Purvi Parikh, MD: The State of Food Allergy Care


In months, the US may have its first marketed peanut immunotherapies. How will pediatric patient management change?

With the pending approval of peanut immunotherapies to the US market, there’s anticipation of what will change in the immediate care of pediatric food allergy.

What the first drugs designated for food allergy desensitization will not change, however, is the emphasis on a network of care—from the physician, to the family, and beyond.

In an interview with MD Magazine®, Purvi Parikh, MD, pediatric allergist and clinical assistant professor in the Departments of Pediatrics and Medicine at NYU Langone Health, explained the particular concerns of families in managing food allergies, and how comorbid conditions may affect treatment strategy.

MD Mag: How will eventual FDA approvals to peanut immunotherapies immediately change food allergy care in the US?

Parikh: So, the approval will immediately change the care, because prior to this, all we really had was avoidance for people who suffer from food allergies. And now we have another option, which isn't necessarily a cure but it does add an extra layer of comfort and safety to the patient in making their reactions less severe.

MD Mag: What is the burden of managing comorbid conditions including asthma and eczema in children with allergies?

Parikh: It is quite a big burden, because just in the last 2 decades, the rise of allergies and asthma in children have gone up almost 50% in terms of the prevalence. And they're becoming more severe, as well.

And often, many of the allergic conditions are interrelated. So, a lot of the children's environmental allergies also trigger their asthma and their eczema, and then same goes for their food allergies as well. So it's very important to diagnose children early and treat them appropriately.

MD Mag: Relative to other conditions, how critical is the role of parents in managing pediatric allergy treatment and progression?

Parikh: It's very critical. Parent involvement is essential because a lot of these allergies, as well as asthma-related conditions, are chronic and they require daily medication or and/or constant vigilance, in terms of watching out for reactions—whether it be food-related, skin allergies, or flares of asthma or their other allergic rhinitis conditions.

So, parent involvement is very importantand then even more so than that, the whole community involvement. School involvement is essential, because children spend most of the time at school. Same goes for after-school activities. So, coaches, teachers, anyone who interacts with a child should be aware and know what medications they are taking and how to use the medicines in case of emergencies.

MD Mag: Do discussions with parents differ based on the pediatric allergy type?

Parikh: It does differ. I think the food allergies cause a lot more anxiety for parents, because many food allergies can be life-threatening. Also, it's very difficult to navigate, because it's almost there's so many ingredients out there and so many different snacks and packaged foods.

And then the parents also have the added anxiety that the child is away from them most of the day. So, then they have to make sure the food that they're getting at school, camp, sports practice, or on the bus isn't contaminated with the allergen.

So, I think that always creates an extra level of anxiety. But even environmentally, it can cause a lot of stress for parents, because often these are the things that trigger asthma, they trigger allergies, severe eczema. Both can be nerve-racking, but I've noticed more stress with the food allergens.

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