The Food Allergy Brain Episode 10: Dr. Manisha Relan, MD

This week on The Food Allergy Brain, Mia sits down with Dr. Manisha Relan, a pediatric allergist and immunologist who sees patients of all ages and has been one of the OG allergy voices on social media since 2019.

Dr. Relan shares how she approaches the emotional weight of food allergies with her patients every day, the proximity challenges she uses to help kids build real confidence, and what her dream care team for allergy families actually looks like (including support for the sibling, which often gets overlooked). She also breaks down the latest on early allergen introduction, OIT, SLIT, and Xolair, and gets candid about fighting misinformation online and knowing when to step away.

Dr. Manisha Relan's handle: 

Instagram: @pedsallergymd

Find Mia Silverman (Allergies with Mia): 

Instagram & TikTok: @allergieswithmia 

Website: allergieswithmia.com

Transcript

SPEAKER_00 0:01

Welcome to the Food Allergy Brain. I'm your host, Mia Silverman, Food Allergy Advocate, Content Creator, and Master's student in clinical psychology. This podcast explores the mental and emotional side of living with food allergies through conversations with experts and people doing important work in this space. Before you begin, please remember that everything discussed on this podcast is for informational and educational purposes only. It is not medical advice. For questions about your own health, food allergies, or treatment, always consult with a qualified doctor or medical professional. For today's episode, I'm so excited to welcome Dr. Manisha Raylen, a pediatric allergist and immunologist who sees patients of all ages and has been a trusted voice in the allergy community on social media since 2019. In this episode, Dr. Railin opens up about what drew her to the allergy field, how she approaches the emotional weight of living with food allergies with her patients every single day, and the fascinating techniques she uses like proximity challenges to help patients build confidence and reclaim their lives. We also dive into the latest science on early allergen introduction, immunotherapy, and what Dr. Railin's dream care team for food allergy families actually looks like. Let's get into the conversation. Dr. Manisha Raylen, it is such an honor to have you on the podcast today. Thank you for taking the time out of your really busy schedule to be here today.

SPEAKER_01 1:27

Yes, thank you for having me. I'm so excited. I just made it to the table at time.

SPEAKER_00 1:35

Perfect. So for those that maybe, you know, don't know who you are or learning about you for the first time, could you just kind of share a bit about yourself and what you do? Yes, absolutely.

SPEAKER_01 1:44

I am a pediatric allergist by training, but I see all ages. I've been in private practice since I finished my training over a decade ago. So oldie and goldy. Um, but still, I say mid-career is the best way to describe me. I am not new, but I also have a lot more to learn. And I think that's like one of the most exciting things about allergies, is that we are learning a lot and there's a new and up and coming, and it's a wonderful place to be. I'm also an author and a writer and a speaker, as well as a mother and a wife, and all the other duties. And you're a social media star too. You got you got some emotion on Instagram, like you're killing it. I I was one of the OGs as an allergist, and I'm still active in that space, and it's really a privilege to be there. I was thinking about that actually. You know, I've been there since 2019. No pitting. It's a long time. Like anything else, because it's a second passion. It's uh it comes and goes with life and all the other things.

SPEAKER_00 2:54

It's not a real, right? Of course. No, but it's it's a it's a good to have it's good to have like a little like passion project or something that you you enjoy to do for fun. And I feel like you post such great content, it's so informative and fun and engaging. So as I said, you're killing it. Thanks. So I I'd love to first kind of just get into you being an allergist. Like, what got you interested in being an allergist in the first place? Yeah, tell me about that, that journey.

