Food Allergy and Your Kiddo
If your kiddo has a food allergy, then this is the podcast for you. Join food allergy experts - board-certified allergist Dr. Alice Hoyt, MD, FAAAAI, and food allergy mama Pam Lestage, MBA - as they dive into all things food allergy. Hear interviews with world-renown allergists as well as food allergy advocates and food allergy families, just like yours. This podcast will answer many of your food allergy questions and provide you with strategies to make your life and your family's life ones of LESS STRESS and MORE JOY.
Food Allergy and Your Kiddo
Transforming Food Allergy Management in Children: A Deep Dive into Oral Immunotherapy with Dr. Richard Wasserman
Oral immunotherapy (OIT) has revolutionized the way we manage food allergies in children. Join Dr. Alice Hoyt as she interviews Dr. Richard Wasserman, a true pioneer in this groundbreaking treatment.
Dr. Wasserman shares his journey on how and why he started offering OIT to patients over 15 years ago. Dr. Hoyt and Dr. Wasserman discuss the history of OIT and its similarities to allergy shots. They also emphasize the importance of collaboration among allergists to make life-changing therapies more accessible worldwide.
OIT presents unique challenges across different age groups, and this conversation sheds light on these nuances. With relatable analogies like gym workouts, Dr. Wasserman and I talk through the adjustments necessary to maintain tolerance without overwhelming the patient. From the unique challenges faced by children and teens at different ages to potential family conflicts, this episode offers practical insights for managing food allergies over the long run, helping both the patient and the patient's family feel supported every step of the way.
Dr. Hoyt asks Dr. Wasserman to share his experiences on helping families navigate the myriad challenges that come with OIT, from the impact of illnesses on dosing schedules to the necessity of avoiding certain activities post-dosing. Dr. Wasserman shares his thoughts on the FDA-approved peanut allergy product and shares about his team's efforts to ease the journey of peanut OIT for kids. Concluding on a high note, Drs. Hoyt and Wasserman celebrate the immense relief and joy that OIT brings to many families, many times enabling children to safely consume previously dangerous allergens. Don't miss this opportunity to hear from a true trailblazer in the field of food allergy management!
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This podcast is the official podcast of the Hoyt Institute of Food Allergy. Information on, within, and associated with this site and Food Allergy and Your Kiddo is for educational purposes only and is not medical advice.
Hello and welcome to Food Allergy and your Kiddo. I am your host, dr Alice Hoyt, over the moon, super excited to be joined today by Dr Richard Wasserman. For those of you who have ever looked up OIT or wondered about oral immunotherapy, chances are you have come across Dr Wasserman. Dr Wasserman is one of the pioneers who has taken OIT and made it what it is today, which is significantly more accessible to families, not just across the country but literally across the globe. Dr Wasserman's academic accolades are outstanding. He is board certified in allergy and immunology and in pediatrics. His medical degree is from Mount Sinai, also UT Southwestern. He did pediatrics residency at Children's Hospital of Philadelphia, fellowship training bone marrow transplant immunology at Children's Hospital of Philadelphia, postdoctoral cancer immunology University of Texas, southwestern and immunology rheumatology, rockefeller University. He has a PhD in biomedical sciences from University of New York, mount Sinai. I mean um? And then when you go to PubMed and look for Wasserman, see he's so popular, someone's calling him right now because of his expertise and his brilliance. That's totally fine. Oh my gosh.
Speaker 1:Um, I'm not surprised someone's calling you and it's probably somebody calling you with an OIT question because you have really made this amazing therapy that helps kids and adults be significantly less allergic to foods much more available to these tens of thousands, hundreds of thousands, arguably millions of patients. So thank you very much for joining us today to really talk about oral immunotherapy.
Speaker 2:Thank you very much for having me. It's a pleasure to be speaking to you this afternoon and I just have to react to your introduction by saying that I've been in medicine for a very long time and when I grew up in medicine, doctors were not interested in patents and startups. They were interested in sharing what they knew for the betterment of the medical profession and patients, and that has been my North Star in my practice and the activities that I've been involved with, particularly in food allergy treatment.
