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Understanding Food Allergies And The Pediatric Airway

an article from ...ask the ‘boogor doctor‘

Reproduced with permission of our trusted friend and colleague,

Dr. Russell Faust, PhD, MD

Below is the transcribed podcast of a wonderful ‘ask the boogor doctor’ (boogordoctor.com) interview with physician and food allergy expert, Dr. Janice Joneja. The interview discusses food allergies as they relate to pediatric airway illnesses - enjoy!

As I promised last week, when I introduced food allergy expert Dr. Janice Joneja, the following is a transcript of my first interview with Dr. Jonega:

This is the transcript (provided by www.castingwords.com) Interview with Dr. Joneja.

Warning – this is over 3,000 words.

Just listen to the Podcast of the Interview with Dr. Joneja.

BD: Hello and welcome to podcasts from the Boogordoctor.com site. I’m Russell Faust, author of this blog. This is an inaugural interview for what I hope to be a series of interviews and discussions with experts in the field of pediatric airway ? meaning asthma, allergies, rhinitis, sinusitis, reflux, and related topics.

I’m very proud to have as my first guest, Dr. Janice Joneja, expert in food allergies and food intolerance. Dr. Joneja, first let me welcome you to my medical education blog, Boogordoctor.com.

Dr. Joneja: Thank you so much. I’m delighted to be here.

BD: Thank you so much for generously agreeing to chat with me today. I sincerely believe that listeners and readers of the blogs, yours as well as mine, will find your insights to be very valuable. Before I ask you about your experiences, I want to take just a moment to introduce you to our listeners. Let me first say that more details can be found on my site with links to your site for those folks who might want further counseling or have questions for you.

There are two main reasons that I wanted to invite you to be the first expert to be interviewed here for these blog podcasts. The first is that, and I’ll speak to my listeners here, she has impeccable scientific credentials. The second is that as a mother of a sick child she was frustrated by what the world of science and medicine had to offer to help care for her child.

So let me just first review some of those scientific credentials and her background a little bit and then open it up. Dr. Joneja is a researcher, an educator, an author, and a clinical counselor with over 30 years of experience in the area of biochemical and immunological reactions involved in food allergy and food intolerance. She holds a Ph. D. in microbiology and immunology, has been a member of the academic faculty of the University of British Columbia and other universities.

Currently she’s adjunct professor in the faculty of agricultural sciences at the University of British Columbia and an honorary research fellow in the School of Biosciences at the University of Birmingham, England. Dr. Joneja is also a registered dietician. She is very well published with more than a dozen articles in scientific and medical journals, has authored six well?reviewed books including two recent editions that focus on food allergies.

You can find more information about these on the website. As an expert in her field, she has also authored articles in popular magazines and has been a frequent guest expert on radio and television. As you listen to her, you’ll understand why she’s been such a popular speaker.

Finally and perhaps most importantly in her development of her expertise, Dr. Joneja is also a mother. Clearly as she has great scientific credentials she knows her stuff, but she also brings a unique perspective to the world of food allergy, the experience of a mother with an ill child. That is why I’ve invited her here to share her experience and wisdom with us. She is one of the early integrators and pioneers in this field.

She practices in integrative allergy and nutrition counseling, just returning from a workshop where she’s giving a workshop in Oregon. Dr. Joneja joins us from British Columbia this morning. Dr. Joneja, welcome and can you please give us a little bit about your background and your experiences that led you to look beyond what you had learned as a scientist?

Dr. Joneja: Indeed I can and thank you so much for inviting me. This is a delightful experience for me. I’m really happy to be able to share my experience, as you said, as on both sides of the desk if you like. We can look at it that way. I started my career as a research scientist. I did a doctorate in medical microbiology/immunology and started in at the University of British Columbia as an assistant professor.

My field was focused actually in oral microbiology/immunology and the immunology of mucosal surfaces, which is actually the very point where we see the coming together of the external world with the internal world. Of course there’s nothing more important than that, than the external world of food that becomes internalized in our bodies.

