UP NEXT ON "CYCLE OF HEALTH."

>> TONIGHT'S TOPIC: FOOD ALLERGIES.

6% OF US HAVE THEM, AND NEARLY 90% ARE CAUSED BY THE SAME NINE FOOD TYPES.

SYMPTOMS INCLUDE HIVES, SWELLING, AND EVEN ANAPHYLAXIS - KABOOM!

TONIGHT WE'LL DISCUSS WITH OUR PANEL OF EXPERTS HOW THEY'RE DIFFERENT FROM OTHER GI PROBLEMS, AND HOW TO PREVENT, DIAGNOSE, AND TREAT THEM.

BE.

♪ ♪ HELLO AND WELCOME TO "CYCLE OF HEALTH."

I'M YOUR HOST, DR. RICH O'NEILL.

TONIGHT'S TOPIC: FOOD ALLERGIES.

6% OF US HAVE THEM, AND NEARLY 90% ARE CAUSED BY THE SAME NINE FOOD TYPES.

SYMPTOMS INCLUDE HIVES, SWELLING, AND EVEN ANAPHYLAXIS - KABOOM!

TONIGHT WE'LL DISCUSS WITH OUR PANEL OF EXPERTS HOW THEY'RE DIFFERENT FROM OTHER GI PROBLEMS, AND HOW TO PREVENT, DIAGNOSE, AND TREAT THEM.

JOINING US TONIGHT ARE DR. CHRISTOPHER JUSTINICH, PEDIATRIC GASTROENTEROLOGIST WITH UPSTATE MEDICAL UNIVERSITY; DR. PETER CAPUCILLI, PEDIATRIC ALLERGY & IMMUNOLOGY SPECIALIST AT ROCHESTER REGIONAL HEALTH; AND MS. KATRINA DUFRESNE, CLINICAL PEDIATRIC DIETITIAN, ALSO COMING TO US TODAY FROM UPSTATE MEDICAL UNIVERSITY.

>> WELL, YEARS AGO I WAS ON A BLIND DATE AND WE WENT TO A SPANISH RESTAURANT.

AND I HAD SOME KIND OF SPANISH THING WITH SHRIMP IN IT.

AND ABOUT A HALF HOUR LATER, I'M WALKING HOME WITH THIS YOUNG WOMAN AND I HAD THE ICHIEST STUFF GOING ON BEHIND MY EARS AS I REMEMBER.

LATER ON I HAD MORE HIVES.

I THOUGHT WHAT IS THIS?

THAT WAS THE BEGINNING OF THE MY SHRIMP ALLERGY WHICH HAS UNFORTUNATELY GONE ON MY ENTIRE LIFE.

SO I CARRY AROUND AN EPIPEN NOW WITH ME.

WHAT IS A FOOD ALLERGY?

>> YEAH, SO, YOU KNOW, WE'LL TALK A LOT TODAY ABOUT THE DIFFERENT KINDS OF ADVERSE REACTIONS THAT YOU CAN HAVE TO FOODS.

PROBABLY THE FIRST THING THAT WE THINK ABOUT WHEN WE HEAR THE TERM FOOD ALLERGY ARE THESE CLASSIC ANAPHYLAXIS TYPE OF REACTIONSES THAT INVOLVE SYMPTOMS SUCH AS HIVES, SWELLING, FLUSHING, ITCHY SNEEZY SYMPTOMS, VOMITING.

AND THEY TEND TO BE IMMEDIATE, MEANING THEY OCCUR WITHIN MINUTES OF INGESTING THE ALLERGEN.

AND ENAT THISALLY IS,-- AND IT TYPICALLY ARE THE NINE CLASSIC FOODS INVOLVED IN THOSE TYPES OF REACTIONS.

THINGS LIKE PEANUT, NUTS, SHELLFISH, MILK AND EGG AMONG OTHERS.

THESE REACTIONS, AS THEY'RE HAPPENING, CAN BE QUITE SEVERE.

YOU OFTEN NEED TO TREAT, YOU KNOW, THE PATIENT OR THE PERSON WITH AN EPINEPHRINE AUTO INJECTOR TO STOP THE REACTION.

SO IF YOU HAVE ONE OF THESE ALLERGIES, IT'S IMPORTANT TO BE CARRYING ONE OF THOSE AT ALL TIMES BECAUSE OF ACCIDENTAL EXPOSURE.