Speaker 1:And that really shines through, through not just your words but literally your actions. And that's a lot of what we'll talk about in the interview, about in the interview. But just to sort of dive right in, what is oral immunotherapy For our listener who is tuning in maybe for the first or second time and say, hey, I've heard that name Wasserman before. Something about OIT. How do you introduce OIT?
Speaker 2:is one of the ways of retraining the body's allergy system so that a food in this situation, a food that causes a problem becomes acceptable to the child or adult with food allergy, and it's one of several therapies that lead to what's referred to as desensitization, which just means reducing the sensitivity level that people have to their allergenic food, and it's really very similar to allergy shots.
Speaker 2:It's, in fact, it's about as old as allergy shots.
Speaker 2:Allergy shots are almost 120 years old and the first reports of food therapy date back to early in the last century, but it's kind of lost to history for a while. There was a report in 1935 in a major allergy journal, but nobody appeared to really produce it. And when I met Dr Lyndon Mansfield from El Paso, who I had known before at a meeting almost 20 years ago, and he told me that he had treated a couple of peanut-allergic patients with oral immunotherapy and that it had worked out well, I was somewhat startled and just very enthusiastic. He was generous and shared his protocols with me, and I spent about two years reviewing the field and the available literature and then we started in the summer of 2008 with our first treatment of patients with egg and milk allergy, which is kind of interesting in retrospect, because I chose milk and egg because I was afraid of peanut and it turns out that for most people peanut's a lot easier than milk and egg. So we've learned a lot in the past 15 plus years.
Speaker 1:Oh, that's amazing. That's amazing, that's amazing and that really speaks to, in part, the culture of allergists and the culture of what medicine I believe needs to be, which is allergists talking to each other and learning from each other and sharing with each other what works, what doesn't work, what experience they've had. Absolutely, we lean into journals and and big studies and that is absolute. Those are absolutely important. But there's also so much wisdom in talking to others and talking to those who have come before us and have experiences that aren't necessarily documented or maybe it's a few case reports here or there to really continue to move the field forward and in a way that is you know, I keep using the word accessible but is accessible to families so many times when something goes through a big clinical research trial and clinical research trials are incredibly important and they validate and it's just incredibly important. Trials are incredibly important and they validate and it's just incredibly important, but sometimes, as you know, it can take 10 plus years for those findings to really get implemented into practice. But in this day and age, when we can continue to have conversations and share just like we do with the OIT advisors listserv sharing cases, tough cases, what worked, what hasn't worked. It's so helpful. And it's helpful especially I will say personally and talk a lot about myself on this podcast, but I would say from a professional standpoint in my practice I love being able to talk, to hear your opinions on clinical cases through our email list server. We have hundreds of allergists in the trenches with oral immunotherapy, sublingual immunotherapy, complex difficult food allergy. But because we're able to talk to each other and learn from each other and kind of you know, you hit the nail on the head with how you kind of spoke about what I call your spirit of sharing information and that that's what medicine needs to be about. You know I mean God bless you Because of all before we came on. What I told you is because of the work you have done. You have allowed me and other allergists like me to offer more therapies to patients and it's amazing. It's amazing and you know I love that you talked to him about the history of oral immunotherapy and that it's amazing. It's amazing and you know I love that that you talked some about the history of oral immunotherapy and that it's it's it's not necessarily this super new novel concept that it really is very similar to allergy shots that we have been doing for a very long time that we know work. We know that if you slowly introduce an allergen to the system, that over time it will teach the immune system in many cases to become more tolerant to it. So that's amazing that that's how you started it.
Speaker 1:Tell me a little bit more about sort of the first time in your practice. And were you in private practice then? Yes, nice. And were you in private practice then, yes, nice. And so you had a little bit more control over how your practice integrated new service lines. I would say is a nice diplomatic way to talk about trying new things. And how did the families respond?
Speaker 2:Well, there was pent-up demand. Well, there was pent-up demand. People were looking for solutions and you know I knew the first and that was about 1,200 patients ago. So there's been a lot, a lot has gone on.