SPEAKER_01 3:18

I I cite different moments in my life, really just happened during my residency. So while I was in the pediatric program three-year program, and I found out about an allergy fellowship after the date had already closed, so I applied late. And I found out about it because a co-resident of mine was doing the rotation and said how fun it was. And I was like, wait, you're having fun? What are you doing? I don't, I'm like, I was you know, when you're in the throes of things, so like take the pit, but like kind of think about it like in a long spectrum of of the years of residency. And I guess I have a passion for food allergies because of my nutrition background. I was a nutrition major and undergrad, and I think just growing up with some food intolerances and being in a in a culture where I just didn't eat certain foods, and so I've kind of navigated and understood cross-contact since I was a little girl. So yeah, and it just comes. Wow. Yeah.

SPEAKER_00 4:21

That's amazing. And so you've been an allergist for a decent amount of time now, you're kind of like mid-career. What has been the most rewarding experience of being an allergist thus far or so far?

SPEAKER_01 4:31

Oh my gosh. Okay. So if you have more than one, that's okay, T.

SPEAKER_00 4:35

Unless the top three.

SPEAKER_01 4:38

Okay, good. Definitely when I get someone's breathing under control. So I have I've seen people that are having asthma and this they're just breathing so I I just have vivid I pictures of people in my mind who I met me and then I fixed them, quote unquote fix them, stabilize them, control them, help them breathe better, get them on a regimen. People who did allergen immunotherapy with me. I just had a patient even this morning, it's only been 18 months, and he's like, the quality of life, the way my day-to-day has shifted. And I write immunotherapy very different. I think about things very different. I like to think outside the box. And so I love when my patients come back and tell me that. And then the third is when I help people clarify their food allergy status, whether it be through an oral challenge and you know, and getting over that. It's a it's a big, it's a podcast episode in and of itself. Working yourself up to getting to the challenge and then going through the challenge and then actually realizing I may have outgrown this. Like it's it's amazing.

SPEAKER_00 5:40

Yeah, that's that's I mean, there's so many. I mean, allergists, I mean, as an allergy patient myself, I'm just so grateful for allergists like you that are trying to make our lives and quality of life better. So just thank you for what you do for the allergy community. And on the opposite end of the spectrum, what have been the most difficult experiences of being an allergist throughout your career so far?

SPEAKER_01 5:59

Yeah, I got I got a couple good ones on that too. I would say hives, chronic hives is really hard because and eczema flick skin stuff, right? Yeah, people want to know why. People want to know the trigger, they want to know how to fix it, and I I too want to fix it, and I too don't want to depend on medications if I can find the root cause. Like I talk about root cause all the time. And the problem is that like I don't always have all the answers. And like I said, I'm willing to learn, I'm willing to listen, I'm willing to read things and look up things, but I would say some of those diagnoses are so challenging because we there's multi-factor, it's multifactorial. Many, many things contribute to the bucket that causes that diagnosis. And those are really difficult to control at times, and people are displeased when we don't have an answer.

SPEAKER_00 6:53

Yeah, because I mean, as you said, allergy is a new evolve, it's a forever-evolving field. There's so much things that we don't have answers to. So that kind of like makes sense that you're not always gonna have the answer to everything, and that's just like the unfortunate truth, I guess, right?

SPEAKER_01 7:07

Our testing modalities too, Mia, like you know, people that have irritable bowel syndrome or people that have food intolerances, we just don't have good tests for that. That doesn't mean that you're not experiencing those symptoms, like brain fog or headache and fatigue. It's true, that's real. It's just that I don't have a good test, and so therefore, it feels very like uh disenheartening as a doctor, too, to not be able to solve that. And same thing with EOE, even sinophilic esophagitis. Like, I wish that there was a test, and there is there's stuff coming down the pipeline, but uh tests that don't involve sedation and endoscopy and biopsy to monitor a disease, like that's really difficult.

SPEAKER_00 7:48

There's clearly a lot of limitations still. That's even in 2026, which is kind of surprising. Why why kind of going off the shirt right now? But why do you think that is that due to funding for like more research? Like, why do you think that's the case?