WHEN WE SEE PATIENTS WITH THESE CONCERNS IN THE OFFICE, THE CLINICAL HISTORY REALLY IS MOST IMPORTANT PIECE THAT WE ARE TAKING INTO CONSIDERATION AS TO FIGURING OUT IF WE ARE WORRIED THAT THEY MAY HAVE A CLASSIC TYPE FOOD ALLERGY BUT THEN WE USE SKIN TESTING AND BLOOD TESTING AS OUR DIAGNOSTIC TOOLS TO HELP US DETERMINE WHAT COULD BE THE ALLERGY UNDERLYING.

>> WHEN DO ALLERGIES TYPICALLY FIRST APPEAR?

WHEN DO THEY FIRST COME UP?

>> THESE TYPES OF ALLERGIES TEND TO ACTUALLY COME UP PRETTY EARLY ON IN LIFE.

UBL USUALLY THE FIRST FEW INTRODUCTIONS OF THE FOOD, YOU KNOW, IN INFANCY.

SOME, LIKE SHELLFISH CAN COME A BIT LATER IN ADULTHOOD.

BUT TYPICALLY THEY'RE COMING ABOUT WHEN YOU ARE STARTING TO INTRODUCE THE FOODS THE FIRST FEW TIMES.

>> AND I HAVE A FRIEND WHOSE INFANT, THE FIRST TIME HE HAD MILK, BLEGH, THE NEXT TIME HE HAD IT, SAME THING AND SO THEN THEY TOOK HIM TO THE DOC AND SAID YOU REALLY HAVE A FOOD ALLERGY.

>> I THINK REPRODUCIBLE IN NATURE A SYMPTOM OCCURRING TO A SPECIFIC FOOD IS REALLY IMPORTANT TO NOT IGNORE AND THAT'S WHEN YOU WOULD ABSOLUTELY WANT TO BE SEEKING, YOU KNOW, A DOCTOR TO SEE WHAT IS UNDER LYING THERE.

>> ARE SYMPTOMS DIFFERENT FOR ADULTS AND KIDS?

>> THEY CAN BE ACTUALLY.

A LOT OF TIMES IN INFANCY, SOME OF THESE YOUNG INFANTS MAY HAVE MORE MILD SYMPTOMS, MILD RAUB-- MILD RASHES, OR NO VOMITING.

SOMETIMES IN THE OLDER AGE GROUP THE SYMPTOMS ARE MORE SEVERE.

>> AND I UNDERSTAND THERE ARE-- THERE IS A DIFFERENCE BETWEEN A FOOD ALLERGY AND OTHER KINDS OF REACTIONS TO FOODS.

>> SO, MANY PATIENTS WE SEE IN OUR OFFICE, GASTROENTEROLOGISTS ARE COMING WITH DIFFERENT G.I.

SYMPTOMS, VOMITING, DIARRHEA, NOT GAINING WEIGHT WELL.

SOME OF THESE CHILDREN WILL HAVE SIGNS OF ALLERGY SUCH AS ATOPIC DERMATITIS AND/OR ASTHMA AND IT'S OUR CHALLENGE TO FIND OUT IF THE CHILDREN ARE ALLERGIC TO FOOD FROM A G.I.

POINT OF VIEW.

THERE IS A LOT OF MISCONCEPTIONS ABOUT FOOD ALLERGY.

MANY OF OUR PATIENTS COME IN FEELING THEIR CHILDREN AR LEDGERRIC TO FOOD BUT THERE ARE STUDIES THAT SHOW THAT OVER 80% OF PEOPLE THAT COME TO THE DOCTOR THINKING THEIR CHILDREN ARE ALLERGIC TO FOOD ARE NOT ALLERGIC TO THE FOOD.

THE SYMPTOMS ARE CAUSED BY SOMETHING ELSE.

THERE ARE A VARIETY OF G.I.

SYMPTOMS YOU CAN GET FROM MANY G.I.

DISEASES.

GALL BLADDER DISEASE AND SO MANY DISEASES THAT MIMIC FOOD ALLERGY.

SO WE ARE ALWAYS TRYING TO FIND OUT IF THAT REALLY AN ALLERGIC PROCESS OR NOT.

ONE OF THE EXAMPLES OF THAT IS LACTOSE INTOLERANCE.

PEOPLE MAY HAVE A PROBLEM WITH DRINKING MILK BECAUSE THEY'RE ALLERGIC TO THE MILK OR JUST NOT DIGESTING THE SUGAR IN THE MILK AND WHEN WE TRY TO SORT THOSE THINGS OUT, WE USE THE HELP OF OUR DIETICIANS TO TRY AND COUNSEL FAMILIES ABOUT MILK ALLERGY VERSUS LACK TOE INTOLERANCE.