Speaker 2:And your point about experience and taking advantage of that I think it's important for people to understand that doctors shouldn't go down the garden path based on one experience, but they need to be aware of their experience and we collected our experience.
Speaker 2:We have a spreadsheet of 120 columns and now 1,200 rows of all the patients we've ever treated and, even though they weren't formal controlled trials, when you analyze that information you can learn important things and one of the differences between thoughtful clinical practice and a research trial In a research trial, the trial is designed to answer specific questions that are laid out in advance in a very rigid way and participation in that trial is very rigid. There's not flexibility of dosing or timing or other things in order to get the purest answer to the question. But we embarked on treatment and in treatment you learn from your patients in what we do over the years, by paying attention to our patients and learning from them and using that collected experience to then apply that to the next round of patients and hopefully get an easier treatment with fewer side effects and better outcomes.
Speaker 1:That's amazing. I mean, that's what I think patients hope we're always doing is being mindful and very thoughtful and specifically especially if it's a little kiddo that we are thinking about that particular child specifically and trying to apply the best possible evidence and experience that we have to make that child's treatment plan the best treatment plan for that child.
Speaker 2:Data is crucially important, but you and I take care of patients one at a time, and it's the other person in the examining room who is the focus of everything that came before that person and applying that knowledge.
Speaker 1:Oh my gosh, that's so good. So it sounds like in the beginning it was fairly well received understatement. People wanted it, of course. Even to this day I have patients coming in saying there has to be more than just carry an EpiPen. There has to be more, there has to be more. And I say, well, yes, there is more. And then we talk about things. So what are some of the biggest, I would say, misconceptions when a family first comes in and they've heard something about OIT, but what are some of the biggest misconceptions that you hear from families?
Speaker 2:I think the big misconceptions are that it is a relatively short-term treatment. So there's a lot of data about allergy shots that says, after an appropriate course of allergy shots that last three to five years, you can stop the shots and the progress you've made is enduring.
Speaker 2:We don't have that kind of data for OIT In fact the best evidence because I see it at this point says that at some level people who are successful in OIT need to continue eating that food on a regular basis, not necessarily every day, but indefinitely.
Speaker 2:And so I think, even though we make a big deal of the fact that there needs to be indefinite dosing, when people reach certain milestones along the way in their treatment.
Speaker 2:People reach certain milestones along the way in their treatment they're inclined to think that, to say, well, now I'm cured and I don't have to think about it and it's really. For at least at this point, it's not correct to say that any kind of food therapy is a cure, and food therapy can bring a patient into a remission and the remission can last a very long time without any problem. So if someone is treated for peanut or milk or egg or something more exotic and is treated successfully and maintains their treatment for a period of time and gradually has a decreasing need for regular dosing, we still hold them on dosing no less than once a week indefinitely to maintain that remission. And I think, even though we talk about that in the beginning and the middle and further on, it's still kind of a surprise to many families that it's indefinite Now. In the past several years, others and we have started treating very young children.
Speaker 2:In our first several hundred OIT patients we limited the lower age to four years, but then there were reports of success with younger children and now we will start as young as six months and now we will start as young as six months and some of those very young children who just had one reaction that was not a bad reaction and whose tests are very weakly positive, we may challenge them to be sure that they actually have a reaction and then we treat them and their allergic antibody disappears Some of them. They go to zero, and exactly what's going to happen with those children over time is unclear. They may in fact have a cure. Fortunately, there's really good research being done looking at more detailed and specific tests that will tell us exactly what's going on.
Speaker 2:Right now we don't know for sure whether a treated patient is the same as one who has outgrown their food allergy. Is the same as one who has outgrown their food allergy? So somebody who was allergic to milk at age three and is now age eight and passes the milk challenge and is no longer allergic, is that the same person allergically as somebody who started OIT at age three and has been drinking milk without thinking about it since age four or five at age eight? Are they the same? We don't know that yet, but I think that there are studies in progress and very interesting translational research that's looking at studies that are not used in clinic lab tests that are really not available generally to you and me? That may answer that question. I think that's one of the, perhaps one of the next revolutions that will come down the line.