My research was focused on science. Literally, I was a laboratory scientist, and the mechanisms of the immunology of allergy were really where I started in immunology because I did my training in the department at the University of Birmingham where the immunological processes of allergy were actually discovered and delineated.

My background as far as allergy was concerned would probably be as much as was known in those days, and I’m talking over 30 years ago now. As a scientist I knew as much as there was to know about the mechanisms responsible for allergy, but it wasn’t until I had a child of my own with really perhaps the greatest number of allergies that I’ve ever seen in my practice as in the field of clinical allergy. I’ve seen over 4,000 families now.

My son, when he was born actually, had eczema. He very quickly developed quite severe asthma, and even as early as two years of age he was given prednisone and became steroid dependent, a steroid dependent asthmatic. He became anaphylactic to peanuts, and later on in his teenage years started to develop severe migraine headaches.

His father is a neurologist, and so he had every test that was available to find out the origin of his migraines, and nothing was discovered. Now when I was seeing him I could see definitely that he was responding to different foods. So I would speak to his pediatrician about this and discuss it with his respirologist and was told in no uncertain terms there’s no such thing as food allergy. It’s a product of a neurotic and in my case overprotective and overeducated mother. [laughs]

BD: Even 30 years later, now I’m sure many of the listeners are familiar with this response in medicine.

Dr. Joneja: Oh, dear. I’m really sad to hear that. Now we have so much more research to guide us, but nevertheless you’re absolutely correct because I hear the same thing from the patients who come into my office.

BD: Sure.

Dr. Joneja: So what was I to do? I knew the mechanisms. I knew what was going on my child, no doubt, and no one was available to help me. I looked to dieticians. They were absolutely uneducated in the field because nobody wanted to consider this as part of traditional medicine. So what happened of course was that he moved into the field of alternative medicine.

It seems that the traditional scientists and the traditional clinicians even today will shy away from a field that is considered fringe medicine unfortunately. So there was not a lot of scientific basis for us to even move into knowing what was going on. So me being what I usually do is, “OK, there’s no one out there to help me. I’ll do it myself.” [laughs]

I went back to university, became a registered dietician by taking all the courses required for registration, doing an internship, and then moving into the field to apply what I knew as a scientist in the field of clinical dietetics. In other words, trying to apply in a practical way all that I’d learned as a scientist to enable other people to help their children and themselves in managing what they knew were adverse reactions to foods.

Now having said that, I would like to at least say that since that time more and more traditional scientists and clinicians have recognized that food allergy is indeed a very important aspect. A lot of this is fueled by the anaphylactic societies who recognize the real danger of food to a sensitized individual because in the most extreme case we have of course a life?threatening situation.

That itself has fueled tremendous research into the field, which I am happy to say now is what is guiding us in our practice.

BD: And how did things turn out for your boy?

Dr. Joneja: Ah! [laughs] Well, he’s now in his thirties. He has a child of his own.

BD: Congratulations.

Dr. Joneja: Thank you. A very small one, but it’s delightful.

[laughter]

Dr. Joneja: Well, I think, as we experience, because I wasn’t able to intervene at the very early stages where we now see the possibility that we can perhaps reduce if not prevent the onset of food allergy.

Unfortunately he really did get into a very stressful situation where he was in status asthmaticus several times, which is of course an extremely frightening situation for everyone, including his pediatrician. He was steroid dependent, and do you know prednisone at high levels for a young child of six years of age can be devastating?

BD: Oh, yes.

Dr. Joneja: And with the migraine headaches again, well, that one he solved himself. He decided at the age of 13 that he was going to become vegan. He said, “Mommy, every time I eat anything that is made of meat, it makes me vomit.” And it did. He became a vegan. We took out every animal source from his diet, which I was able to do, thank goodness.

In spite of being anaphylactic to peanuts, his diet was all legumes, no problem. That of course showed me that food allergy is species specific and that the old idea of food families being… I mean we could do a session on that alone of course, Russ.

BD: Sure.

Dr. Joneja: But it doesn’t mean that you’re going to be allergic to everything in a food family. That is the old?fashioned idea before we had the new molecular science to guide us on this structure of allergens.

BD: Right.