>> HERE IS WHERE KARENA WOULD COME IN.

HOW DOES THAT WORK YOU ARE TRYING TO SORT OUT, THIS IS AN ACTUAL ALLERGY THAT TRIGGERS THE IMMUNE SYSTEM IN THE BODY?

TO OVERREACT IN A WAY, OR IS IT ... >> LACTOSE INTOLERANCE.

THEY JUST DON'T HAVE THE ABILITY TO BREAK DOWN THE SUGAR LACTOSE.

BUT THE DIFFERENCE BETWEEN THE TWO IS THAT WITH A MILK PROTEIN ALLERGY, THEY CAN'T HAVE ANY MILL INCOME THEIR DIET.

THOSE WITH LACTOSE INTOLERANCE, THEY CAN HAVE SOME OF THE MILK PRODUCTS IN THERE BUT THEY HAVE TO BE LOWER IN LACTOSE, THINGS LIKE AGED CHEESE IS ACTUALLY VERY LOW IN LACTOSE SO THEY CAN TOLERATE THINGS LIKE THAT.

AND THEY CAN HAVE-- THERE ARE SOME MILKS OUT THERE THAT THEY TAKE OUT THE LACTOSE SUGAR AND THEY CAN STILL TOLERATE IT WHERE PEOPLE WITH A MILK PROTEIN ALLERGY HAVE TO HAVE AN ALTERNATIVE, A SOY MILK, OAT MILK OR RICE MILK.

>> ARE SOME OF THEM BETTER THAN OTHERS FOR LITTLE KIDS?

>> IT REALLY DEPENDS ON THE KID.

IF YOU ARE LOOKING FOR A KID WHO NEEDS MORE NUTRITION CALORIIZE, YOU MIGHT GO WITH AN OAT MILK THAT WOULD HAVE MORE CALORIES COMPARED TO AN ALMOND MILK LOWER IN CALORIES, BUT MAKING SURE THAT THEY'RE GETTING ALL OF THAT WELL ROUNDED NUTRITION, SO MILK IS PROVIDING US WITH OUR CALCIUM, PHOSPHOROUS, PROTEIN, AND SO YOU WANT TO MAKE SURE THAT WHATEVER MILK YOU ARE CHOOSING HAS THOSE COMPARABLE NUTRIENTS IN IT.

>> NOW WHAT ABOUT BREAST FEEDING?

CAN A BABY BE ALLERGIC TO THEIR MOTHER'S BREAST MILK?

>> SO IT'S NOT TECHNICALLY THE BREAST MILK THAT THEY'RE ALLERGIC TO.

WHEN MOTHERS PRODUCE BREAST MILK, WHATEVER IS IN THEIR DIET WILL GO INTO THE BREAST MILK SO IF THEY'RE INCLUDING DAIRY IN THEIR DIET, THAT MILK PROTEIN CAN BE IN THE BREAST MILK AND THAT'S WHERE YOU WILL SEE THAT ALLERGY OR THAT INTOLERANCE, DEPENDING ON WHAT IT IS, AND SOME MOMS WE RECOMMEND THAT THEY DON'T INCLUDE DAIRY IN THEIR DIET.

OTHER MOMS WHO DON'T FIND THAT FEASIBLE, THERE ARE FORMULAS OUT THERE THAT THEY CAN HAVE IF THEY HAVE THAT MILK PROTEIN ALLERGY WHERE IT'S LIKE A HYDROLYZED PROTEIN, EASIER TO BREAK DOWN AND DIGEST.

AND THERE ARE SOME FORMULAS THAT ARE LOWER IN LACTOSE.

SO IT'S WORKING WITH A DIETICIAN TO SEE WHAT IS BEST FOR THE BABY.

>> SO HOW DOES THE DIAGNOSTIC PROCESS ACTUALLY GO OR HAPPEN?

>> YEAH, I MEAN, YOU KNOW, AS I MENTIONED BEFORE, I THINK THE FIRST STARTING POINT AND THE MOST IMPORTANT STARTING POINT IS THE CLINICAL HISTORY.

>> SO AS A MOM OR DAD OR A KID YOU KEEP TRACK OF WHAT YOU EAT AND TRACK YOUR REACTIONS?

>> PARENTS ARE VERY SAVVY AND REALLY KNOW THEIR CHILDREN REALLY WELL AND SO AS THEY'RE INTRODUCING FOODS FOR THE FIRST TIME, THEY MAY SEE A SYMPTOM POP UP, EITHER IMMEDIATELY OR DELAYED.