SPEAKER_01 8:03

Yeah, I think funding probably plays a big role, and maybe just in general time, like research moves slow because things are so controlled. Um, and like one the thing about being a scientist is that you're never done asking questions, like you're always like you do one thing and then you're gonna have another 10 questions out of that, and then out of those 10, you'll have to do like 20 experiments. Um, so I think it's just a never-ending inquisitive nature. And another big part of it is that we are as much as we like to isolate and control things in experiments, we're a human body, we're always bombarded by like many signals, but we can't control for all of those variables all the time. So that's why we need to have reproduced, like so we don't just base it off of one study, we base it off of multiple studies that lead us to the same conclusion over and over. I think that's the hallmark of that.

SPEAKER_00 8:53

That's a good answer. I think that makes complete sense. So thank you for sharing that. Oh, Dr. Raylan. So I'd love to kind of get into because as you know, this podcast kind of focuses on the mental health side of living with food allergies, and you, you know, you see patients every single day. Like, you know, how often does the emotional weight of living with food allergies kind of come up when you meet with your patients? Is that something that they feel keeping comfortable to discuss with you? Like what has your experience been like with that?

SPEAKER_01 9:18

Yeah, I think it comes up every day, and I think it should come up every day. It's part of the visit, it's part of who you are. Um, I would say that some people feel more comfortable than others. For some people, it takes meeting somebody for the first time. You don't know them, they don't know you, and it's like a relationship that has to build like anything else. So I would say it depends and whether people know me and the family knows and I know the family. And so as we learn together, what are the goals, what are your thought processes, what is your support system like? You know, do you live in a place where people support you or are you being bullied and you're you don't feel comfortable talking about it? So it's very important. It should be like a vital sign. Like it should be one of the things that we check off and we measure and assess, right and miss it.

SPEAKER_00 10:10

And do you feel like as you kind of mentioned that you know you see people patients that may be a bit more comfortable with allergies and some that are probably on the polar opposite like end of that spectrum? You know, do you think they're like what would you say is a kind of like a fine line between like having like a healthy sense of like vigilance versus like anxiety that is kind of debilitating in your perspective?

SPEAKER_01 10:29

I think uh one question that can answer that is about travel. Do you feel comfortable traveling with your food allergies? Because that gives me a sense of can you step out of your house? Can you go to a new restaurant? Like it answers all of those questions that I think about. And do you feel comfortable managing that? It doesn't even have to be air travel, it's just travel. Can you travel? Um or do you have to be in your cocoon? And that gives me a sense of where we are. Um so I may not have all the time, right? Because doctors' visits are getting shorter and shorter. But if I can uh get insight by asking a couple of questions, that can lead me to the topic that I need to go into.

SPEAKER_00 11:17

I think that's a really interesting question because it's like it's so true that traveling's not just like going to like Europe, it's just leaving your house, commuting to work, going to school, just living your everyday life. That's a really good question to kind of see you know the status of this person's comfort level with just leaving the house and living their life. So that's a really good I didn't even think of that kind of question to ask, but it's very telling.

SPEAKER_01 11:42

Yeah, it does. It tells me a lot. Because that embeds into it the restaurant experience. It embeds into it going to a completely new environment. And it's a it's a privilege to be able to travel out of the country. So I don't like to say that. And then there's air travel includes people's fear of just flying. So I don't like to always say just air travel, although air travel deserves also another episode of its own Mia.

SPEAKER_00 12:11

There's so many topics. There's a lot to break down. Um but yeah. That's that's really interesting. And you know, when you do have a patient that like says, like, yeah, like I traveling, like just leaving the house is like a very difficult thing. What kind of are the next steps you do to kind of help best support them?

SPEAKER_01 12:37

I build, I go really slow, I backtrack as much as I can. I say, where are we comfortable? And then what's one thing we can do that's uncomfortable but within the safety margins? Because it's it's almost like a proximity challenge. Have you heard of those before?

SPEAKER_00 12:51

I have, yes. I had, yeah, it's it's it's really interesting. I just I learned about it from a previous guest, and I was like, I didn't even know what that was until so yeah. Okay, so I maybe you could share what it is, though, just so our listeners who don't know what proximity challenge, you mind just explaining like, yeah.

