New Guidelines For Handling Food Allergies

Guests

Matthew Fenton, chief, Asthma, Allergy and Inflammation Branch, in the Division of Allergy, Immunology and Transplantation at the National Institute of Allergy and Infectious Diseases
Dr. Hemant Sharma, director, Food Allergy Program at Children's National Medical Center in Washington, D.C.
Julia Bradsher, CEO, Food Allergy Anaphylaxis Network

Ten to 12 million people in the U.S. suffer from a food allergy, according to the National Institute of Allergy and Infectious Diseases — and the number is growing. Diagnosis and treatment can be difficult. The NIAID hopes the new guidelines will help physicians identify and manage food allergies.

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NEAL CONAN, host:

This is TALK OF THE NATION. Im Neal Conan in Washington.

Food allergies are all too common. As many as 12 million Americans may have one or more, and they can be dangerous, sometimes even fatal. But it can be hard to figure out who's allergic and who isn't, and the severity of reactions can vary greatly. A whiff of peanuts can make one person break out in hives or send another into anaphylactic shock.

Many restaurants and schools don't label meals that contain the foods that can trigger an allergic reaction or at least not correctly sometimes, and the number of cases appears to be on the rise.

The National Institute of Allergy and Infectious Diseases released new guidelines in December to help health care professionals who treat patients with food allergies. If that's you or your child, how did you and your doctor figure it out? Tell us your story. 800-989-8255. Email us, talk@npr.org. You can join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.

Later in the program, crowd disasters. What really triggers a dangerous crush? And new ideas on prevention. But first, food allergies, and we begin with Matthew Fenton, chief of the Asthma, Allergy and Inflammation Branch at the Division of Allergy, Immunology and Transplantation -almost made it through - at the National Institute of Allergy and Infectious Diseases. That's not quite a mouthful. He joins us here in Studio 3A. Thanks very much for being with us.

Dr. MATTHEW FENTON (Chief, Asthma, Allergy and Inflammation Branch, Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases): Thank you. It's a pleasure to be here.

CONAN: And why the necessity for new guidelines?

Dr. FENTON: Well, we were actually approached by a patient advocacy group and a professional medical society back in 2007 with the idea that there needed to be updated food allergy clinical guidelines that would speak to the entire clinical community and not simply be guidelines written by allergists for allergists, which has been the case sometimes in the past.

And so we took on the challenge of creating guidelines that could be broadly useful across the clinical spectrum, ranging from the specialist to the general family practice doctor.

CONAN: Does that suggest that, at least in the past, treatment have been very different?

Dr. FENTON: Well, diagnosis and management of food allergy has been very different. One of the startling facts is that there is not even a common definition for food allergy that is used by physicians in different types of practice.

One of the things we did when we started the project of creating guidelines was to look at the definitions that were out there, and they vary quite a bit. So we had our work cut out for us.

CONAN: In fact, it's sometimes hard to distinguish, and certainly from a layman's point of view, between an allergy and an intolerance.

Dr. FENTON: Absolutely. The symptoms can be very similar, and it's certainly quite plausible that a diagnosis of food allergy can be made, only to later find out it's a food intolerance.

And interestingly, for patients who self-report that they have an allergy to their doctor, 50 to 90 percent of the time, they're actually incorrect, and they have a food intolerance.

CONAN: And what's the difference in terms of treatment?

Dr. FENTON: Well, there - for food allergies, which are a disease that's based on a defect in the immune response to food, there is no treatment. We can only advise patients and their families to manage the diet and be very careful to avoid consumption of the food or to manage symptoms, if they're mild, with antihistamines, or in the case of severe reactions, you may have to use epinephrine.

In the case of food intolerance, you certainly want to avoid the food, as well, but in cases such as lactose intolerance, you know exactly what you need to avoid in milk products, but also there are pills available to provide the missing lactase enzyme, and you can actually then go on to consume milk products.

CONAN: And allergies can be, I think devilish is probably as good a word as any, figuring out what it is you're allergic to.

Dr. FENTON: Well, that's a very important point. And one of the things I want to stress at the beginning is that there's a difference between allergic sensitization and allergic disease, that the immune system may recognize a number of different allergens, but you may only have clinical disease arising from one of those allergens.

CONAN: So give me a for instance there.