AND USUALLY FIGURING OUT IF THAT IS SOMETHING THAT IS ALONG THE LINES OF ANAPHYLAXIS INVOLVING HIVES AND SWELLING AND VOMITING VERSUS SOMETHING THAT MIGHT NOT BE IN THE ANAPHYLAXIS TERRITORY BUT MORE OF A G.I.

TYPE OF FOOD ALLERGY OR SENSITIVITY WHERE THEY MAY HAVE DIARRHEA LATER ON OR BLOATING LATER ON RATHER THAN THE IMMEDIATE ALLERGIC REACTION.

IF IT'S IN THE IMMEDIATE TERRITORY, THAT'S WHEN WE SORT OF GO DOWN THE ROUTE OF DOING OUR SKIN TESTING AND BLOOD TESTING TO SEE IF THEY HAVE THAT TYPE OF TYPE ONE CLASSIC ALLERGY.

>> A TYPE ONE ALLERGY.

AND WHEN YOU SAY SKIN TEST, LIKE THAT'S THE THING WHERE YOU HAVE THIS PANEL AND THEY PUT PIECES OF THE ALLERGY GENERAL ON YOUR SKIN AND SEE IF THERE IS A SKIN REACTION.

>> YOU WANT TO BE VERY SPECIFIC ABOUT THE TESTING.

ONE SORT OF IMPORTANT POINT THAT WE TALK ABOUT WITH ALL OUR FAMILIES ARE THAT THESE TESTS CAN HAVE FALSE POSITIVES, MEANING THAT YOU TEST POSITIVE BUT YOU ARE NOT ACTUALLY ALLERGIC.

YOU HAVE TO BE CAREFUL WITH HOW YOU AUTO USE THESE TESTS.

WE DON'T SCREEN FOR FOOD ALLERGY OR TEST BROADLY TO ALL DIFFERENT FOODS TO SEE WHAT THEY MAY BE ALLERGIC TO BUT IF THERE IS AN ISSUE WITH PEANUT, FOR INSTANCE, YOU WANT TO TEST TO THAT PARTICULAR NUT.

>> SO THAT'S THE WAY YOU GO FOR DELEGATION DIAGNOSING THINGS.

HOW DID YOU GET INVOLVED?

>> WE END UP SEEING PATIENTS WITH A VARIETY OF G.I.

SYMPTOMS THAT MAY OR MAY NOT BE RELATED TO FOOD ALLERGY AND QUITE OFTEN IF THE SYMPTOMS ARE SEVERE, MAYBE THE CHILDREN AREN'T GAINING WEIGHT WELL OR HAVE SYMPTOMS THAT INTERFERE WITH THEIR LIFE, WE OFTEN END UP DOING ENDOSCOPIC STUDIES WHERE WE LOOK AT THE STOMACH OR COLON AND TABLING TAKE BIOPSIES OF THE GUT AND THEN WE WORK BACKYARDS TO SEE WHAT COULD THE ALLERGY BE BECAUSE AS PETER MENTIONED, MOST OF THE ALLERGIES THAT WE SEE DO NOT SKIN TEST POSITIVE.

IT'S A DIFFERENT TYPE OF ALLERGY, TYPE 4.

AND OFTEN THOSE LEAD TO DELAYED REACTIONS TO FOODS.

SO ONE OF THE CLASSIC-- WE HAVE OTHER TYPES OF FOOD ALLERGY THAT WE SEE THAT WE WILL TALK ABOUT BUT A CLASSIC ONE WE SEE IS CELIAC DISEASE.

IT'S COMMON, 1% OF PEOPLE.

SO PEOPLE DEVELOP AN ALLERGY TO GLUTEN WHICH IS IN BARLEY, RYE AND WHEAT.

>> AND GLUTEN IS PART OF THE CELIAC DISEASE?

>> CORRECT.

YOU DEVELOP AN ALLERGY TO THE GLUTEN ITSELF.

THE TREATMENT IS TO AVOID THOSE.

BUT WE HAVE A BLOOD SCREENING TEST FOR CELIAC THAT PICKS UP 70 TO 80% OF THEM.

THE GOLD AND ADDER FOR US IS TO BIOPSY THE IN-- STANDARD IS FOR US TO BIOPSY BEFORE-- AND IT IS IMPORTANT FOR THE PATIENTS WITH CELIAC TO WORK WITH A DIETICIAN AHOW TO AVOID GLUTEN.