Speaker 1:That will be very nice. Yeah, I look forward to that. What do you tell patients regarding after they go through buildup and they're on maintenance and then they have that negative ingestion challenge so say they're eating half a teaspoon of peanut butter for their maintenance and then they do a full two tablespoon challenge and they started when they were a couple of years old I talk about. Now you're in tolerance preservation phase and we have to balance out how much peanut you need to eat to keep that tolerance that you've built. Kind of like you go to the gym and you've built up where you want to be. Well, you can't be that gazelle intense forever, right? So you're going to kind of step back from the gym but you still want to preserve the great progress that you've made and the immune system is similar, right? So what are you seeing clinically in patients when they're young, or maybe when they're in that kindergarten third grade age, when they start OIT?
Speaker 1:Some of the differences between the early childhood and the mid-childhood and even teens for when they start and then what really does after maintenance look like for them Are a lot of them getting into, kind of leaving it in the rearview mirror? I know like in my practice. A lot of the younger kids like it's super exciting, right? Working with the younger kids is awesome because we do see some really promising signs that this is something they're not going to have to worry about at high school graduation. So talk a little bit more about what sort of anticipatory guidance you give families on what to expect after maintenance. Like, are they going to be drinking milk every day and going for a run, but still making sure that they're doing something at least once a week? What's sort of your guidance? But still making sure that they're doing something at least once a week? What's?
Speaker 2:sort of your guidance. Well, I'm going to put the exercise issue on the side for a minute. Sure, To focus on the other part of your question. It depends on the nature of the food, For what I would refer to as staple foods basically milk, egg and wheat, or in some cultures it may be soybeans or chickpeas or even cashew nuts. That are a part of some diets where there's going to be a routine, frequent exposure. A fair number of our patients rely on their routine daily consumption for their maintenance dosing at some point.
Speaker 1:And do you still have them have? I'm sorry to interrupt you do you still have? Them eat that within a safety window or over time? Do you allow that guardrail to come down?
Speaker 2:Well, some patients just take it down and tell me later. You know I hate making people sick and I hate reactions, and so I, and when we started, there was a lot more unknown and just a great unknown. A lot more unknown and just a great unknown, and all of us who were involved in OIT were really nervous about the risk of a severe reaction or got committed death, and so we use very high doses for maintenance. What we know now is that the doses that we use for maintenance are probably higher than they need to be, and we're working on reducing maintenance doses and frequency. When we started, we demanded that people dose seven days a week for a minimum of three years, and we've modified that considerably over time and we're still learning.
Speaker 2:These are kinds of questions that are answered by collective experience. Nobody's going to do a research trial comparing three years of six out of seven days a week dosing with one year of six out of seven and two years of four out of seven. Nobody's ever going to do that study Right. Four out of seven Nobody's ever going to do that study Right. And so you just need to pay attention to what patients tell you and put together that experience and in a conversation with families, explain. You know, the data is clear that the higher your daily dose and the more you give, the bigger. The more frequently you give it, the bigger the impact on your allergy testing. There's no question about that. But how much of it is overkill, you know? If you know that you can give somebody 40 peanuts a day for five years and their desensitization is likely to last six months, is that really meaningful and valuable Right? Wouldn't it be easier to have them eat four peanuts a day? Right, four days a week or two days a week and go from there?
Speaker 1:Especially depending on their age.
Speaker 2:Yes, and some families would opt for the higher, more frequent doses. I have families who don't want to cut back at all because they're nervous about that. But you know, when you start it makes a big difference. So the very young, infants and toddlers there's much less problem with getting them to take the dose and the food. It's unusual to have an infant or a toddler refuse a dose or make it hard, whereas in the 6 to 12 age group it's food aversion and resistance to dosing is a much more common problem. They get bored with the dose, even if it's not that they dislike the food. They get bored with having to do it every day and that's very understandable.