Dr. FENTON: Well, for instance, let's take food allergies, since it's the topic of the day. You may have an immune response against a number of different foods. A child may be allergic to milk and egg and peanut. But which one is actually causing the symptoms? And finding out which is the culprit is a large part of the challenge the physician faces. But only the one that you have clinical symptoms from is the one you have to avoid in your diet.

CONAN: Dr. Fenton, stay with us. We're going to turn to somebody who has to deal with some of these problems in his practice. Dr. Hemant Sharma is director of the Food Allergy Program at Children's National Medical Center here in Washington, D.C., also with us here in Studio 3A. And you deal with these kinds of questions all the time.

Dr. HEMANT SHARMA (Director, Food Allergy Program, Children's National Medical Center): Absolutely. I was just dealing with them this morning, in fact, with several of our patients that came to see us.

And, you know, the concerns that families have when they come to see us as a specialist is, number one, making the diagnosis. Oftentimes, they come to us after having had various tests done and without much clarity as to whether their child really has a food allergy, and if they do, which foods are they really allergic to.

CONAN: And we're talking children here, but are most allergies diagnosed in children?

Dr. SHARMA: Well, of the about 12 million people in the U.S. who have a food allergy, three million of them are estimated to be children. So there are a number of adults who have food allergy, some of whom had food allergy as kids and never outgrew them. And some adults develop food allergies later in life.

CONAN: So is that a separate category?

Dr. SHARMA: Not necessarily. They all work through the same mechanisms, and, you know, going back to what Dr. Fenton said, food allergies, by definition, involve the immune system.

And so most of the time, when it comes to a food allergy, that will happen early in childhood. However, for example with fish and shellfish, that allergy can develop anytime, later in adulthood.

CONAN: And is the testing still, well, we'll give you a little of this and see what happens?

Dr. SHARMA: Not exactly, and I think that's one of the strengths of the food allergy guidelines that we're discussing is that they're giving us a framework for the interpretation of these tests.

There are a number of tests that allergist, immunologists can do when a child or an adult comes to them with food allergy concerns. A skin test can be done. A blood test can be done. And sometimes those tests are not always accurate. There can be false positives, as we were discussing before.

So the job that we have in front of us is to take not only the test results but more importantly the history of what happened, the history of when your child or when you ate this food, what symptoms occurred, how soon did they occur. And we put all that together to help make a diagnosis.

CONAN: And especially in the case of children, of course, the parents are sometimes distraught because these reactions can sometimes be very scary.

Dr. SHARMA: Absolutely. I mean, food allergy for a parent is a very frightening thing to go through, particularly in young children. They have life-threatening reactions. These are not the kinds of allergy symptoms that we think of with hay fever, for example, a runny nose or itchy eyes. These symptoms can be a drop in blood pressure, a dangerous tightening or swelling involving the through. And they can be potentially fatal. And so for parents, this is a very, very scary prospect.

CONAN: As a practitioner, do you look at these new guidelines and say: Does this make sense to you? And does it clarify - did these definitions clarify procedures throughout the profession?

Dr. SHARMA: Absolutely. As an allergist-immunologist who treats people with food allergies, these guidelines have been incredibly helpful, number one in terms of getting us on the same page.

I think as Dr. Fenton was alluding to, there's a wide variety of clinical practice when it comes to food allergy, and as practitioners, we all needed a set of common guidelines to help us to decide what we should do when a patient comes to us with a potential food allergy.

And then furthermore, for patients themselves, it gives us a set of guidelines to guide them in better understanding and managing their food allergies.

CONAN: Let's get a caller in on the conversation, 800-989-8255. Email us, talk@npr.org. If you have a food allergy, or your child does, tell us how you and your doctor figured that out. Megan(ph) joins us on the line, calling from Mountain View in California.

MEGAN (Caller): Hi.

CONAN: Hi, Mega, you're on the air. Go ahead, please.

MEGAN: So, I've been working actually from the opposite perspective of not necessarily thinking I have food allergies but having a lot of symptoms, and over the last year working with a naturopath until we ended up sending my blood in to get a comprehensive food panel. And they sent back a list of about 30 different foods, which I'm allergic to.

CONAN: And those include?

MEGAN: Oh my God, from lychee to soy to wheat to yeast to gluten. The list is really long. You probably don't want me to read the whole one.

CONAN: And what does that leave you eating?

MEGAN: You know, it has left me learning to cook, because I can't go to restaurants or even get the processed food or even the soups at Whole Foods because they'd have garlic in them. So I've been learning to cook and adapt recipes to leave out the ingredients. (Unintelligible) in the morning and soup at lunch.