>> SO YOU WOULD GO DOWN WITH THE SCOPE AND THE CAMERA-- >> THROUGH THE MOUTH WHEN THE PATIENT IS SLEEPING.

TAKE SMALL BIOPSY SAMPLES FROM THE SMALL BOWEL.

THEY'RE MADE INTO SLIDES, LOOK UNDER THE MICROSCOPE AND THE PATHOLOGIST WILL DESCRIBE FOR US THE FEATURES OF CELIACS DWIS DISEASE.

WE WENT OUT TO FIND OUT MORE.

>> AN ENDOSCOPY IS WHERE WE LOOK INTO THE STOM WACK A VIDEO SCOPE INSTRUMENT.

WHEN WE SUGGEST THE PROCEDURES, USUALLY THE PATIENTS WE SEE HAVE CHRONIC G.I.

SYMPTOMS.

IT IS DAUNTING FOR FAMILIES AND CHILDREN SOMETIMES TO UNDER GO THE PROCEDURE, BUT THE PROCEDURES ARE DONE UNDER GENERAL ANESTHESIA.

THE PATIENTS COME NOT EATING OR DRINKING THAT MORNING SO THEIR STOMACH IS EMPTY WHEN THEY ARE PUT TO SLEEP.

TYPICALLY THE CHILDREN BREATHE ON THEIR OWN UNDER THE PROCEDURE BUT UNDER FULL ANESTHESIA.

THERE NO, SIR PAIN OR DISCOMFORT ASSOCIATED WITH IT.

EVEN AFTER THEY WAKE UP FROM THE PROCEDURE, THE INSIDE OF THE INTESTINE IS NOT SENSITIVE TO TOUCH SO ANY OF THE SAMPLING WE TAKE DOES NOT CAUSE PAIN AFTERWARD.

THE PAIN FROM THE INTESTINE COMES FROM STRETCHING OR SPASM OF THE INTESTINE.

BUT THE INTESTINE DOES NOT HAVE PAIN FIBERS FOR ACTUAL TOUCH.

EVEN IF WE DID THE PROCEDURE WITHOUT SEDITION, THE PERSON WOULD NOT FEEL THE BIOPSY.

THEY MAY FEEL A TUG BUT NOT PAIN FROM IT AND THAT'S WHY THEY DON'T FEEL PAIN AFTERWARD.

THE ENDOSCOPIC PROCEDURE ONLY TAKES A FEW MINUTES TO DO.

ONCE WE LOOK THROUGH THE ESOPHAGUS, WE LOOK INTO THE STOMACH, CURL THE SCOPE LIKE A CANDY CANE TO SEE THE TOP-OF-THE-STOMACH.

THEN WE FLIP BACK DOWN AND GO THROUGH THE STOMACH INTO THE SMALL BOWEL AND EXAMINE THE RINGS OF TISSUE IN THE SMALL BOWEL AND TYPICALLY WE WOULD TAKE BIOPSIES AS WE ARE COMING OUT, SMALL BOWEL, STOMACH, ESOPHAGUS.

ANESTHESIA THE DOCTORS PLACE A FLOPPY DEVICE IN THE BACK OF THE THROAT THAT JUST DELIVERS AIR AND GAS TO THE PATIENT TO KEEP THEM SLEEPING DURING THE PROCEDURE.

SO WE PASS BY THAT DEVICE CALLED AN LMA AND WE ARE INTO THE ESOPHAGUS, THAT LONG TUBE THAT LEADS FROM THE THROAT INTO THE STOMACH.

THE VIDEOTAPE WE ARE SHOWING TODAY SHOWED EVIDENCE OF INFLAMMATION OF THE ESOPHAGUS BEING SWOLLEN AND BUMPIER THAN IT NORMALLY WOULD BE.

THE SECOND VIDEO SHOWED SOME WHITE PATCH AS LONG THE THE ESOPHAGUS.

SOMETIMES THAT'S A YEAST INFECTION IN THE ESOPHAGUS BUT THIS SHOWED SIGNS OF ALLERGY UNDER THE MICROSCOPE.

WE GET THE BIOPSIES BACK WITHIN THREE TO FOUR DAYS TYPICALLY AND THAT IDENTIFIES THE DISEASE WE SEE UNDER THE MICROSCOPE AND THEN WE CONTACT OUR PATIENTS AND DISCUSS WHAT TREATMENT OPTIONS ARE AVAILABLE FOR THAT.

>> ARE THERE WAYS TO PREVENT THESE PROBLEMS FROM DEVELOPING?

