Hugh Windom, MD: Understanding Food Allergy Rates

Hugh Windom, MD, has a simple strategy to reducing the growing rate of food allergies in the US—focus prevention in the next generation. And the key driver for prevention is allergen exposure.

In an interview with MD Magazine® while at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2019 Annual Meeting in San Francisco, CA, Windom, an allergist/immunologist and professor of medicine at the University of South Florida, explained his practice’s allergen exposure strategy is critical in the role of proper diagnosis, in limitation of patient symptoms, and—eventually—in cutting down the rate of allergies in the coming decades.

MD Mag: How crucial are correct diagnoses and definitions in food allergy patients?

Windom: We do a lot of what we call house-keeping. That's when someone comes in and says, "I'm allergic to this, I want to be treated," and we say, okay, let's clear things up—let's find out what you are allergic to, what you're not allergic to. Some people aren't allergic to anything despite their preconceptions. They come in, and they're done. Other people, we're finding out, okay, it's not the first 3 foods but it is the fourth food.

We also know food allergy can go away. Several foods can: egg, milk, wheat, for instance. Some are more long-lasting through life. Penicillin, after about 10 years, goes away in most people. We test people all the time for penicillin allergy after about 30-40 years, and they're always negative.

We can get rid of some concerns people have by proper testing. Other times, we confuse the matter by doing too much broad testing. That's the problem in primary care and in allergists: we'll test people too broadly, and it'll come up with "false-positive" results that give misleading information, and then we have to straighten that out later.

That's a key part of it—making the right diagnosis before you even start treatment. You wouldn't get surgery without a clear pattern of what needs to be corrected. And we need to be very careful in our diagnosis before we do any treatment.

Do dietary trends in the US indicate the population is developing more food allergies?

The whole development of food allergies is a bigger issue: can we reduce the incidence of food allergies so we don't have to treat them at all? That's also part of this meeting—the earlier induction of food. Pediatricians are becoming very well-informed these days, and they're really encouraging moms and dads to feed their infants everything.

Once this happens for a generation, we'll see a huge drop in food allergies. The problem is we were avoiding foods, and that's where it happened. If the body avoids it, the immune system starts to recognize it as foreign when you finally introduce it, and then you react.

So if everything is friend and not foe early in life, there's not going to be a food allergy. Prevention is the key, but until that generation comes along with a lower rate, we have to deal with those that are already out there—the 5- and 10-years olds that avoided peanut until they were 3, then had a reaction. We deal with them.

So, let's try to treat those who have the allergy, prevent them in the newborns, and then we're moving in the right direction.