CONAN: After getting this rather ferocious list, I wondered if you considered a second opinion.

MEGAN: So what I'm doing is, starting January 1st, for the past month, I cut out all of these 30, 40 different foods. And now each week, I'm going to introduce a new food and see what I'm actually reacting to. And if I don't have a reaction, as I'm keeping a log, then I can put the food back in my diet.

CONAN: But have you considered going, trying another doctor and saying is this a reasonable approach?

MEGAN: I haven't. I have three different friends who've done this, one who last year they, the medical doctors had diagnosed her with maybe having a brain tumor. And after she did the same medical test and cut these foods out, she - a lot of her symptoms went away.

CONAN: And she's doing well?

MEGAN: She's doing really well. So went from a possible brain tumor to really being about food allergies.

CONAN: Megan, thanks very much for the call. And good luck. And good luck with the cooking, as well.

I wonder, Dr. Sharma, is this a reasonable approach? I mean, that seems like an awfully strong reaction.

Dr. SHARMA: It's - well, I guess I'll resort back to the guidelines because that's what we're here focusing on today. The guidelines make it pretty clear that as practitioners, we really should avoid doing these indiscriminate panels of testing to a number of different foods. And the reason is that there can be false-positive results or what is other called sensitization.

Sensitization means that when they do the blood test to look for the IGE, the allergic antibody to the food, they find the IGE to the food, but it could be that that the IGE really is having no clinical consequence at all in terms of an allergy.

And so many of us are walking around with IGE antibody in our blood, to a number of different foods, but we're not allergic to that food. And really, the only true diagnosis of a food allergy is what happens when you eat the food.

CONAN: So that approach, cut them all out and then introduce one at a time and see what happens?

Dr. SHARMA: It could be. I mean, the symptoms of a food allergy that involves IGE are very clear. If you have a food allergy involving IGE, it won't be presenting vaguely, as this did.

CONAN: All right. Stay with us, if you would. We're talking with Dr. Hemant Sharma and also with Dr. Matthew Fenton about food allergies and new guidelines on how they're diagnosed and treated. If you or your child suffer from food allergies, how did you and your doctor figure that out? Tell us your story, 800-989-8255. Email talk@npr.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION, from NPR News. I'm Neal Conan.

We're talking today about food allergies. About one in 20 children have them, one in 25 adults. Those numbers seem to be rising. As of this past December, those with food allergies have new guidelines for diagnosis and management.

If that includes you and your child, how did you and your doctor figure it out? Give us a call: 800-989-8255. Email us: talk@npr.org. You can also join the conversation at our website. That's at npr.org. Click on TALK OF THE NATION.

Just before the break, we had a caller, Megan, who was describing a panel of tests that she had done, a blood screening. And Dr. Matthew Fenton, chief of the Asthma, Allergy and Inflammation Branch in the Division of Allergy, Immunology and Transplantation at the National Institute of Allergy and Infectious Diseases - I got through it that time - wanted to come back on that.

Dr. FENTON: I think the caller raised a very important issue that's very commonly seen among people who have food allergy or suspect they have food allergy. But it's important to put it into context.

Food allergy afflicts about five percent of Americans. But 50 percent of Americans actually have some detectable level of the allergic IGE antibody against a food. So, far more people have some state of allergic sensitization than actually have clinical disease.

So what these test panels show you, a blood test, a RAST test or a skin test, is - tells you about the foods you're sensitized to. And the danger, especially in children with suspected food allergy, is to not restrict the diet to the point where your nutrition is harmed.

It's important to identify the allergen that actually causes symptoms and then work from there. And to identify that allergen, we, in the guidelines, recommend something called the oral food challenge, to precisely identify the causative food.

CONAN: Here's an email we have from Beth in Greenville, Wisconsin: I'm in my 40s, and something has always stymied me and others that I've spoken to about this topic. When I was a kid, I don't remember anybody in my school class that had allergies to such things as peanut butter, peanuts.

What happened between now and then? Why are there now more kids that have a serious enough allergy to peanut products that they're banned from sending peanut butter and jelly sandwiches in school lunches?

Dr. Fenton, would you address that?

Dr. FENTON: We think at this point that the increase in food allergy that's been seen over the past few decades reflects a similar increase in allergic diseases across the board - so asthma, hay fever, for example. We've seem similar rises.