>> SOME.

THE ORIGINAL THOUGHT IS THAT YOU WOULD DELAY INTRODUCTION TO THESE QUOTE HIGHLY ALLERGENIC FOODS.

SO PARENTS WERE INITIALLY TOLD, DON'T GIVE THESE TO BABIES.

WAIT UNTIL THEY'RE OLDER.

THAT WAS THE OFFICIAL RECOMMENDATION FOR A LONG TIME.

IT TURNS OUT THAT EARLY INTRODUCTION TO THESE FOODSINGS ACTUALLY IMPORTANT FOR PREVENTING FOOD ALER ALLERGY.

THE PARADIGM HAS SHIFTED AT THIS POINT AND NOW THE RECOMMENDATION IS TO ACTUALLY GET THE FOODS IN WHEN BABIES START TO EAT FOODS FOR THE FIRST TIME, FOUR TO SIX MONTHS.

ARE.

>> MY FRIEND WHOSE CHILD HAS THE MILK ALLERGY WAS TELLING ME THEY HAVE THESE LITTLE PACKETS OF DIFFERENT KINDS OF FOODS THAT THEY START INTRODUCING TO THEIR BABY RIGHT AWAY ALL SORTS OF, HERE IS THE SOY ONE.

HERE IS THE NUT ONE.

SO IT'S A COMPLEX PROCESS.

>> YOU CAN SEE, YOU KNOW, PREPACKAGED FOODS FOR THIS.

YOU CAN ALSO JUST USE REGULAR FOODS.

YOU KNOW, MY KIDS, ONE OF THE FIRST FOODS THEY EATD WERE JUST PEANUT BUTTER AND YOU CAN WATER THAT DOWN WITH FORMULA OR BREAST MILK SO IT'S, YOU KNOW, EASIER FOR THE BABY TO SWALLOW FROM THE ANATOMIC STAND POINT.

>> SO THAT WOULD LITERALLY START RIGHT AFTER THE BABY IS BORN, VERY SHORTLY AFTER.

>> RIGHT, WHEN THEY'RE READY TO START EATING SOLID FOODS.

>> SO THAT'S THE BEST WAY TO PREVENT IS REALLY TO INTRODUCE THE FOODS, SEE IF THE CHILD HAS A REACTION TO IT.

ANY PARTICULAR WAY TO AVOID THE KINDS OF THINGS YOU ARE TALKING ABOUT?

THE MORE CHRONIC... >> I THINK IT'S A LITTLE MORE DIFFICULT BECAUSE WE DON'T ARRIVE AT THAT ALLERGY DIAGNOSES UNTIL WE DO ENDOSCOPY IN THE PATIENTS.

WE SEE ANOTHER GROUP OF ALLERGIES THAT ARE NOT CELIAC DISEASE BUT ARE CAUSED BY MAYBE DELAYED REACTION TO FOOD.

SO WHEN WE ENDOSCOPE THOSE PATIENTS, WE SEE SIGNS OF THESE CELLS... WE HAVE THESE TISSUE AND THEY'RE THE CELLS THAT ARE IMPLICATED IN ALLERGY.

WHEN PEOPLE HAVE ASTHMA, THEY HAVE THESE CELLS IN THE LUNG, AND IN THE GUT.

ONE OF THE COMMON CONDITIONS WE SEE NOW THAT CAME OUT OF THE BLUE ABOUT 20 YEARS AGO IS THE ALLERGY IN THE ESOPHAGUS AND THAT USUALLY PRESENTS TO US WITH DIFFICULTY SWAL SWALLOWING, MORE IN MALE PATIENTS.

SOME OF THE LITTLE BABIES WITH THAT PROBLEM HAVE MORE REFLUX VOMITING TYPE SYMPTOMS AND WE SEE ALLERGY IN THE STOMACH THAT CAUSES VOMITING AND ALLERGY IN THE SMALL INTESTINE THAT WILL CAUSE DIARRHEA AND POOR WEIGHT GAIN.

THESE ARE CONDITIONS OF THE GUT THAT WE CAN FIND AND WE TRY TO WORK BACKWARDS.

YOU CANNOT PREVENT THEM.

IN THE YOUNGER CHILDREN, A LOT OF THEM ARE RELATED TO MILK PROTEIN AND WE WILL SEND OUR PATIENTS TO DIETICIAN TO REMOVE MILK PROTEIN FROM THEIR DIET.

>> SO SO THEY GET SENT TO YOU AND THEN YOU WEIGH IN ON WHAT ARE THE ALTERNATIVES TO MILK FOR THAT BABY?

