You know your child better than anyone else in the world. If you are really, truly worried get them to an emergency room. Call EMS. Tell them that you have a child who is potentially having a food allergy reaction so they send the right kind of emergency medical services to your home, or if you live within reasonable driving distance to a hospital just get them there quickly yourselves.

Jaclyn Bjelac:     Very mild reactions can sometimes be treated with antihistamines. Things like Benadryl and Zyrtec, which can just help you feel better as the reaction goes away on its own, but anything more serious we recommend epinephrine. Of course, if you don't have a prescription for one that requires emergency medical services.

Nada Youssef:   Okay. Well, that was going to be a question later on, but since you brought it up I'm going to talk about it.

Jaclyn Bjelac:     Sorry to get ahead, Nada.

Nada Youssef:   No, you're good. What does epinephrine do? The injection itself. Right? It's an injection. Like an EpiPen?

Jaclyn Bjelac:     Exactly. Self-injectable epinephrine comes in a couple of different devices. Probably most familiar and recognizable in the United States is the EpiPen or its generic. There's also the AUVI-Q, Adrenaclick, and some others. These are injections that go into a muscle, and what epinephrine is, very simply is a shot of adrenaline. It works to counteract some of the things going on inside your body that can cause that food allergy reaction to get much worse.

Nada Youssef:   I see. Now, can the severity of a person's allergic reactions to food be predicted by their previous reaction? Is it always the same?

Jaclyn Bjelac:     That is an excellent question and the short answer is no. We wish we had a better way to predict severity. Of course, if someone has had a severe reaction in the past they're far more likely to have a severe reaction in the future, but many times patients who have very mild reactions can progress to more severe reactions on their next exposure. That being said, sometimes someone who had a severe reaction may not have quite a severe reaction the next time, but we just don't know for sure.

Nada Youssef:   What would be the best way to cope with a food allergy? If you're having a mild food allergy but you still like the food a lot, should we just stay away from it because it doesn't like your body?

Jaclyn Bjelac:     How to cope with food allergy is a really big question and it involves a lot of really important components. This is very impactful on children and their families, so you definitely need the help of a board-certified allergist-immunologist to help you through this. What I recommend to families when we have a new diagnosis in clinic, the first visit we really just talk a lot. We talked about strictly avoiding your food allergen, which isn't as simple as saying, "Oh, I'm just not going to drink milk," if you're milk allergic, for example. You have to avoid all forms of that food.

Jaclyn Bjelac:     You have to learn how to read labels, and there are a number of amazing resources to help you do that, including your allergist. We're avoiding the food, but then we have to be prepared for accidents. In the real world accidents happen, so your allergist should go over a food allergy action plan with you. What to do if you're having symptoms of an allergic reaction, and your allergist can help go through symptoms that can be managed with antihistamines or symptoms for which you should just give and go. Give epinephrine and go to the emergency room.

Nada Youssef:   Okay. Now, is there any correlation between introducing certain types of food too early or too late?

Jaclyn Bjelac:     This is a great question.

Nada Youssef:   A million dollar question?

Jaclyn Bjelac:     Yeah. This is a really great question, and I want to back up a little bit. When we were growing up, Nada, the recommendations because of what we knew at the time was to delay introduction of some of these allergenic foods. Most notably, peanut. Then we were seeing an increase in food allergy within a generation, and some very smart researchers noticed that Israeli children have very little peanut allergy and they said, "Why?"

Jaclyn Bjelac:     In Israel, there's a little snack called Bambas. I sort of anecdotally call it the Cheerios of Israel.

Jaclyn Bjelac:     It's a little puff that's almost ... It looks like Kix. It's a peanut butter snack.

Nada Youssef:   Oh.

Jaclyn Bjelac:     In this country, people get Cheerios when they're little as some of their first finger foods. One of your first finger foods was Bamba, so these very, very smart researchers said, "Do they have less allergy because they're eating the food earlier?" Then a landmark study was done called Learning Early About Peanut or the LEAP study. They took kids who were a very high risk of developing peanut allergy either because they have a sibling with peanut allergy or very severe eczema, which are both risk factors for development of food allergy of any type, not just peanut, and they broke them into two groups.