SPEAKER_01 13:07

Yeah, yeah. So it's like if you're allergic to peanut butter, for example, a proximity challenge would be to have a jar of peanut butter on the table next to you. You're in close like proximity nearby to something that you're allergic to. You're not touching the food, it's definitely sealed and closed jar. So it's not like you're gonna anaphylax, you can't even smell it, it's completely closed, but you're right next to your allergen. How does that make you feel? And for many people that's gonna increase your heart rate. It's gonna it's it's stressful to be that close to your allergen when that's something that can make you really sick. And that's a really scary experience. But I have kids that do that with me because they're so scared. Like we can't talk about leaving the house if we can't talk about just being in the same space as that allergen, and that's a visible allergen. So, how are we gonna talk about the the cross contact, you know? And how are we gonna talk about dining and all of that if we can't get past what we can see and isn't even touching us? It's an it's an inanimate object, it's not moving.

SPEAKER_00 14:14

Yeah, and from your experience, obviously, it's a kind of a generalized question, but how have patients been like responsive to that? Like, how how do you see like a a difference in the way they like like their self-confidence? Are they feeling more comfortable being in environments maybe they were were not once before after doing this type of like yeah?

SPEAKER_01 14:35

It's a good question. I think it builds. I started with that, I even went to a couple more steps after that is like opening the jar and having it open. And then I even I took a little bit of peanut butter once and I even put it on their forearm because the child was so scared to go to school, he was so scared to be in the same vicinity, you know. And I wanted to show him that like even if it touches your skin, you're not gonna anaphylax, you're gonna be okay. It's gonna be red and itchy there for sure. Right. I mean, I was I was wiped it off after a minute, you know. Like, I'm like, you're not gonna, but I wanted to to go through those steps because at least we're together and it's a controlled environment. But I would say that it takes time. Some people, it's just the the conversation alone sends their heart rate racing. I have patients that tell me that coming to see me is the hardest part of the year for them. They dread it. They dread cu coming to the visit, like the kids dread it, the parents are you know, they have to, but it's I could see that, and every one of us has a different tolerance, and every one of us has a l different lived experience. Yeah, it's a lot of b steps.

SPEAKER_00 15:49

It's a lot, no, but I but I think that that's important. I think you know, you've seen just in general other types of therapy or people that have different mental health conditions, like exposure therapy can be really beneficial. This seems like it's kind of a form of like exposure therapy. Obviously, you have to make sure you're doing it in a controlled, like safe, like medical setting, like not like without the consent of like your like or permission from like your allergist or doctor, but that's really interesting. So thank you for kind of providing that insight. Yeah, you know, because you say that you see, you know, because we also see like you know, young adults probably with allergies are different ages of uh allergy patients. You know, what how does the emotional experience of like food living with food allergies kind of differ from like a child versus someone like who's gonna be my age from your perspective? Like what have you kind of seen?

SPEAKER_01 16:32

I think confidence is like a big one. You know, the more time you you spend navigating this day to day, the better you start to figure out what questions are important, what time of day should you go to the restaurant, like which restaurants do you pick and how do you pick it? Like you just get better at it because you've been doing it for so long. And I'm not saying it's easy, I'm not saying that there's not extra time involved, and not saying that there's not a stress component, I'm not saying it's a hundred percent safe. I'm just saying you get better at something that you practice, and the more you do it, the better you get at it. So I would say that's one big difference. And then I think for some, I notice some patients are a lot more hyper-vigilant, and then some lax, like some teenagers get so relaxed. I'm like, okay, no, no, no. You went we went past my comfort. And I'm like, no, no, no, you gotta carry our P Pen. Like epinephrine device. Like, you can't just have that in the car or at home or in the bag. Like, no, no, no, no, no. On your person.

