An Interview at the Food Allergy Institute in Southern California

The Allergy Chef at the Food Allergy Institute in Southern California

Today I’m sharing an interview I had the pleasure of conducting at the Food Allergy Institute in southern California. If you don’t know about their groundbreaking program, buckle up. You’re about to learn what sets them apart, their success rate, and a whole lot more.

Now, as always, I have to preface this info. NO TWO PEOPLE ARE THE SAME. What works for one won’t work for others. There are absolutely pros and cons to any OIT or TIP type of program. Where my own personal journey is concerned, the child who would benefit from TIP doesn’t want to try it. And for me? No thank you.

However, I’ll say this too: if I were a child who could not give fully informed consent, AND had a parent that wanted OIT, I’d prefer they put me in a program like the one at the Food Allergy Institute in SoCal. From what I gathered at my time in the Food Allergy Institute, the team is beyond caring. They don’t push past your boundaries, they make sure everything is medically sound, and they seem pretty transparent. These are all critical qualities when managing a complex case like myself.

For those who are wanting to travel down a more holistic path that incorporates the rebuilding of gut health et al., OIT and TIP may not be the best option yet. I’d suggest picking a path and exploring it completely, rather than mixing many modalities that may end up conflicting with one another.

My Interview with a Doctor at the Food Allergy Institute

Kathlena: So I have a list of questions we’ll be working through, many of which are from followers online. I’m Kathlena the allergy chef and I’m here with…

Food Allergy Institute Provider (FAI): I’m one of the physicians at the Food Allergy Institute.

Kathlena: How long have you worked here?

FAI: I’ve worked here since probably February, so almost three years. February 2020

Kathlena: Do you have any food allergies, do you manage someone with food allergies. What is your connection with food allergies?

FAI: My connection is my daughter has food allergies. Yeah.

Kathlena: Cool. Alright. So first official question is, what is OIT, and what is TIP and what is the difference between them?

FAI: So OIT stands for Oral Immuno Therapy. And then you have TIP which stands for the Tolerance Induction Program. I think the big difference between OIT and TIP is both the treatment as well as the end results. So with OIT usually you’re focusing on a certain allergen and on building up a tolerance to the proteins in an allergen to hopefully desensitize a patient. And the end goal is to maintain a certain amount of that protein, usually on a daily basis to keep that patient clear from cross contamination.

Versus Tolerance Induction Program is something we’re using a lot of different data points looking at the immune system. It’s very heavily data driven to create an individualized plan for every patient that comes in to tailor an approach to decrease reaction rates to make sure their patient journey is smooth safe as possible. And then the end result is actually not desensitization but building a tolerance. Which tolerance we define that as a sustained unresponsiveness. So being able to eat a large amount of what you’re allergic to infrequently and not having any reactions. And so kids, patients at the end of the program are freely eating so they are eating a certain amount. You know, maybe weekly or even once a month but in between they are eating as much as they want without having to worry about any reactions. So it’s definitely clear from cross reactions basically being able to freely eat.

Kathlena: With TIP are there maintenance doses that still need to be adhered to like with OIT?

FAI: Yes, so unfortunately there’s no cure for food allergies.

Kathlena: Correct.

FAI: So there’s still going to be some type of exposure, but instead of every single day which would make it very difficult to maintain, the first goal is like once a week and then ultimately the kids are eating it just once a month.

Kathlena: Ok, cool, cool.

FAI: Yeah, which is much, much more doable. I know there are usually questions compliance like how do you comply and how do you keep up with that, I think because we’re so technologically driven, we’re trying to develop and app, and help all of our kids who are in you know, high school and college and working now to better assist them with reminders like, hey did you have your maintenance food and hey don’t forget to do this and  the goal actually is to continue to interact with the patients and provide support if they need it. Recipes, you know, basically to be able to interact with them into remission. So you’re not like hey you’re in remission, just go. We still want you to do well. We want you to be able to freely eat, so yeah. It’s a lot of continuity.