Now, why this is occurring is really still scientifically a mystery. There's certainly factors in the environment, factors in our lifestyle, factors in our diet that are involved. And one hypothesis that's been put forward to help explain this is something called the hygiene hypothesis, that says as our environments and lifestyles get cleaner, and we are less exposed to microbes, and we use higher - antibiotics at a higher frequency, that our immune systems, in a sense, are looking for something to do. They're not able to do their normal job, which is to fight off pathogens in the environment, because we have such a clean environment.

Now, that's a somewhat naive hypothesis, but there are some very strong points to that that are likely to underlie the connection between the cleaner environment, the trend in increased allergic diseases and our immune system looking for something to do.

CONAN: Let's introduce another voice in the conversation: Julia Bradsher, chief executive officer of the Food Allergy Anaphylaxis Network, a group that supports awareness and research on this subject. She also joins us here in Studio 3A.

Nice to have you with us today.

Ms. JULIA BRADSHER (Chief Executive Officer, Food Allergy Anaphylaxis Network): Thank you.

CONAN: And yours was one of the groups that urged the conduct of this new guideline?

Ms. BRADSHER: Yes, FAAN, the Food Allergy Anaphylaxis Network, was very instrumental in pushing for these guidelines so that families with food allergies could be better supported.

CONAN: And if there's one misconception that people have about allergies, what would it be?

Ms. BRADSHER: I guess one of the greatest misconceptions is something that Dr. Fenton mentioned earlier, which is that people think that a food allergy is, you know, basically a sneeze or, you know, a cough: You eat something, and you sneeze.

But it's really a potentially life-threatening condition. And, you know, people are walking around, you know, being exposed on a daily basis to a potential allergen that, if they consume it, it could be fatal.

CONAN: And just given the numbers that we were talking about earlier, is that emailer right? I mean, you know, entirely possible that 40 years ago, when she was in school, this didn't seem to be a problem, and now it is.

Ms. BRADSHER: I talk to people all the time about food allergies, and one of the things I hear frequently is: When my child started, there was one child, mine, in a classroom. And today - you know, that was in kindergarten. Today, my child's in the fifth grade, and there's 10 children. So we hear this anecdotally all the time.

CONAN: President Obama signed the Food Allergy and Anaphylaxis Management Act into law at the beginning of last month, after five years pending in Congress. What changes is that going to portend?

Ms. BRADSHER: Well, the wonderful thing about getting the FAAMA passed and getting it signed into law is that we now have guidelines for the country for schools to manage food allergies in the schools.

CONAN: And that means we're not going to see peanut butter in the cafeteria?

Ms. BRADSHER: What it means is that schools now have - no matter if it's a school in California or a school in Virginia, those schools have uniform guidelines that they can go to to learn how to manage the food allergies in schools.

CONAN: All right, let's get another caller on the line. And this is Derrick(ph), Derrick with us from Louisville.

DERRICK (Caller): Yeah, it's Louisville, actually, west of the Mississippi.

CONAN: Oh, the wrong Louisville. I apologize. Louisville in Colorado. Go ahead.

DERRICK: That's okay. Yeah, my son has a Latex allergy, and we discovered it when he was a baby, about 18 months old, and when he was doing an eczema study for some topical medication and his arms swelled up like a balloon right in front of our eyes at the doctor's office. And it turned out it was because of the Latex gloves the nurses were wearing when they were taking blood draws.

And - so because it was a part of a study, we had to find out what exactly it was. It turns out, it was the Latex. And because of that, that protein crosses over into foods like bananas and cantaloupe and honeydew and kiwi and a whole list. And things we know, like bananas, he can't really even touch without having an allergic reaction. It's not about eating it. It's just about coming into contact with it.

CONAN: Mm-hmm. And how does that change his life?

DERRICK: Well, he's got an EpiPen that he's got to have with him everywhere, and...

CONAN: That's in case he needs an injection to save his life.

DERRICK: Yeah, right, right. Balloons for parties in the classroom, you know, Latex balloons, especially if they have a little powder inside of it, if it pops, then it floats around in the air. Or, you know, the foods that are mixed in a fruit salad. Usually, he can't even touch a fruit salad, even though there may be, say, a strawberry that he could eat, but the cross-contamination is there.

So it's - he's really had to educate and be an activist - or not an activist, but, you know, speak up for himself and say, you know, I can't eat that. I can't touch that. And this needs to not be in my classroom because I don't want to use my EpiPen.