Speaker 2:For teenagers it's a whole other issue, especially because most teenagers have gotten used to avoiding their food by that time. And there's often a mismatch between the parent and the child, and the parent wants to do OIT and the child at best has no interest and often has an active interest in not doing it. And so one of the things we had talked about is who's a good candidate and who's not a good candidate, and I would say that children over the age of 10 or 12 have to really be committed to wanting to do it and we have some kids who are really committed and want to do it. But if I don't get that vibe, I will kind of stop the OIT conversation and say you know, we really can't go any further unless your child is really motivated to want to do this. You're going to have enough opportunities to fight with your teenager without giving you another one, and I definitely don't want to make conflict in your household for the next six years.
Speaker 2:And a common response to that is well, I'm worried about what happens when they go to college, and my answer to that is you only have the illusion of control.
Speaker 2:Now, when they start driving, or certainly when they go to college, the illusion will be gone and, regardless of what you say, they're going to do what they want to do, and so I'm completely satisfied. If a four-, five-, six-year-old does OIT and has a normal life and then, at age 16, decides they want to stop dosing Not my recommendation recommendation but if that child has had 10 years of going to birthday parties and eating the cupcakes and everything at school and not having to sit at the peanut table and is able to go to sleepovers and then, at age 16, decides they don't want to dose anymore, I can live with that, and we talk about strategies for college for those kids who want to continue their OIT dosing. Hopefully we get them to once a week by then, which gives them a lot of flexibility, because the safe dosing rules, which I'm sure you tell everybody about we all do are really important and they stay important, could you?
Speaker 1:talk a little bit about that now, about safe dosing rules. Yeah, even when they go to college they're still important.
Speaker 2:So we know there are some things that increase the risk of a reaction. The most straightforward of them are sickness Viral infection is the biggest but infections in general that stress the body. So when a child gets sick we'll cut their dose in half for several days until they get better and then we gradually go back up. Some practitioners stop dosing when they're sick. We haven't found a need to do that. We just cut the dose in half and that works pretty well. The other big factor is physical activity, and for most children vigorous aerobic physical activity within two hours of dosing is a significant risk for reaction.
Speaker 2:There is the rare and I emphasize rare child who needs a three or four-hour window after dosing. That happens but it's very rare. So you want to do that. And that thing that a lot of families have trouble remembering is that dosing after 8 o'clock at night increases the risk of a reaction. So you're better off skipping that day's dose. If the family's been out, you can't dose until 9 or 10 at night. You're better off skipping that day. That's what we recommend.
Speaker 1:Can you talk a little bit about why that is?
Speaker 2:Well, all people make steroids inside their body and the production of steroids in the body is circadian. That means it follows a 24-hour clock and the low point of steroid production is 2 am. And so you don't want things happening when the body's own production of steroids is low, so we want them to dose well before that. I think that's what creates that risk.
Speaker 2:Forget is that there's actually published studies that report that sleep deprivation and tiredness being overtired are both risks for reaction. So if you've been at Six Flags or Disney World from eight in the morning to 6 at night and your child can barely stay awake for dinner, you're probably better off skipping that night's dose. Just skip the dose. Yes, right. So those are the important ones and those can apply in college, where hours are irregular and late nights are common and being overtired is common. That's why we try hard to get to a once a week dose, so the child can a college student can figure out a time that's going to work for them, where they can do their once a week dose and obey the safe dose rules.
Speaker 1:And otherwise those college kids are avoiding their allergen.
Speaker 2:Yes, yes, which is okay, you know. Food allergy is not that rare in adults either. Right, and they adapt to it. Mm-hmm, yes, and one student is almost an adult.
Speaker 1:Touche right, right. Um, who we've talked somewhat about, who is and who's not typically kind of like a good candidate and not great candidate. Um, what are some of the challenges that parents or kiddos kind of unexpectedly come up against? Like cause, cause you kind of talked, talked about it, how in the beginning they're kind of thinking about one thing and really just they want their child to not be like so allergic anymore that they can't even. You know, we know from an evidence-based standpoint that even if you're very severely allergic to a peanut, you can still be in the room with a peanut and not have a reaction. But they want to feel that level of comfort. They want to be able to see their child actually eating the allergen and not have a reaction. So I guess what are some of the challenges that kind of pop up along the way that you see in your experience that maybe they weren't expecting?