SPEAKER_00 17:39

You don't want to have like any, you want it to be kind of right in the middle, not like super, like super cautious or or like not cautious at all, but like just right.

SPEAKER_01 17:46

Yeah, and then it'll ebb and flow, right, Mia? Like, depending on what the activity is, depending on like you're not gonna go into a a restaurant or a bar that has peanut shells all over if that's your allergy. You're gonna ebb and flow in terms of what you're gonna do and what kind of risk you're willing to take. But as a first step, if you have never been to a restaurant, can you go to a restaurant with a parent and bring a safe food with you? Bring your own food, but can you go to a new place, a new table that you would have to sit at? You know, can that be the first step that you take?

SPEAKER_00 18:19

Yeah, I mean, I think that a lot of it's just meeting where you're at and where you're comfortable with, and also trying things that are maybe out of your comfort zone, but of course you have to be safe and responsible. I think like what you just said makes complete sense. So I guess I'd like to kind of, you know, because because I feel like you're pretty informed about the mental health side of allergies, and that's not really the reality for a lot of allergists, no offense to allergists that are listening to this. Like, there are some allergists who are really informed and some that are not, and I feel like you're very informed. Do you think that like you could you get training like on the mental health side of allergies when you were in your fellowship? Like, how did you kind of know?

SPEAKER_01 18:57

You just I mean, I read a lot, I enjoy humans, I think deeply about how I would feel if I was in someone else's shoes. And then I uh one of the things I always say in real life to my patients is I try to think of everything they need to know with all the knowledge I have. And like, how what do you need to know to navigate what's superfluous? Like, you know, do you need to know the exact names of the interleukins that are causing your like no, that's superfluous for you for this moment in time, but like what do you need to know? And I I think it's just again practice, it's also a personality thing, and then perhaps experience. It's it's just something I I don't know.

SPEAKER_00 19:49

That's it. No, it's that's another. I think you you gave a really great answer. So thank you for sharing that. Do you feel like there needs to be improvement with like allergy training and making sure there is like an emphasis on the mental health side of allergies? Like, like what do you kind of like how like what are your thoughts on that?

SPEAKER_01 20:09

I think in my ideal world, which it's not Manisha's world or Dr. Baylin's world, but in my ideal world, everything should be approached with a team emphasis. I am a good doctor, but I'm not a good therapist. That's not what I trained for. I'm a good doctor, but I'm not a nutritionist, even though I have my undergraduate degree in nutrition, doesn't mean that I'm a dietitian, that's a practicing dietitian. And I think that having a support team is really important. And in an ideal setting, we would have these ancillary members of our team readily accessible so that if I met someone, especially with the more number of foods you're avoiding, the more increased risk of nutritional deficiency. And so having someone that is food allergy informed is really helpful to make that referral, and we should be a team.

SPEAKER_00 21:00

Yeah, I love that. I love that. So, you know, there's been a massive shift in the last decade, I'd say, around like aller early allergen introduction, I feel like. Like, what what does the current science actually tell us? And like, why did the guidance or the the suggestions like for treatment kind of change so dramatically from what parents were told before? Because at least when I was a kid, my my parents were not like told to for to introduce like peanuts to me. They're like, don't do that. So, like or how has how has that kind of changed in your perspective?

