Welcome to the future of food allergy. If you're reading this book, then you're probably affected by food allergy in some way. Or maybe you're simply interested in understanding more about this epidemic gripping the country and, increasingly, the world. Perhaps your baby was just diagnosed with an allergy to nuts or dairy or egg. Maybe you have a child in elementary school confined to the nut-free table in the cafeteria and turning down invitations to birthday parties out of fear that an accidental exposure to wheat or dairy will send him or her to the hospital. Maybe you have friends with food allergy in their family or their own diagnosis. Maybe you are a clinician wishing you had more options for your patients. Or maybe you're a parent anxious about putting your food-allergic child into anyone's care but your own. It could be that you're a teacher with food-allergic children in the classroom. Or maybe you have a teenage family member who seems always on the verge of forgetting to bring their epinephrine when they go out with friends. Or maybe you are the one in your family who has never tasted peanut, the result of arranging your life around avoiding places and foods where your allergen is likely to lurk. Whoever you are, if you are one of the tens of millions of people touched by food allergy in some way or are simply curious about the condition, then this book is for you. This book is here to help. Food allergy is entering a new era. For decades we have grappled with this alarming and perplexing epidemic that has affected an increasing number of children and adults. Yet science has had little to offer to those fated to a life of fear about possible death (albeit very rare) by accidental exposure. That time is over. Gone are the days when avoiding a food at all costs was the only option, when nothing could be done and no one had any clues about treatment. We are also done with the years when claims of food allergy were met with skepticism, ignorance, and dismissal. Both science and the general public now recognize this condition as a serious disease that requires our help. For the past century, food allergy researchers have been forging a new continent. Hard-won understandings about the immune system now form fertile ground that allowed something new to grow: options. Immunotherapy is at the heart of this new world. This powerful technique trains the immune system to stop treating a given food as an enemy. It sets the body back on course by reeducating it, slowly but surely, about the safety of nuts or wheat or eggs or dairy, or whatever other food triggers the dangerous, self-harming reaction known as an allergy attack. Exploring a New Land This book provides an in-depth look at the complete program for preventing, diagnosing, and reversing food allergy. Part One starts with the harrowing numbers showing the dramatic rise of the condition over the past thirty years or so. We unpack the various theories seeking to explain this increase in prevalence, collecting the grains of truth scattered across this field of research. Next we address one of the most pernicious side effects of food allergy: parental guilt. We look at what the science tells us about pregnancy diets, breastfeeding diets, genetic inheritance, and other possible pathways through which food confusion may enter the immune system. With self-blame set aside, we then tackle the kitchen, guiding families on everything they need to know about changes to make at home following an allergy diagnosis-including a clear-eyed walk through the tangled mire of food labeling laws. Part Two delves into the heart of the new era for food allergy. It begins with a look back at how we became so focused on avoidance as the only option. Equipped with the lessons of the past, we then shift to knowledge we now have about preventing food allergy. We make a clean escape from the avoidance myth aided by rigorous research on early introduction. And we offer an evidence-based, practical guide for when and how to add new foods into our diets in order to prevent food allergy. That brings us to immunotherapy. To put it simply: it is now possible to treat and reverse food allergy. The research is still in progress and we are still identifying standard regimens that allergists everywhere can offer in their clinics. But the thousands of patients who now live free from the fear of accidental exposure-many of whom freely eat their former allergens as if they never had a bad reaction to them-are a testament to the power of this program. The new era for food allergy is all about returning control to people's lives. Immunotherapy is one way that happens. We include information to help you decide if immunotherapy is for you, how you can become a study participant or be treated safely in a clinic, and what other cautions you will need to take into consideration as you step into this new era. In short, we equip you with all you need to know about this new treatment. We give you a map of the landscape, tell you how to get around, show you the best sights, and make sure you have a place to stay. But there is so much more to this new moment for food allergy. Research and development pipelines are full of products, from new medications to wearables to (of course) apps. We look at every corner where advances are now under way, with a dose of healthy skepticism. This view of the not-too-distant future is a realistic one, focused on what might truly assist you and recognizing that the money to be made from the food allergy "market"-that is, people living with the condition-is reason for caution. In the final section, we address an aspect of food allergy that has been under-recognized for far too long: the emotional toll. We look at the research showing just how much the condition affects all members of a family, and offer plenty of wisdom, for children and parents, about how to cope. The voices of teenagers and young adults who grew up with food allergy and now live on the other side provide invaluable insights. Finally we consider our part in the future health of the planet. The rise of allergy is not separate from many other dire issues we are confronting. And so the suggestions in the last section are aimed at not only preventing food allergy but also reducing our impact on the earth. The new era of food allergy rests upon the truth that we do not have to accept the status quo. Our choices make a difference. About Your Guides Before we go any further, we want to share our own stories. For both of us, our initial connection to food allergy was personal. But spreading the word that a new time has begun has become a mission. Our goal with this book is to tell you everything we know so that you can make informed decisions for yourself and your family. We'll start with telling you about us. Kari My career in science and medicine has been dedicated to the care of children and adults suffering from food allergy. In the clinic and in the laboratory, I study the immune system and work with collaborators around the world who share the vision of preventing and treating food allergy. My first exposure to the world of allergies arrived as a toddler growing up in New Jersey. My father, a marine biologist, was researching how pollution affected the water and marine