Kathlena: That’s awesome. Ok, one person asks, what are the risks of this specific program. So not OIT, but TIP specifically.

FAI: Risk, I feel like probably what the questions going is going for is like reaction risks.

Kathlena: So part of what drives this sort of question and I think pretty much, and I think you’ve had this sort of question as a parent, we’ve all seen the stories where someone does OIT, they gain tolerance then wake up one day and tolerance is lost even with doing the maintenance religiously. So then people start to wonder, well then what is the risk? Because you and I both know there is no cure.

FAI: Yeah.

Kathlena: So what could a patient here expect to see. Because here’s the thing. I know you guys have a very high success rate specifically here. And it has to do with the data points and it has to do with the fact that you’re taking people through these very interesting ladders. Some of which you know you look at it from a 3rd party perspective and you’re like, that makes no sense. But it does when we look at the molecular structure of these things you guys are way ahead of the curve.

FAI: Y.eah

Kathlena: So what kind of risks can a person plan for?

FAI: Yeah, so it’s not common, but patients can have some symptoms like stomachaches, some can hives. I feel most often the case is when you’re not being compliant whether it’s because kids have crazy schedules or it is just hard to eat the foods during treatment every day. So for a lot of kids it’s who are just unable to stay compliant with the program than the risk of reactions and symptoms definitely does go up.

To your point of if they stopped while in remission and then will they have anaphylaxis. Yes, if a patient once they’re in remission stopped eating their proteins for I don’t know, six months to a year would they lost their tolerance? I don’t know, but it’s possible. We do have some kids that you know their lives are so busy that they have fallen off where we are able to get them back on track and look at the immune system to see you know, do we need to start at the beginning from the middle can we just pick you up from where they left off? Because our goal is to really support our patients and we know that it’s a lot of work it’s a lot of time, it’s a lot of dedication, commitment. So to have them go through the program and then not be able to continue it is a shame from our perspective too so we want to support our families in any way that we can. So if that’s picking them up while they are in remission, we’ll always be there for them.

Kathlena: That’s awesome. I’d take it, It’s important to note, is it safe to say you have a full medical staff for them?

FAI: Yeah.

Kathlena: People can rest assured you’re not just going to some random place and eating food. It’s like no, no. If something bad happens, you guys are already ready for it.

FAI: Yeah. We have a whole team of physicians and as well as providers nurse practitioners and nursing assistants. We have a whole call center built up where there’s support 24/7. Because we have patients from all over California and throughout the rest of the United States and even internationally, it really is 24/7. No matter where you are if something were to happen and you were to call you’d get connected immediately. So there’s always support 24/7.

Kathlena: That’s awesome. One person asks why and they specifically asked about OIT because I think it’s different for you guys, but why is OIT offered for some foods but not others.

FAI: So I can’t speak to like I guess OIT I mean I feel like allergist and their OIT program I feel like it depends on the comfort level of the allergist. I will hear from patients “oh my allergist will only deal with one food allergy but my child is allergic to peanut, milk, egg, tree nut, seeds”, and so it’s because of their provider, that their provider isn’t willing to take on multiple allergens. I do know that there are some providers that will take on more complex cases. For us, we will take everything.

Kathlena: For real? So if I were a kid, me specifically, if I was a kid, you’d have taken me specifically?

FAI: So we’d look at your data and yeah…

Kathlena: Do you think I’d have qualified?

FAI: If you have a risk or you have a history of food anaphylaxis then we would treat you.

Kathlena: Really?

FAI: Yeah, we have kids who are allergic to many, many, many things…

Kathlena: I’ve got more than 200 food intolerances combined, can’t drink most water, contact, airborne allergic. You’re confident you could have treated a kid like me?

FAI: I’d have to defer Dr. Randhawa, but we do very complex cases.

Kathlena: That’s actually really exciting because for a lot of people in my boat, well at least the kids. Because there are a lot of people who find me and are like, wow, my kid is just like you. And of course it breaks my heart because I’m like, yeah, I don’t want your kid to be like me, that’s just a hard life. You know?