AND THAT FAMILY, IT SOUNDS LIKE.

THEY MAY ALL NEED TO BE... >> AND IT DEPENDS ON, YOU KNOW, THE ALLERGY.

WE TALKED ABOUT THE MILK BEFORE BUT WITH CELIAC DISEASE, SOME FAMILIES MAY GO ALL GLUTEN FREE AND SOME FAMILIES MAY JUST HAVE THE CHILD WHO HAS THE CELIAC DISEASE BUT FOR US AS DIETICIANS WE ARE HELPING THEM NAVIGATE THE FOOD LABEL, WHAT TO LOOK FOR TO SEE WHERE THE FOOD ALLERGEN IS AND HOW TO IDENTIFY IF THE FOOD HAS THE FOOD ALLERGEN.

>> YEAH, WHEN YOU READ THOSE LABELS, I'M A LABEL READER.

I TRY TO AVOID SUGAR AND FAT AND , YOU KNOW, THEY ARE VERY OPAQUE, LET'S JUST PUT IT THAT WAY.

VERY HARD TO FIGURE OUT.

WHAT-- LIKE WHEN YOU ARE READING THEM, HOW DO YOU KNOW IF THERE IS MILL INCOME THERE BECAUSE SOMETIMES I THINK IT'S NOT ACTUALLY VERY CLEAR.

>> SO THE NICE THING IS THE FDA CAME OUT AND THEY HAVE AN ADVISORY STATEMENT THAT HAS TO BE ON LABELS FOR THOSE TOP NINE ALLERGENS IF A PRODUCT CONTAINS MILK, IT HAS TO HAVE A BOLDED STATEMENT UNDER THE INGREDIENT LIST THAT SAYS THIS PRODUCT CONTAINS MILK, THE SAME THING WITH YOUR WHEAT, YOUR SOY, ALL THOSE TOP NINE ALLERGENS.

FOR CELIAC IT'S A LITTLE MORE CONFUSING BECAUSE BARLEY AND RYE DON'T FALL UNDER THOSE STATEMENTS.

HAVE YOU TO LOOK THROUGH THE LABEL A LITTLE MORE AND BECOME MORE FAMILIAR WITH READING INGREDIENTS.

>> SO THE MEDITERRANEAN DIET GETS A LOT OF PRESS THESE DAYS.

IS IT AS GOOD FOR YOU AS EVERYBODY SAYS?

I KNOW IT'S REALLY NOT SPECIFICALLY RELATED TO ALLERGIES BUT I WANT TO KNOW.

>> AT THE END OF THE DAY, THE MEDITERRANEAN DIET IS JUST FOLLOWING YOUR GENERAL HEALTHY GUIDELINES WHEN IT COMES TO FOOD.

SO THINGS LIKE LEAN MEATS, FISH, FRUITS, VEGETABLES, WHOLE GRAINS, LIMITING PROCESSED FOODS AND SUGARS.

>> SO THAT ULTRAPROCESSED THING, AGAIN IN THE NEWS A LOT THESE DAYS, REALLY THAT'S A GOOD IDEA TO AVOID ULTRAPROCESSED FOODS.

>> YEAH AND YOU REALLY WANT TO STICK TO THE WHOLE FOODS.

THINGS THAT ARE ON THE PERIMETER OF THE GROCERY STORE.

THOSE ARE THE THINGS THAT HAVE THE MOST NUTRIENTS FOR YOU.

>> ON THE PERIMETER.

TELL ME ABOUT ON THE PERIMETER OF THE GROCERY STORE.

THIS IS A NEW IDEA TO ME.

>> SO THAT'S THE EASIEST WAY FOR PEOPLE WHO WANT 20 EAT A LITTLE HEALTHIER, THEY STICK TO THE PERIMETER.

THE PRODUCE SECTION WHEN YOU FIRST WALK.

YOU HAVE THE MEATS ON THE OUTSIDE.

YOU WILL HAVE LIKE POLITICAL CAN AND DAIRY AND THEN TYPICALLY IN THE CENTER OF THE GROCERY STORE IS GOING TO BE YOUR MORE PROCESSED THINGS LIKE YOUR COOKIES, CLIPS, THINGS THAT WE WANT TO KEEP MIN PLAL IN OUR DIET.

>> SO THAT'S DON'T MAKE A BEELINE FOR THE CHIPS AND GET HUNG UP RIGHT THERE.

YEAH.