Dr. Joneja: He became a vegan. His migraine headaches cleared up instantly.

BD: Amazing.

Dr. Joneja: And I finally discovered after my methods of elimination and challenge, number one, he was very allergic to pork. We used to eat quite a bit of that in all sorts of forms, bacon and ham and so on. He was allergic to beef also. He was allergic to milk protein and on top of all that, which is very, very common in a steroid?dependent asthmatic, he was sulphite sensitive. With that knowledge he was then able to, number one, control his migraine headaches. It did to some extent reduce his severity of asthma, because as you know sulphite sensitivity and exposure to sulphites can exacerbate asthma.

BD: Sure.

Dr. Joneja: And so he’s still asthmatic. He still needs quite a bit of medication, but he does not need steroids. Inhaled steroids yes, but not the systemic steroids.

BD: Not systemic. Right.

Dr. Joneja: So he doesn’t suffer from the migraine headaches, but he does have an aura. And aura for your listeners is sort of a ‘before headache symptom’ where he may have visual disturbances that would indicate that a migraine may be coming on.

He doesn’t have the migraine headaches. He doesn’t have the severe asthma, it’s controlled. He still has eczema. He never did outgrow that, although he outgrew quite a few of his early food allergies. With eczema we do see the impact of environmental allergens later on where they gain access to the lower tissues through the braided skin of eczema.

BD: Sure.

Dr. Joneja: Dust mite, mold spores, animal dander and sometimes pollen spores will exacerbate his eczema. But he grew beautifully; he’s six feet four inches.

BD: So not malnourished.

Dr. Joneja: Not at all, not at all. I make sure of that.

BD: That leads me to ask and there will be listeners who are facing similar situations with their children. It must be very frustrating to have a child, an infant, who is significantly limited, and who has many food allergies. For example, your son, not only being a vegan, but also being limited on even that diet what he could have.

So give us some sense of how you successfully nourished him, raised him. How did you manage to get enough protein into him so the little guy would grow? That’s hugely challenging.

Dr. Joneja: It is a challenge and it was a challenge because being vegan is very difficult when they start in adolescence and he was very well nourished as far as his legume intake. Interestingly, although he was allergic to peanuts he was not allergic to all nuts. He was allergic to some nuts.

BD: Right. But not all tree nuts?

Dr. Joneja: No. No.

BD: OK.

Dr. Joneja: Because as we know, as long as a person is not allergic to a pan?allergen… We might discuss that in a future series too. He isn’t allergic to all nuts, but we found out he is OK with almonds, he was all right with Brazil nuts, a variety of seeds he was fine with, so I could utilize those in the flours and increase his protein from that source and fortunately, later on he was not allergic to egg and so I was able to introduce that later.

BD: I was going to ask.

Dr. Joneja: Yes.

BD: So you were able to maintain a fairly high quality breadth of amino acids and proteins to keep him well nourished.

Dr. Joneja: Indeed.

BD: Yeah. Quite the challenge.

Dr. Joneja: Which was fine, which was perfectly fine until he went away to school and university and that was where the problem started. In fact, there was a time when unfortunately the way he was eating in the university and he went to boarding school, the way he was eating there. He would vomit after a meal, after most meals. He lost a considerable amount of weight at that time, so this was where the challenge arose for him, when he was away from home.

BD: I think children who can be maintained at home, when this sort of care, meticulous investigation into their diet and elimination and reintroduction, this sort of meticulous care is taken, really do run into trouble when they’re out in that environment, when they go away to school or they go away for a job or something. It’s a huge adjustment.

Dr. Joneja: Definitely. That is the problem. With young people, young men particularly, they want to be part of the social scene. They don’t want to be seen as different. He did suffer, I must admit, he did suffer a lot.

BD: Sure.

Dr. Joneja: Young men like to go to the bar and so on and so forth and for a person with his sensitivities as far as fruits and other ingredients, it became really a big problem. It really was. Yes.

BD: Over what sort of time would you say that you began to not only recognize based on your scientific background recognize what was going in your son, but really to work it out, to develop kind of a detailed sense of what he was reacting to and what was safe for him since you didn’t receive a lot of assistance from his pediatricians? You did all this on your own?