CONAN: Yeah. Dr. Sharma, is this all too common?

Dr. SHARMA: It is. And what you're describing, Derrick, is you used the exact right term. It's cross-reactivity. And so there are - our bodies, oftentimes, our immune system will see proteins that are similar structurally in the same way. So the Latex protein that your son is reacting to is similar to some of the proteins that are present in these other fruits, like banana, kiwi, avocado, mango.

And so even touching a food can, in some children, cause a reaction. The route of exposure that most commonly will cause a reaction is ingestion, actually eating the food, but reactions can also occur through contact and, in rare cases, even through inhalational exposure.

CONAN: And Julie Bradsher, I wanted to ask you: That part about becoming his own advocate, that's what your organization talks a lot about, too.

Ms. BRADSHER: Yeah. We do - we spend a lot of time talking with families about how to advocate for themselves, whether it's in the school, in a restaurant, on an airline. You know, we - that's an important factor. And for kids in particular, they really have to learn how to speak up for themselves. And, you know, I've met many parents, many children where the kids are actually very resilient. They're incredibly great advocates for themselves.

CONAN: Derrick, how old is your son now?

DERRICK: He's going to be 14 in two weeks. But - so he's grown up with this, and, you know, being an advocate for himself, he's really done well.

CONAN: And is this something he's likely to grow out of? Is that what you're told?

DERRICK: No. We're told it's a lifetime thing that he needs to be, you know, always watchful of.

CONAN: Well, we wish you and him the best of luck. Thanks very much for the call.

DERRICK: Yeah.

CONAN: There's an email from Amy in Cincinnati: On a recent mission trip with my church to a township in South Africa, we were doing a children's program and provided a snack. The snack the locals provided was a raisin-peanut trail mix. We immediately voiced our concern for peanut allergies with the kids, and the moms laughed at us. They'd never heard of such a thing. Are allergies more common in certain countries? Why is there not a peanut allergy problem in South Africa?

Dr. Fenton, is that the peck-of-dirt syndrome that we were talking about before?

Dr. FENTON: Well, that may be part of it in certain areas. But this geographical restriction of food allergies is really a fascinating phenomena. And clearly, if you take Africa as a whole, the continent has far less food allergies and far less asthma than the United States or Europe.

There was an interesting study that was completed last year in Europe called the EUROPREVAL study, which looked at allergies on a country by country basis. And what was really surprising was even within Europe, Western Europe, with a lot of commerce between various countries and the close geographic proximity, there was a huge variation from country to country, even within country, where one part of a country would have a particularly high incidence of peanut or soy allergy, and that would be very different from the adjoining country or even different parts of the same country.

So there are a lot of factors involved. Again, the environment, genetics, pollution, so many - and diet. So many different factors can play a role.

CONAN: Let's go next to Melissa, Melissa with us from Brick Township in New Jersey.

MELISSA (Caller): Hi. Good afternoon.

CONAN: Good afternoon. Go ahead, please.

MELISSA: Yeah. I had a question for the doctor. My daughter is one. I have four children. And about six months ago, I gave her an egg to eat, and I noticed that her ears were turning up purplish. And, of course, I called the pediatrician. And it looks like hives, so she ordered a blood panel of, I guess, food allergy test (unintelligible) drew serums. And they found out that she was not allergic to eggs, but she was allergic to peanuts and tuna fish, which I had never exposed her to and - so it must have been a fluke thing of why her ears, you know, had broken out in that rash.

But my concern is the sensitivity level. She marked that it wasn't severe. I think she said it was level two, if I remember. I don't know how it's actually measured. But is this something that if I keep her away from it, she's likely to grow out of in the future, or is this something that, you know, if I keep her from being around anything with peanuts in it...

CONAN: Mm-hmm. Melissa, I'm going to refer your question to Dr. Sharma. But we have to say he can't diagnose your daughter on the radio. This is very broad, generalized response.

MELISSA: Yeah.

CONAN: But, Dr. Sharma.

Dr. SHARMA: Thanks. Well, Melissa, unfortunately, I can't speak more than in general terms. But these blood tests are helpful both at the time of diagnosis as well as in terms of giving some information about prognosis. And so oftentimes, we will repeat blood tests annually, perhaps more frequently depending on a specific circumstance, to look at the trend in the level and that can sometimes give us some information about whether a child is outgrowing given food allergy or whether it's persisting. And the gold standard as Dr. Fenton had already alluded to is to do an oral food challenge in a supervised setting where that food is actually fed to the child and you observe for any signs of a reaction.