Jaclyn Bjelac:     They had one of the groups eat peanut early in life and one of the groups not eat peanut, just avoid it. They saw a dramatic reduction in the incidents of food allergy in those who were eating it early. About a 70% percent reduction, which is huge.

Nada Youssef:   Now, how early is early?

Jaclyn Bjelac:     Like four to six months of age?

Nada Youssef:   Really? Wow.

Jaclyn Bjelac:     Yeah, so people say, "How am I going to get peanut into my six-month-old?" There are guidelines now that have come out because of this study. It's completely changed the way that we practice allergy, and I don't say that lightly. Now we're learning that as you eat the food your body's learning that it's safe to-

Nada Youssef:   I see.

Jaclyn Bjelac:     That food is safe, as opposed to avoiding it where your immune system might say later on, "We haven't seen this before."

Nada Youssef:   "We don't know what this is," right.

Jaclyn Bjelac:     "This might be dangerous."

Nada Youssef:   Right.

Jaclyn Bjelac:     There are guidelines, so talk to your pediatrician about if a referral to an allergist is appropriate for you. We always want to talk to our pediatricians before introducing foods to anyone, but there are some infants who are candidates to start eating these foods very early, at four to six months of age. Some might need testing beforehand and some may not, but I'll tell you, so my kids are pretty low risk for developing food allergy. We started with our purees, and as soon as they were doing well we mixed in some peanut butter and it was their second food.

Nada Youssef:   Before they turned one?

Jaclyn Bjelac:     Oh, yeah. They were like six months old.

Nada Youssef:   They were six months old. I started with my youngest. I actually give him milk like at seven months.

Jaclyn Bjelac:     Yes. We want to introduce all of these allergenic foods. Now the only food that you need to avoid in the first year of life is honey, and that's not an allergy concern. It's for botulism. Your kids can eat what you're eating. Obviously, different textures are a concern so you want to do it in a safe way. In addition to Bambas, there's peanut butter powders and other forms of foods that are still safe for infants and very young children.

Nada Youssef:   So you can see this stuff in stores? It's not like it's not off the shelves?

Jaclyn Bjelac:     Oh, yeah. Right next to the peanut butter in the aisle.

Nada Youssef:   Yes, you would know. Is there a treatment that can stop the body from acting the way it does beforehand?

Jaclyn Bjelac:     Yeah, good question. Up until about 10 years ago we just had to say, "You have a food allergy. Don't eat the food. Here's your EpiPen. I'll see you in a year." I'm lucky that I'm practicing in a time where we say that's not good enough. There are many researchers and even practitioners now who are offering treatments for food allergy. None of these are FDA approved at this time, but they are becoming more widely available.

Jaclyn Bjelac:     One of the more promising treatments is something called oral immunotherapy. This is something that is only done under the direction of a trained allergy immunology physician. Basically, through the process you're training your immune system to not overreact to the food anymore. In case of accidents, you wouldn't have reaction, and there are some kids who can even, what we call pre-eat the food. They could have the peanut butter and jelly sandwich with no reactions.

Nada Youssef:   Oh, great.

Jaclyn Bjelac:     It's an intensive process and not without some risks and side effects, of course. There are other options. There's a company called ... Well, I won't share the name because I don't know if I'm allowed.

Nada Youssef:   Yeah, don't share the name. No sharing names.

Jaclyn Bjelac:     There's a company coming out with a patch that looks almost like a nicotine patch that can sort of do the same process through the skin. There's lots of promising treatments out there. If you are a family who has food allergy in your home I really encourage you to talk to your allergist about treatments that are coming out. Some may be offered in your area and talk to them if you might be a candidate.

Nada Youssef:   Great. How about pregnant moms? Can a pregnant mom check if her child's going to be allergic to something before?

Jaclyn Bjelac:     Great question. There's lots of testing we can do now when we're pregnant, but food allergy is not one of them.

Nada Youssef:   Not one of them? Okay.

Jaclyn Bjelac:     Nor should it be. Without a history concerning for a possible food allergy reaction, food allergy testing can honestly cause more harm than good.