Speaker 2:OIT is a demanding therapy. There is a significant burden of care. So in everything we do we need to balance the burden of disease with the burden of care. And there's a big burden of food allergy at many levels and I don't think we have time to talk about all of those burdens today, but it is important for people to understand there is a burden of care During the time when you're doing up dosing or starting the process.
Speaker 2:There are office visits every week or every other week, depending upon your allergist's approach, and so that's a pretty demanding thing. There's daily dosing and fitting that into the schedule, which gets harder and harder as the child gets older. You know there are so many middle school kids who are playing three sports at a time, not just three sports a year, and you know they're getting up at four o'clock in the morning for ice skating or ice hockey and then they're playing soccer in the afternoon and taekwondo at night. So it's really hard to fit dosing into that kind of a schedule Right. So I think those are two big elements of the burden of care. And then, especially the older children, some of them develop a distaste. I don't know what your experience has been. I think it's roughly for peanut, for example. Roughly a third can't stand it, a third are indifferent to it and a third run right out and get a payday candy bar as soon as they're able.
Speaker 1:Yeah, I think that's about right. That seems about right.
Speaker 2:And even when the food does not give the patient a bad taste, it's boring. It's boring to have to eat the same thing every time, and that's why I try to encourage parents to mix it up a little bit. Food coloring, food flavors, different forms, and we go out of our way to generate lists of alternative foods that can be substituted for people, so I think that helps.
Speaker 1:No, absolutely. I was telling someone the other day one of the things I love about my practice is that children come into my office and eat snacks and that's what I do 80% of my day and I love it, right, Because they're happy, their families are happy. And then when you check those labs and they're just going down, it's amazing. And when you see a child who has had a reaction to even like the smallest amount of peanut butter or whatever it is, and then you're doing your buildup and then you're beyond, you're at the dose that caused the reaction and they do great with it, and then they're beyond the dose. And then you start to see the families.
Speaker 1:Um, we use the, so the sofa, the survey of food allergy anxiety, to help kind of guide us on very specific things. We can set goals with our families with, like, going out to restaurants, things like that. So then you see families not just saying that they feel more comfortable, but but, but walking that walk of being more comfortable and yeah, they're still like doing their due diligence when they go out to dinner and talking to the wait staff and the chef and you know all the things. But they're doing it now and you see them their lives opening up, and it's it's such a blessing to be a part of that.
Speaker 2:Yes, yes, I would have to say that the incidents that have impacted me most have been the crying moms, been the crying moms, the moms who bring their senior in high school, who did OIT a number of years ago, and they, through tearful eyes, say I never would have been able to let my child go off to college. Thank you, dr Wasserman.
Speaker 1:That gets me most. Oh my gosh, that's beautiful, that's amazing. That's amazing and I mean God bless you for the work you did starting back in 2008 and use your physician mind to recognize this process should work. This makes sense. There's evidence for it in different areas not nearly as much as we have now and here's a trusted colleague who has had experience and good experience with it. And let's be mindful and let's give these patients the chance to build tolerance. That's amazing. That's amazing. So you know, we talked about some of the difficulties with OIT and we also talked about some of the success stories. I think one of the big questions that patients have early on is about well, what about FDA approval? So what do you talk about, or how do you discuss FDA approval when families ask about that?
Speaker 2:I have to admit that I am virtually never asked. Really.
Speaker 2:Yes, I may have been asked a couple of times, but I am unenthusiastic about the medical medicalization of a food. Yes, and this is a problem with food and let's treat a food problem with a food and in terms of FDA approval. So it's something that people, many people, don't understand and many doctors don't understand. The FDA does not approve therapies or disapprove of therapies. The FDA approves or disapproves individual drugs and devices, proves individual drugs and devices, and in order to prove a drug, the manufacturer of the drug needs to prove that the food is safe and effective. Doesn't mean that's the only way to treat the problem and it doesn't even mean that it's the best way to treat the problem. All it means is that the study that was designed to test the drug or, in this case, of food, the outcome, the predetermined outcome, was met and the FDA grants that approval and so that gets the label of FDA approval.