SPEAKER_01 21:29

Yeah, I it's changed a lot even in my training because the leap trial, the thing that changed a lot of our perspective, was published around 2015, which is over a decade ago at this point. But I think that we were starting to notice trends, and I think science is all about curiosity and asking questions and noticing things and noticing patterns. So a lot of the early guidance came from risk of choking, right? Like big globs of peanut butter is probably not good for an infant because a choking hazard. And it's like, well, maybe we can wait till they're a little bit older and then we could feed them. Not realizing that delaying the introduction of any food, but especially some of the top allergens, could actually cause you to become allergic to them. So it was observational, and scientists started noticing that certain populations of people who culturally believed in introducing peanuts early because they had these puffs, they noticed that there were less incidences of peanut allergy in those cultures. And then they started asking, well, that's interesting. Why is that the case? And let's study this, let's make it organized and controlled. And that's what the leap protocol did. But it was it was rolling on other studies that had already been done with showing something similar with other foods. And the leap was focused on peanut, it was focused on infants for it to 11 months of age, and it was focused on a huge number. Over 600 infants participated in that. And so that's a big number. That's a big, you know, big sample size. Yes, it's all water. It is, it is. And then just this just for the like the listeners, nothing is perfect. One of the biggest interventions we can make is early introduction of these foods, but that doesn't guarantee it either, which is really interesting, Mia, because that asks the question well, should the introduction be earlier? So should it be even before four months of age? Or is there something else that's playing a role that we haven't discovered? And I think perhaps the answer is both. But is there like a genetic component? Is there something else in the environment that's driving these allergy forces that we don't know? And so for a certain population, about 20% of kids, it wouldn't matter when you introduce the peanut, like they would have been allergic anyway. So there's a lot of science that's shifting into that now and saying, well, it's what can we do? Do we do it at two months? Do we do it at three months? Like, what do we do? And what can we do to prevent more and more? One of the interesting things that we can do once a baby is diagnosed with a food allergy is start oral immunotherapy. And so to start OIT for short, which is basically micro exposure of the allergen, it may actually help retrain the immune system while the immune system is still developing and really young. And it may lead to some free eating by the time they're in early elementary. And that is like amazing. Amazing. I learned of that over the last year or two, and I'm like, this is this is where we have to be. This is where we need to go.

SPEAKER_00 24:32

I was actually like wanted to I have a whole section I want to talk to you about about OIT. Yeah. Because it's just I'm starting OIT in May, which is exciting but also nerve-wracking as an adult.

SPEAKER_01 24:43

No, it's never too late. It's never too late to be curious to try something. And Mia, no matter what happens, it's a learning experience, and you pivot if it doesn't work, you know? You can drop it to slip. If it's not OIT, it's slip, you know, whatever. But congratulations, that's a huge deal. Thank you.

SPEAKER_00 25:04

Thank you so much. So yeah, I guess we kind of just discuss what OIT is. Like, you know, I feel like, at least for me, like growing up, like I had an allergist who told me I was not eligible for OIT. It's like you can't do OIT, it's not for you. And then I'm seeing a new allergist who's like, oh no, like we could do OIT. But I guess like there probably are patients who maybe OIT's not the right fit for. Or do you think that that can happen? And if so, why?

SPEAKER_01 25:30

Yeah, I I mean to do any procedure, but especially something with a long-term investment of it, it's a time thing, it's a scheduling thing. It may be a cost thing because it's not covered by the FDA. And so some t some docs can get it covered under like visits that are covered by insurance, and some can't. And there's a lot of communication amongst the OIT groups about this right now, like how to make it more streamlined so that it is more accessible. But to do anything every day is really hard for human behavior and to do it consistently. So there are people for whom that might not be right. The number of foods, perhaps it's a food that you don't even care about. So seafood is an example that's used often. Not every culture eats seafood, not everybody likes seafood, it may not even be in your home. So, do you go through this whole big complicated thing of once a day, you know, dosing for a food that you don't even like, won't even eat, don't even go to those restaurants, does it matter? So if it's a food that doesn't impact you, it may not be something you want to do OIT for.

SPEAKER_00 26:41

Right. That makes sense. And you know, you mentioned that you also do slit in your U are you and so that is that that's that's sub lingual immunotherapy, right? Is that what it's called? What is that? Because I don't even know what that is, if I'm being honest with you. What's the difference between slit and OIT?