CONAN: All right. And Dr. Fenton.

Dr. FENTON: I wanted to follow up on what Dr. Sharma was mentioning because it seems to make common sense to most people that avoiding a food for a child who might have an allergic sensitization is the right thing to do.

But actually there is a lot of evidence to support that early consumption of those foods can actually prevent a food allergy. For example, in Israel, a country where young children are traditionally given a peanut-containing snack called Bamba, these children have an amazingly low rate of peanut allergy compared to other countries.

So we've actually taken a look at that, and the NIAID is funding a study that is looking at whether consumption or avoidance of peanut in early life is more protective against the eventual development of peanut allergy.

CONAN: Melissa, good luck with your daughter. Appreciate it.

MELISSA: Thank you. Thank you.

CONAN: Here's an email. This is from Karen. Thirty years ago, I had a massive anaphylactic reaction within 10 to 15 minutes after consuming shrimp. My husband rushed me to a nearby hospital that he worked for. We were met in the parking lot by staff with the epinephrine in hand. I had airway compromise, massive hives over my entire body, including face and oral mucosa. Of course, I went for allergy testing following this episode. And the allergist at the University of Cincinnati decided after an exhaustive period of testing, I was likely allergic to what the shrimp ate. I carried an EpiPen for years but no longer do, and I eat shrimp often.

The exhaustive series of tests, and Dr. Sharma, so many patients complain about that. Why can't we find out what the diagnosis is more easily?

Dr. SHARMA: It's a great question. And the testing is moving forward. And I think with funding from organizations like the NIAID, we're getting more refined diagnostic testing. And, eventually, we will have testing that has greater sensitivity and specificity. The specific question regarding this food; hard to know what exactly happened. There are cases of anaphylaxis which we call idiopathic. That means that it wasn't related to anything that was eaten or in the environment, and the immune system just did it on its own. But it certainly - our hope is that, with time, we'll have even better diagnostic tools.

CONAN: Let's go next to Nathan, Nathan with us from Berkeley.

NATHAN (Caller): Hi. Yeah. I have an awful lot of questions. But if I restrict myself to one, the symptoms that I get - I talked to various doctors at various times and they don't even have a name for this reaction. And, you know, in my case, I get bleeding blisters in my sinuses in my nose. Or from cranberries, I get blisters on the back of my neck and the back of my hands. And I was wondering, is this something that is just completely unfamiliar to physicians?

CONAN: Dr. Fenton, has this come up in your experience?

Dr. FENTON: Well, I think I'll pump that one to Dr. Sharma since I'm not a physician.

CONAN: All right.

Dr. SHARMA: It's often that we'll see patients who have a variety of vague complaints. And they're wondering, or sometimes worrying that they might have a food allergy. And so sometimes our job is to say that we don't think this is a food allergy. And oftentimes that happens more in adults because it is unusual if we would have a new onset of food allergy with the exception, perhaps, of fish - to fish or shellfish later in adulthood. But these kinds of vague complaints, it's difficult to connect them directly to food allergy.

CONAN: Is it vague to say, every time I eat cranberries I get hives at the back of my hands and at the back of my neck?

Dr. SHARMA: Well, that particular reaction I wasn't referring to. But the bleeding and the oral ulcers, that's not something that we commonly see with any particular kind of immune media, that food allergy. Hives certainly are one sign of a food allergic reaction where the allergic cells under the skin are releasing their chemicals causing the hives. And that can happen after certain foods. Cranberries are not one of the top eight food allergens. And groups like the NIAID and FAAN, we really try to focus our emphasis on the top eight food allergens, which are responsible for more than 90 percent of food allergies.

CONAN: And those eight are?

Dr. SHARMA: So milk, eggs, soy, wheat, peanut, tree nuts, fish and shellfish.

CONAN: Okay. It sounds like you got that list memorized. Thank you very much for the call, Nathan. And good luck at Thanksgiving.

In any case, thanks to Dr. Sharma - Dr. Hemant Sharma of the Food Allergy Program at the Children's National Medical Center in Washington, D.C. Matthew Fenton, I'm not going to read your title again. But he's with the National Institute of Allergy and Infectious Diseases, and Julia Bradsher of the Food Allergy Anaphylaxis Network.

I'm Neal Conan. Stay with us. It's the TALK OF THE NATION from NPR News.

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