FAI: Yeah.

Kathlena: And of course, our management is simply avoidance, right?

FAI: Yes.

Kathlena: It’s making everything at home and jumping through all the hoops but I’m sure there’s some parents who will read this and see this and think, there might be an option here for us.

FAI: Yeah, and that’s why I feel like we find a lot of more complex cases and a lot of our patients are more complex because they’ve been trying to find a provider who will help them. But because of their case it’s just too much.

Kathlena: And what’s the time frame. Let’s give readers a general idea. If someone like me, or at least a child like me…

FAI: Yes.

Kathlena: And came to you at let’s say age 10, ok? What’s the timeline in general. Give me a rough idea. Is it going to be 5 years of treatment? 1 year?

FAI: It’s hard to say, it’s hard to, the reason for that is because it is based off the immune system and all of those data points that we’re looking at and so a child starting at 2 years old versus 10 years old versus 13 all that it’s going to differ, a child, depending on their allergies will differ, too. A kid who’s peanut allergic might take a couple years versus another kid who’s allergic to peanut and hazelnut could take the same number of years or different. It just depends.

Kathlena: So people should plan to get to know you for a couple of years then. Just in like, a general rule of thumb.

FAI: Probably.

Kathlena: I don’t want anyone to read this and think, oh, you know, we’re going to be free eating in six months. You know.

FAI: Correct.

Kathlena: I want to give people a real idea like plan for two years, three years kind of thing.

FAI: We are really changing the immune system to build that tolerance. So if we could do that overnight it’d be great but unfortunately it takes time. And it is very patient specific. So two kids coming in with the same allergy may take different…

Kathlena: You’re preaching to the choir. I’m always telling people that no two people are the same.

FAI: Yeah.

Kathlena: So let’s ask this question, because immunity is more than, it’s such a nuanced thing. Do you guys also enlist other modalities like fermented foods, building gut health, doing anything else or do you guys strictly stick to we’re going to stick to here’s our path, eat these foods and build that tolerance.

FAI: Yeah.

Kathlena: I mean do you guys do other things with immune building? Is it a bad thing to combine the two techniques compared to someone who might be getting into this?

FAI: We stick mostly related to the food allergies and the proteins. We haven’t I guess collaborated or worked with other modalities only because we just don’t know how it will affect the immune system.

Kathlena: Well that’s why I was asking because I was thinking, gee, I wonder if they’ve already started to figure this out because, and then I mean you look at other things like fecal matter transplant.

FAI: Yeah.

Kathlena: You know which is ground breaking, super cool, you know you look at all these different options and it’s just, you know. Because the immune system is just so…

FAI: Complex.

Kathlena: Right? You took the word right out of my mouth. So it’s still, it’s amazing what you guys are doing.

FAI: So right now I don’t have an answer for you.

Kathlena: No, no, that’s ok. But I’m happy that you’re willing to say that in a sense of, that’s what I’m always saying, I’m always telling people like, I don’t know. Nobody knows. All we can do is know you and do you and you’re the expert in you and it’s either going to work or it’s not.

FAI: Yeah.

Kathlena: And don’t go, don’t get upset if it didn’t work. Don’t go, oh this doesn’t work. It just didn’t work for you, you know.

FAI: Yeah.

Kathlena: Ok, so someone’s wondering, how successful are these treatment programs? And they asked about both OIT and TIP.

FAI: For that I can’t answer specifically to OIT because I don’t do OIT. For TIP I know our CEO/founder, Dr. Randhawa, says it’s a 99% success rate and I will tell you that for families that are willing to stick with us. We will get them to the end. The most complex cases , patients that are hitting some hurdles and if we need to trouble shoot, we will we will get them to the end. So yeah, we have really, I guess I keep saying we have complex cases. Patients will really elevated values or high IgE values that no other allergist would touch. And I’m working with them in remission and they’re doing great.

Kathlena: You guys should be so proud of that, because not everyone is willing to touch that.