SPEAKER_01 26:59

Talk about it. So for clarification and for honesty and uh transparency, I do slit for arrow allergens at this time. I don't currently do food slit, but it is something that I know a lot about and I hope to be able to incorporate into my practice in the future. So it is one of my favorite forms of immunotherapy. Slit literally means sublingual immunotherapy. So immunotherapy means changing your immune system, right? A therapy that will actually affect your immune system. Sublingual means under the tongue. So it's basically what OIT is, but it's like a lesser quantity. So early OIT doses could even be called slit. And so they can call it low dose OIT is another name that's sometimes or another phrase that's sometimes used to describe slit. And you're basically going to take the allergen that you're allergic to in very micro doses and hold it under your tongue and then swallow.

SPEAKER_00 27:53

Wow. So it's a smaller dose that OIT if that's even possible. Wow.

SPEAKER_01 28:00

So you're doing it for like environmental allergens, is that I am truly offering it in addition to um regular allergy shots as a possibility for some people for whom regular allergy shots may not be an option or is difficult because of schedules and stuff like that. But it is definitely an a thing with food, and one of the things about it is that it's because it's low, such a lower dose, it's a lot safer, there's a lot less reactions to it. And then in the bigger question is like, well, do I want to do slit? Do I want to do OIT? The goals, like what is your treatment goal? And that kind of dictates it. But what I was telling you earlier is that if you start with one and you can't make it past a certain dose, or you just change your mind and you're like, I just don't want to do this anymore, then drop it to the lowest dose you feel comfortable. Talk with your allergists. Like we're supposed to be meeting and talking, so we can always pivot if things aren't making sense.

SPEAKER_00 28:58

That's well, it's really again. I I just learned something new today because I did not. I was like, I I've seen like stuff about slip, I never knew, but that actually is that's super fascinating. Yeah. I mean, I mean, as we've we've discussed, kind of how allergy just the field is always changing. There's always new findings, new treatments, research. What are some of like the new treatments or research that's evolving that brings you a lot of hope or excitement for food allergy patients and families?

SPEAKER_01 29:24

Well, definitely using real food to treat the allergy. I love it. I love things that just sound intuitive. And it sounds intuitive because allergy shots have been around since 1911. Like we've been microdosing things in the aero allergen space. Aero allergens are things that are like airborne. So basically pet dander, dust mites, mold, polls that kind of stuff. And so we've been very, very comfortable. And this is very similar. Instead of injecting it, we're putting it in our mouth. And if this data is showing the younger you are and the safer it is, that's amazing. Like I'm so excited for it. I'm excited to see more allergists offering it. I am in the process of learning more about it because it wasn't something I trained with or I knew I got a lot of exposure to, but that will change. And I think some of the newer therapies that are coming out for people for families that are not yet ready to put allergens inside their body or under their tongue. There's uh like the peanut patch that is coming, and so that's uh just like a sticker, and that's very safe, and it's just offers you as another stepping stone. But the goal would be to go from that to slit or OIT, in my perspective, because I think eating the food is the safest place to be. That's what we worry about, right? When you have a food allergy, your biggest concern is I don't want to eat my allergen by mistake. That's like the biggest thing. So let's get everybody to be at least biteproof. Like, that's always my first thought is like, let's get you to safety. And then if we can get you past that, that's amazing and wonderful, and let's do that too, as long as you want to. And then I am also really excited about two more things. One is probably hopefully coming down the pipeline. It's an option to take pills to offer protection from accidental exposures. And I think that's great because injectable therapy is really hard. And then the second thing I'm really, really excited about in in terms of pharmacotherapy is the gut microbiome stuff. Like I'm really obsessed with that. If we can find the root cause of why food allergies are happening, or find the missing bugs in our gut that we needed that we somehow accidentally erased with industrialization or pollution or antibiotics or some something else in the environment that we did for betterment of human life, but accidentally caused disease state. I don't know. I want to hear more about that, and I'm excited for that.

SPEAKER_00 32:02

And I'd love to quickly for you to talk about this pill. Because I've never heard of a pill. Like, could you are you are you like allowed to share more about that for my listeners or what you do know?