life. Part of that work meant studying animal life at the bottom of a river-which meant living on a houseboat. A moldy houseboat. And it turned out that I was terribly allergic. Between that and my bad asthma, I gained an early appreciation of just how much our surroundings can affect our bodies. Working as an emergency medical technician when I was 16-the ambulance was the first car I ever drove-helped me realize I wanted to be a doctor. I joined one of the first freshman classes to include women at Haverford College. Thanks to a scholarship and the excellent teachers there, I had my first glimpse of molecular biology and the profound inner workings of our cells, including the immune cells responsible for allergies. I decided to pursue both research and medical care, earning my MD/PhD at Harvard Medical School through the Medical Scientist Training Program, sponsored by the National Institutes of Health (that program also introduced me to my future husband). One day in 2003, when I was a clinical trainee, my mentor and I were called to the intensive care unit. I was a fellow in asthma, allergy, and immunology by then, learning under Dale Umetsu at Stanford University. I followed Dale to the ICU, where a father approached us in tears. He held a plastic bag containing an epinephrine auto-injector. I could see the needle was bent. "I don't understand," he told us, "I don't understand." But very soon Dale and I understood the matter all too clearly. The father's 9-year-old son had been diagnosed with a milk allergy when he was a toddler. Doctors at the time knew very little about milk allergy, and the family was left with the impression that it would fade. One night, their son accidentally drank from his sister's glass of milk. When allergic symptoms appeared, his family tried the epinephrine, but the dose was sized for a small child. He went into anaphylactic shock and within twelve hours his brain had swelled so much that there was no hope of saving his life. The story didn't end there. The child became a liver donor and the recipient developed a milk allergy. I had little clue about why that would happen and was determined to find out by studying the immune system. And I knew I wanted to do something to stop completely preventable deaths like this one. I could see that researching the mechanisms behind food allergy and finding ways to improve the care of people living with the condition were inseparable aims. For me, they became inseparable dreams. As I delved further into the world of food allergy, parents and patients started approaching me. We met in cafes around the world, where they shared the struggles they had with their children's allergies or their own. As family after family asked if there would ever be a way to do something better for people with food allergy, I resolved to help them. These conversations evolved into extensive involvement with the food allergy community. This community has been invaluable in guiding my work by pointing me toward the most pressing needs and questions. Other allergy centers were having good results with experimental approaches to treating milk, egg and peanut allergy. Within a few years, my team at Stanford was conducting the first-ever clinical trial of immunotherapy combined with the asthma drug omalizumab, which blocks a crucial component in severe reactions, for the treatment of milk allergy. The study included just eleven patients, but the results amazed us. Several patients could tolerate a much higher amount of milk within nine months; for some, the change took just three months. That success was repeated in our next study, this time treating people with more than one food allergy. I met Sloan and her family in 2013 when she approached me about treating her children for their allergies. In the years that followed, we spoke often about finding a way to tell others about the revolutionary transformation happening with food allergy. Her vision, compassion, and sheer drive led us to create this book together. As the research progressed, I was driven to ensure that families and patients would know all they can about preventing and treating food allergy, and so was she-which led to the book you now hold. Sloan I was plunged into the world of food allergy at a restaurant near our home in New York when my son was 2 years old. He started to seem sick and we figured he was coming down with a cold. But when I put him into bed at home, I realized his heart was racing. My husband and I rushed him to the nearest emergency room, and after two days in intensive care, he was diagnosed with asthma. The doctor told us that our son would need to be tested for food allergy because it's so common among children with asthma. When he was diagnosed with peanut allergy, the doctor then suggested that our daughter, who was just 6 months old at the time, be checked, too. She tested positive for tree nut allergy. The experience was entirely new for me. I remembered that the captain of the squash team at my college had died from an allergic reaction to peanuts. But no one in my family had ever encountered a threat like that. My family relocated to California when my children were 4 and 5. Allergy attacks seemed to follow our daughter around the world. Wherever she went, some kind of tree nut residue seemed to find her. We managed to keep peanuts away from my son entirely, but I saw the threat of food allergy up close, again and again, as my daughter grew up. Then one day at a wedding, a couple seated at our table began talking about their own experience with a food-allergic child. "You live near Kari Nadeau," they told us. "Haven't you met her?" I hadn't-and decided to remedy that fact right away. It turned out that the timing was perfect. My son enrolled in a trial investigating a new treatment for peanut allergy and my daughter enrolled in one for tree nut allergy. For the next year, I made the ninety-minute drive to Stanford every week so one child or the other could have their treatment dose increased. It was never easy, but the possibility of overcoming this potentially fatal condition made the challenge worthwhile. And the incredible bedside manner upheld by Kari and her team made us confident that we were in the safest hands possible. Later, when my children had both overcome their allergies and Kari and I had become friends, I encouraged Kari to bring this work to the world. I could see what a brilliant researcher and physician she was, and believed her prodigious gifts deserved a wider audience. By then, Kari knew about my background as a lawyer, a journalist, and author of the bestselling book Green Goes With Everything, a guide for clean and healthy living. She knew that I was just as passionate as she was about broadening environmental awareness, identifying the causes of food allergy, and spreading information about treatment options to as wide an audience as possible. So we joined as coauthors to help families everywhere access the knowledge and feel empowered to steer their own ship. Our vision for the future is simple: the end of food allergy. Excerpted from The End of Food Allergy: The First Program to Prevent and Reverse a 21st Century Epidemic by Kari Nadeau, Sloan Barnett All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