Speaker 2:My own feeling about the FDA-approved peanut product is that there is no good data supporting the underlying concept, no good data supporting the underlying concept and that's a somewhat technical discussion, but the basis of that product.
Speaker 2:So in order to be commercially viable, it had to be patentable, and in order to patent it, they had to say they were doing something to the peanut powder that made it different from off-the-shelf peanut powder.
Speaker 2:So they measured the components of the different proteins in peanut and there are more than half a dozen and they made this product that had a controlled amount of different proteins. But there is no data that that's clinically relevant, that it makes a difference to patients, and so I'm unenthusiastic about that. And in fact the way their study was done did not reflect the best information available. And so the rate of reactions. If you follow the package insert for that product with the dose increments that are recommended, you have a higher reaction rate than we do when we're using a different regimen based on experience. So there are those kinds of problems. So I have never used that product and in our practice of more than 1,200 patients, about half of whom are peanut patients, we've never used the FDA-approved product. Plus, I can treat 400 patients for $16 worth of peanut butter powder and I think that the FDA-approved product is a little bit more expensive than that.
Speaker 1:Yes, likely. So yes, Before we leave that general subject.
Speaker 2:I want to tease your audience with a new development that I talked about before we came on. We talked about an annual meeting that we have, and I've been a consultant to a company that has developed a peanut powder with virtually no taste.
Speaker 1:Nice, very nice.
Speaker 2:If you taste the powder with nothing else, you get a vague hint of peanut, but if you mix it with a small amount of chocolate pudding you can't tell that it's there.
Speaker 1:Oh, that's awesome.
Speaker 2:And that's going to be really helpful to many kids who develop diversion to peanut and I'm hoping that that'll be available in the US early next year.
Speaker 1:I was going to ask about when do you think it'll be available? That's awesome. That's awesome. Yeah, down here we have hurricanes, and so the concept of a family having to rely on getting a drug from a mail order pharmacy or coming to my office, or when you could just go to Walmart and get peanut butter, um, or now even PB two, is like available in so many places. It just makes so much more sense. It just makes so much more sense, and I know that when a peanut butter tasting less powder is available, that will make a lot of mobs. I would say especially in that 8-, 9 10-year-olds and definitely any of the teens doing OIT because that has absolutely been my experience too is like the taste and the smell. There's just significant aversion and some of it, I do wonder, is clearly, is clearly like immune protection. It's a way for their body to say hey, don't you know, this is not great for you.
Speaker 1:But, also right, so like, and there'll never be a study that shows it but also there's such a strong connection with smell in our minds and in in that age group and you're you're a trained pediatrician.
Speaker 1:Like pediatrician, you know that there's developmental stages and when kids start to realize their own mortality and they've been told, especially now with social media and especially how much we as moms can, can sometimes put our anxiety on our kids is that, oh well, this is something that could kill me. You know, and and we talked a little bit before before we started recording about food allergy, informed therapy and and how social media can significantly sensationalize some of this and the importance of talking with your allergist when you have a question Um, but absolutely that that sounds like a great product and we'll have to have you cut back when that comes on comes out to market, be happy to.
Speaker 1:I think you know I want to talk for 25 minutes. I think we're beyond that. I could talk to you for hours. God bless you for the work you do and fastoitorg, where I mean you've just done so much work to make sure that other allergists are able to have the information to help provide these just life-altering therapies to families, not just here and not just in Texas, where you are not just in the US, but literally across the globe. So, dr Richard Wasserman, thank you so much.
Speaker 2:Thank you for the opportunity to chat with you. It's been a delightful experience and your listeners and viewers are privileged to be able to hear what you have to say.
Speaker 3:Oh, thank you. Thanks so much for tuning in. Remember I'm an allergist, but I'm not your allergist. So talk with your allergist about what you learned today, like subscribe, share this with your friends and go to foodallergyandyourkiddocom, where you can join our newsletter. God bless you and God bless your family.