Dr. Joneja: Absolutely. In fact, one of his pediatricians told me to go and find another pediatrician because she couldn’t deal with me anymore.

BD: Oh, that’s so sad.

Dr. Joneja: Oh, it was terrible. It was his respirologist, the doctor that was helping, or should’ve been helping, with his asthma that literally told me there’s no such thing as food allergy. In those days, in fact, I don’t know whether you would be aware of this, but in the early days of allergy teaching in medical school, asthma and eczema were not considered to be allergic diseases. The only real allergic disease was considered to be hay fever.

BD: Right. Allergic rhinitis.

Dr. Joneja: Rhinitis. Exactly. And it was denied. In fact, we have research papers in those days denying the allergic component to asthma and eczema.

BD: Unbelievable.

Dr. Joneja: Then the early papers would say intrinsic and extrinsic asthma, sort of claiming, “OK, we’ve got extrinsic asthma that may be triggered by pollen and animal dander and mold spores” and intrinsic asthma was considered to be just an idiosyncratic response of the body.

BD: Right. An odd physiological response.

Dr. Joneja: Not to food. Certainly not to food or food components. No. That was completely denied in research papers.

BD: Amazing.

Dr. Joneja: And then of course I believe there is still within the world of dermatology practitioners who deny the allergic component of eczema. Yeah we know atopic dermatitis and OK, we’ll sort of say that, but fortunately there’s another group of scientists showing quite clearly the triggers in foods that are associated with the onset and the exacerbation of eczema with food and pollen.

BD: Certainly in my field, there’s a recent convergence between pulmonologists and allergists, immunologists, ENT, ear, nose, throat, and otolaryngologists toward the so?called unified airway theory, which states that the lining of the aerodigestive tract is all the same basically and it’s all exposed to the same toxins or pollutants or allergens and irritation in one area of that tract stimulates in the body various cytokines and other stimulants that can be systemic and irritate the entire tract.

Dr. Joneja: Precisely. We see that very clearly in two conditions that are being recognized more and more now. They’re usually of adult onset, but we do see them occasionally in children, that would be ‘oral allergy syndrome’ where the initial trigger for IgE, that’s the antibody that mediates allergy, is pollen. So we start with a pollinosis, which would be cedar birch, older pollen and then we see oral symptoms as a result of consuming raw fruits and vegetables and have a very similar structure and can in fact release the mediators from our cells that were not actually sensitized initially by the food.

BD: Were not the original allergens.

Dr. Joneja: And we also see that with latex allergy, where that can become systemic. The initial trigger is latex. There are many different antigens in latex.

BD: Right.

Dr. Joneja: And these trigger IgE. Sometimes we’ll get them through the hands where there’s sort of an eczematous reaction to the latex, or even inhaled which would be the powder from latex gloves, become systemic. The IgE is systemic and then a person consumes foods that have similar structures within the protein in the food and then can in fact have an anaphylactic reaction to the foods, although they’re not initially sensitized to the food.

BD: Scary.

Dr. Joneja: This is where we see that too. As you said, the integration between all of the mucosal surfaces of the body, although they are different. Because we’ve got what we would say the mast, the mucosal associated lymphoid tissue of the respiratory tract and the vault, which is the gut associated lymphoid tissue of the digestive tract, which are very different immunologically.

Yet they’re both mucosal tissues and therefore can respond in the same way and contain very similar cells, particularly mast cells, which can release the mediators that cause allergy. So I think it’s absolutely essential that the integration of these systems is recognized from a scientific point of view.

BD: Absolutely. For listeners, I hope that you’ll return to listen to more from Dr. Joneja regarding food allergies, food intolerance, food reactions, and things like eczema, childhood behaviors. I hope we touch on at some point and other interesting topics and I think that will wrap it up. Thank you so much.

Dr. Joneja: Thank you.

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Transcription by CastingWords.com.

Transparency and Comment: I have no financial or other relationship with CastngWords. CastingWords provided excellent service, for a reasonable price, to transcribe my recordings of interviews. I would recommend them highly, and without reservation.

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