FAI: Exactly.

Kathlena: You guys have a lot to be proud of. That’s really cool. This person asks, what age is too young for an in office oral challenge. Is that something you can speak to?

FAI: So for our program specifically we want the child to be at least a year and a half, so at least 18 months before they start the program. For OIT, I don’t know. But yeah for us it’s 18 months and then it also will depend on the patient themselves. Meaning we do have some young kids, because we do treat allergies with food, we have some young kids that are great eaters that are able to keep up with their maintenance and eat their proteins. We have some other kids who just naturally could be a little more picky because they are only two years old which is very age appropriate. In that case it might be better for them to wait until they get a little bit older.

Kathlena: Ok, so in some cases it’s not that they were too young, it’s just not for that kid yet.

FAI: Yeah.

Kathlena: Ok. Someone asks, is TIP, is it similar to allergy drops.

FAI: I would say no. Allergy drops, so we do do sublingual immune allergy treatments for environmental allergies, those would be the drops that you do under the tongue, and for, I don’t know how to explain it really, but because we are just using different proteins and the way that we would introduce those proteins would be very different than allergy drops.

Kathlena: Yeah, so it’s not really, it’s,

FAI: It’s own…

Kathlena: Yeah like it’s still the same that it treats allergies but it’s two different things.

FAI: Yeah, it’s in the same wheelhouse.

Kathlena: You know what it’s like those tiny little smart cars and a big ol’ pick up truck.

FAI: Probably, yes.

Kathlena: They’re both vehicles, but worlds apart.

FAI: Yes.

Kathlena: How are children treated when anaphylaxis isn’t their main symptom and do they still qualify for treatment? So it’s a two part question.

FAI: OK. So that one will depend on the data from the immune system. Because we do have kids that have food sensitivities, and looking at their immune system, they are at high risk of developing food anaphylaxis. And we will come up for a plan for them. We do have some patients, I think the most common scenario is the older sibling has food allergies and a history of food anaphylaxis, so the parents want to test the younger sibling. Who’s already really eating, but just to make sure, to ensure they aren’t a TIP candidate. And if they’re not a TIP candidate, we will tell the family you’re not a candidate, it’s not worth it for you to go through the program.

Kathlena: So there’s still, basically if, because not every reaction is anaphylaxis. So it’s still ok to contact you guys…

FAI: Yeah.

Kathlena: …and say hey I’d still like to be evaluated kind of thing.

FAI: So yeah if after we do the initial evaluation and we determine that no, you don’t have high risk for anaphylaxis, you’re not a TIP candidate.

Kathlena: That’s actually really cool that you won’t treat someone if they don’t necessarily need it.

FAI: Correct, yes.

Kathlena: Which is nice because a lot of people have had doctors take them for a ride. So that’s really stand up of you.

FAI: No, we’re not going to string you along.

Kathlena: That’s awesome. Ok, I guess we’ll leave it there then because the other questions we sort of already covered earlier. That’s it.

FAI: Ok, cool.

Kathlena: Cool that was great, you’re awesome.

FAI: Thank you

My Final Thoughts

I hope you found this interview insightful, because I certainly did. The team at the Food Allergy Institute aren’t here to give you false hope and take you for a ride. If you have a complex case, I’m sure you’ve been in that boat before. I really appreciate their screening process and participation criteria.

I’ve had the opportunity to talk with many people who have gone to the clinic, and all but one has experienced total success. Of the one who didn’t, in their particular case, there were a lot of external variables in play, and they still had nothing but good things to say about the Food Allergy Institute.

The one thing you’ll continue to hear again and again from patients is the cost of the program. I’m not going to sugar coat this, TIP is expensive. If you choose to make this investment, stick to your doses and stay compliant. You’re spending a lot of money and I don’t want to see it wasted.

Finally, if you have more questions about TIP, please, reach out to the Food Allergy Institute. They would be SO happy to talk over your questions and concerns before you make the trip out to them.

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