>> WE HAVE TWO TWO R MINUTES LEFT.

ANY PARTICULAR WORDS OF WISDOM.

>> FOOD ALLERGY IS MORE COMPLICATED THAN I THINK PEOPLE REALIZE.

>> IT SOUNDS LIKE THAT TO ME.

>> SYMPTOMS MAY OR MAY NOT BE FROM FOOD ALLERGY.

IT'S GOOD TO, YOU KNOW, VISIT YOUR HEALTHCARE PROVIDER TO DISCUSS CONCERNS ABOUT FOOD ALLERGY AND THEY KNOW WHEN TO ENLIST THE HELP OF A GASTROENTEROLOGIST OR ALLERGIST AND THE NUTRITION PIECE IS VERY IMPORTANT BECAUSE GROWING CHILDREN NEED ADEQUATE NUTRITION EVEN IF WE ARE RESTRICTING CERTAIN FOODS FROM THE DIET.

WE ARE OUT THERE, WE ARE AVAILABLE FOR HELPING PEOPLE OUT IF THEY NEED OUR HELP.

>> AND YOU FOLKS ARE, I THINK YOU ARE STARTING A NEW CLINIC, RIGHT?

>> WE ARE STARTING A G.I.E-- A CLINIC SO WE COLLABORATE WITH PETER'S GROUP IN ROCHESTER BECAUSE THEY'RE AN ALER J I GROUP THAT REALLY UNDERSTANDS FOOD ALLERGY.

AND WE-- I HAVE AN INTEREST IN FOOD ALLERGY MYSELF.

WE ARE SETTING UP A MULTIDISCIPLINARY CLINIC WHERE WE CAN SEE PATIENTS TOGETHER EVEN IF WE ARE NOT IN THE SAME SITE, WE CAN TRY TO SEE PATIENTS TOGETHER AND PUT OUR HEADS TOGETHER AND MAKE BEST PLANS FOR THEM.

>> THAT SOUNDS GOOD.

SO IT'S PROBABLY SAFE TO GO OUT TO LUNCH WITH YOU FOLKS.

LIKE YOU WOULD BE ABLE TO POINT ME, DON'T EAT... WELL, THAT'S ABOUT ALL THE TIME WE HAVE.

I WANT TO THANK OUR GUEST VERY MUCH FOR COMING IN DR. CHRISTOPHER JUSTINICH, PEDIATRIC GASTROENTEROLOGIST, AND MS. KATRINA DUFRESNE, CLINICAL PEDIATRIC DIETITIAN WITH UPSTATE MEDICAL UNIVERSITY AND DR. PETER CAPUCILLI, PEDIATRIC ALLERGY & IMMUNOLOGY SPECIALIST AT ROCHESTER REGIONAL HEALTH FINALLY, WE HAVE A TRADITION HERE CALLED ‘LAUGHTER IS THE BEST MEDICINE'.

LET'S SEE IF YOU CAN ‘STOMACH' THESE JOKES-- >>KNOCK KNOCK.

>> WHO'S THERE?

>> MAY.

>> MAY WHO?

MAY CONTAIN TRACE AMOUNT OF NUTS!

>> I HAVE A FOLK FOR YOU.

>> KATRINA, GO FOR IT.

>> WHAT HAPPENED TO THE BEE WHO HAD AN ALLERGY TO HONE?

>> I DON'T KNOW.

THE BEE HAD AN ALLERGY TO HONEY?

HE BROKE OUT INTO HIVES!

TO HEAR OUR NEW COMPANION COMMUNITY FM RADIO SHOW, CHECK UP FROM THE NECK UP, VISIT WCNY.ORG/COMMUNITYFM.

AND FOR ONLINE EXTRAS, VISIT WCNY.ORG/CYCLEOFHEALTH.

FOR 'CYCLE OF HEALTH,' I'M PSYCHOLOGIST DR. RICH O'NEILL.

THANK YOU FOR CHECKING IN, AND WE'LL ‘SNEEZE' YOU LATER!

NEXT WEEK ON "CYCLE OF HEALTH..." >> TONIGHT'S TOPIC...

ATTENTION DEFICIT HYPERACTIVITY DISORDER.

COMMON FOR KIDS AND ONCE THOUGHT TO AFFECT ONLY KIDS BUT ROUGHLY EIGHT MILLION ADULTS IN THE U.S. HAVE IT.

WHAT ARE THE TELL TALE SIGNS.

CAN IT BE TREATED?

AND CAN YOU HAVE A SUCCESSFUL LIFE ANYWAY?