Jaclyn Bjelac:     Food allergy testing is designed to show are you sensitive to something or not, and many people who even show sensitivity to foods on this testing can eat the food without a problem. We really try and be very careful about tests that we select because, to me, there could be very little worse in my allergy clinic than saying, "You need to avoid this food," and have that be unnecessary.

Nada Youssef:   Right. So testing is not something that you would just go get a test for your child? It's only if needed.

Jaclyn Bjelac:     No. Yeah, and as parents, I think that there could be some concern when you're giving a child a new food. I'm an allergist and my husband feeds my kids the allergenic foods first and I just hang out in the living room. I would be too nervous. I empathize with families who have these questions. Talk to your doctor if your kid's at risk for food allergy, if testing before introduction might be for you, but we're designed to eat food. We don't need to medicalize how we feed our kids.

Nada Youssef:   Right.

Jaclyn Bjelac:     Just let them eat.

Nada Youssef:   Just let them eat their food. Yes. If Mom and Dad have allergies to food, various, is it likely that the child would have the same? I know you talked about genetics.

Jaclyn Bjelac:     It's more likely but it's not a given.

Nada Youssef:   Okay.

Jaclyn Bjelac:     For those families, in particular, I would encourage that they introduce those food allergens early in a child's life. Of course, keeping in mind that we want to be conscientious. If it's a risk to the parent to have that food in the house or be handling that food, we don't recommend that.

Nada Youssef:   Okay. Great. Now, can you outgrow an allergy?

Jaclyn Bjelac:     Yes.

Nada Youssef:   You can?

Jaclyn Bjelac:     Thankfully.

Nada Youssef:   Oh, okay.

Jaclyn Bjelac:     It depends on the allergen. Some allergens it seems that we outgrow. Kids tend to outgrow milk and egg, whereas peanuts and tree nuts are less likely to be outgrown.

Nada Youssef:   Okay.

Jaclyn Bjelac:     You can develop allergy later in life as an adult, but most allergy does manifest itself in childhood.

Nada Youssef:   I was going to ask about that. I have a family member that absolutely addicted to milk. Every single day, cups of milk and now completely cannot touch it.

Jaclyn Bjelac:     Oh, I'm sorry to hear that.

Nada Youssef:   You can also get allergies.

Jaclyn Bjelac:     You can. It's not common, but it's-

Nada Youssef:   There's no reason? I mean, is it just too much of it or is there a reason why?

Jaclyn Bjelac:     No. We don't think that it's that you took too much. Maybe there's something else going on that needs to be explored that's kind of affecting how their immune system's functioning, but really, we just don't understand. That's so much more that needs to be explored and lots of research is being done in the field.

Nada Youssef:   If my child was allergic at one point to a certain type of food and now we're starting to see a change, is it okay to start reintroducing small amounts of that food or is that dangerous?

Jaclyn Bjelac:     We never want to do it without consulting first with your allergist. Likely we would do some testing and talk about what symptoms were. Different allergists have different practices. I tend to be aggressive because the parent really wants to know, "Is my child still allergic?" If we don't think that there is unnecessary risk we try the food in the office in a controlled setting where we can intervene if any symptoms occur.

Nada Youssef:   Sounds good. Great. Well, we're getting some questions.

Jaclyn Bjelac:     Okay.

Nada Youssef:   I'm going to go ahead and go to Lynn. Lynn asks, "Can food allergies be inherited? If I'm allergic to peanuts, for example, will my child be more likely to be allergic?"

Jaclyn Bjelac:     That's a really great question, Lynn. We know that genes play an important role in the development allergy. Any type of allergy. Food allergies, environmental allergies, kids with eczema are more likely to have parents who've had eczema, but the specific allergen is not heritable in that way. If you have peanut allergy, for example, your child's more likely to have a food allergy but not necessarily to peanut.

Nada Youssef:   I see. Okay, very good to know. Emily, "My daughter had serum sickness in response to penicillin. Should we have allergy testing for this?" I guess I'll have you explain what serum sickness is. I've never heard of it.

Jaclyn Bjelac:     Yeah, so, Emily, that's a really good question. I would talk to your pediatrician about it. Just to touch on what serum sickness is, it's a type of inappropriate immune response sometimes to an infection, sometimes to a medication. We don't have any validated testing to assess if you would get serum sickness again if a penicillin was used, so talk to your doctor about what your other alternatives are and see an allergist if you guys feel like penicillin's really needed.

Nada Youssef:   Okay, great. And then Kristen, "Can you explain the difference between different allergy tests? I've heard there are mail order tests, scratch tests, or blood tests. Which one is best?"

Jaclyn Bjelac:     Which one is best? You're right in that there's a couple of different tests. I want to take a moment just to caution against any mail order tests because of the reasons that we spoke about before. Interpreting allergy tests is actually very difficult. Allergist-immunologists go through a lot of training and have experience in interpreting these tests. What I would hate to happen is you send off this mail order test and get some really unexpected positives and it creates some unnecessary fear and difficulty in your life.

Jaclyn Bjelac:     Any allergy testing should be under the direction of a physician. Many primary care physicians feel comfortable ordering preliminary testing. Typically, outside of an allergy office that's always blood testing. Blood testing is measuring the level of your allergy antibody, which is what's responsible for allergic reactions to a given food in your body. It shows sensitivity to a food. It tells us, for some foods how likely based on certain levels it would be for you to have a reaction if you ate the food.

Jaclyn Bjelac:     Skin testing is more immediate. We do it in the allergist's office. It's a really good yes or no test. A no test, if you have no reaction on skin testing is associated with a pretty low likelihood of reaction to a food, so it's a really great no test. If it does show sensitivity, typically an allergist would follow that up with some blood testing to help with risk stratification. The short answer to the question of which test is best, the answer is it depends on what the scenario is.

Nada Youssef:   What's a scratch test? Is that same as a skin?

Jaclyn Bjelac:     The scratch test ... Yes.

Nada Youssef:   Okay.

Jaclyn Bjelac:     A skin test ... We say scratch because you place a drop of liquid on the skin and that drop of liquid has the relevant allergen in it. You lightly scratch through to just disturb the top level of the skin. It's almost like if somebody scratched you through with a nail. You don't feel pain. We're allergists. We don't want to see your blood.

Jaclyn Bjelac:     The hardest part is that some of those spots on your back when we do the test could get pretty itchy. That's what we're looking-

Nada Youssef:   That's why they're starting to do the arms?

Jaclyn Bjelac:     ... for. Yes. We put it on the back a lot of times so kids can't reach, but a lot of the cells that we need are on your back, but some can be on the arm too. Depending on how many tests you're getting in a certain time or how old you are, if you can not scratch, it might be on your back or on your arm.

Nada Youssef:   This is very informative. Thank you.

Jaclyn Bjelac:     Yeah.

Nada Youssef:   All right, now Melissa asks, "My mom worries about dark circles under my son's eyes. She thinks it's an allergy. Is this something to be worried about?"

Jaclyn Bjelac:     Good question. Dark circles under the eyes can be from a number of different things. What we worry about is that kind of the blood's not draining properly. That could be because your nose is stuffy. A stuffy nose can be because of a number of different things. In the very acute setting, your nose can get stuffy if you're having a food allergy reaction, but a nose that's stuffy all the time, unless you're continually eating the food, isn't because of a food. It could be environmental allergy. In kids, we also worry about have large adenoids or other things. Some people just naturally have more visibility in that blood underneath your eye pocket, so I would talk to your doctor and see if based on other symptoms or other conditions your child has if allergy testing might be appropriate.

Nada Youssef:   So she should go to a pediatrician to-

Jaclyn Bjelac:     Yeah. Pediatricians are an amazing resource to kind of help figure out what might be going on and if they think that there might be an allergy involved then they can make the appropriate referral.

Nada Youssef:   Thank you. All right. Then Jill, "When do I know if symptoms are concerning enough to get checked out or warrant avoiding the foods? Specifically, my daughter gets an itchy mouth when she has fruits. Should we avoid feeding her those fruits or there is a way to get her system use to that fruit, or is it just not worth the risk of possible dangerous reaction? I just want to know what to do."

Jaclyn Bjelac:     My short answer is, as a parent you know your child better than anyone in the world. If you are worried you should get it checked out. The interesting thing, and I don't want to say this is what's happening, but some people who have food reactions like an itchy mouth just with fresh forms of fruit might actually have a primary allergen to a pollen, like a tree pollen. The proteins in those pollens look very similar to the proteins in fresh forms of the fruit, so the common situation that we see in clinic is someone comes in and they say, "When I eat fresh apples my mouth is itchy, but I can eat apple pie no problem." That is sort of the defining characteristic of something called pollen-food allergy syndrome.

Jaclyn Bjelac:     Of course, if you're having symptoms due to a food I recommend that you see your doctor and they can help determine if it sounds like it's an allergy that's concerning or something to be looked at. Better safe than sorry. If you're worried and you're having symptoms with food, we just want to help you be safe. We're happy to talk to you and do any testing that might be appropriate.

Nada Youssef:   Great. Then Jean, "Can a seven-month-old be so allergic to food that he instantly breaks out with hives? Also, can it cause him to vomit?"

Jaclyn Bjelac:     Yes.

Nada Youssef:   Oh. All right, short and sweet.

Jaclyn Bjelac:     You can have a food allergy at any point. Very few children who are exclusively breastfed have reactions to foods, but as we start to introduce foods then you can react at any point in your life. We sometimes see very, very young children with food allergy reactions. If your child's having any symptoms related to food you should see your doctor right away. Could this be something that's not food related, like reflux? Of course, but if you're worried about a food it's something that we need to check out immediately.

Nada Youssef:   Okay, great. Then Christine, "At what age would you recommend starting allergy shots? My five-year-old had a pretty difficult spring and her allergist mentioned starting shots in the near future as she has many environmental allergies."

Jaclyn Bjelac:     I'm sorry to hear about that, Christine. That's no good. When your kid's five years old you want them to be able to go outside and play and enjoy their time being little. An environmental allergy can make that really difficult. Allergy shots, right now, are for environmental allergies only. Since we're in a food allergy thing I want to make that very clear. If anyone's offering you shots for food please decline and leave.

Jaclyn Bjelac:     Environmental allergy shots can be really helpful in reducing symptoms related to that allergy. I have kids as young as four on it. I don't do that lightly. It's very patient dependent, very family dependent. Talk to your doctor about what's involved and see if that might be right for your child to kind of reach your guys' health care goals.

Nada Youssef:   Okay, great. Then Dan, "How do you know if oral immunotherapy is right for your child?"

Jaclyn Bjelac:     I think it's important to just talk to your allergist. If they don't feel like they know enough about oral immunotherapy ask them for a referral to someone close by who might be willing to meet you for a consultation. The only way to know if OIT is right for your child is to learn about it and then decide if it's right for you and your family.

Nada Youssef:   All right. Well, we are actually out of time, but is there anything that we have not touched on that you wanted to talk about? Because I know we haven't talked a whole lot about all kinds of stuff.

Jaclyn Bjelac:     Yeah. Well, I think this has been great.

Nada Youssef:   Any recommendations?

Jaclyn Bjelac:     Time flies when you're having fun.

Nada Youssef:   Yes.

Jaclyn Bjelac:     I just think that food allergy's one of those things that we're learning so much about. As parents, we just want to do what's best for our kids. If you're worried please ask your doctor, and then as a pediatric allergist, we're always happy to meet with you even if it's just to provide reassurance. You should never feel like you're wasting our time. It's our job to help you feel good about what you feed your kids.

Nada Youssef:   Yeah, absolutely. Thank you so much for being here.

Jaclyn Bjelac:     It was my pleasure.

Nada Youssef:   Very, very informative session.

Jaclyn Bjelac:     It was my pleasure. Thanks so much for having me.

Nada Youssef:   Sure thing. Thank you for watching or listening. We hope you found this very helpful and informative as I did. If you'd like to make an appointment with Dr. Jaclyn Bjelac, please call 216-444-KIDS. That's 216-444-5437, or visit us at clevelandclinicchildrens.org for more information. For more health news information from Cleveland Clinic, make sure you're following us on Facebook, Twitter, Snapchat, and Instagram @ClevelandClinic, one word, and we'll see you again next time. Thank you.