SPEAKER_01 32:14

I don't know that much about it myself. I just know that it's in like trial stuff, and so it's just I don't wanna I don't wanna give anyone false hope. I just wanted to say that their scientists are working and the immune system is marvelous, and so they are working on finding alternative therapies to protect us from accidental exposures and something that could be, you know, decrease your risk of anaphylaxis.

SPEAKER_00 32:41

That's really that's really exciting. And then what are your thoughts on like you know, mast cell stabilizer like shots like Zolair or Dupixin? Like, do you use those in your clinic? Like, what are and you can be I mean I take Zolair, but I'm always open to hearing different allergist perspective on it because I feel like it's still relatively new because I believe Zolar just got approved for allergy about like a year or two ago by the FDA and about four or five years ago because it was approved for asthma. So what are your thoughts on on like shots like that?

SPEAKER_01 33:12

Yeah, I it's actually been approved for asthma a lot longer. It was one of the first biologics. Omaluzumab is a generic name, and Zolar is a branded name, and so it was approved over two decades ago.

SPEAKER_00 33:25

Oh, I thought it was like four or five years.

SPEAKER_01 33:27

Oh my goodness. Um but it was the first biologic for asthma, and slowly over time it's being approved for more and more conditions. No, no, it really was. There's other stuff that just recently got approved. So it's been approved for chronic articaria, which is hives. It was approved for like polyps, it's been approved for now food allergies, and so the food allergy approval was definitely newer, but I think it's fabulous because it's another tool in the toolbox, and I get into little tit-tats with with practicing OIT docs because they're all just like, well, just use the food. And I'm like, I agree with you, but I work in a practice where we're not doing OIT right now, and for me, offering a therapy is better than doing no therapy because this medication shows that it can increase your threshold, and so isn't it better to do something to offer my patient safety, even if it means I don't have the OIT right now? So I am a big believer in it. I think it's a marvelous medication. My youngest patients, it's approved for ages one and up for any IgE mediated food allergy. So my young patients that have navigating like eight to fourteen different food allergies, like it's been a blessing. Those parents have cried tears in my office when I told them about its approval because it's really, really hard when your kid is so little and has to navigate a lot of the top eight of the nine, you know, foods. That's that's incredibly brutal. It's brutal. It's brutal. And I have to tell you while we're chatting, just for a second, because this is a passion space, please don't do food allergy panels because that's how that child got diagnosed. Was they had eczema, they saw a different provider, they did the food allergy panel testing, everything came back positive, and mom started to avoid the foods because that's what she was told, and then the kid became allergic to all of these foods.

SPEAKER_00 35:29

Oh, yeah, yeah. I mean food allergy skin testing, well testing, they're just not accurate, they're not I'm not sure. They're not accurate in the right situation, I would say.

SPEAKER_01 35:38

Like the history has to be right, and so who's ordering the test and who's interpreting the test, and are they up to date with what they're doing and saying? So I think in the right hands it's appropriate because that's the only thing I have available, and I use both of them. I use both skin tests and blood tests, but it just has to be in the right situation.

SPEAKER_00 35:59

Right, right. I think it's important to know for listeners who want to do those kinds of tests, just to be aware of they're not 100% like it's it's helpful to know, but what the way you really know is by doing a food challenge, kind of how you probably yeah, gold standard is the oral challenge itself.

SPEAKER_01 36:16

Yeah, and then the other population of people that I love is omelezimabis is like the older teenager going to college or navigating early adulthood and has multiple food allergies and then wants to pursue a therapy like OIT or slit, like that's fabulous.

SPEAKER_00 36:35

Yes. I'd love to kind of transition more to you know your online presence, even though it might be like something like a more of a passion project type of thing. I mean, you still have an online presence, and I think especially when you're a doctor, that's you know, it's definitely can be hard because there's a lot of misinformation on the internet. Like, how do you combat that? Like, like what what are some of the craziest things you've seen people post about? And how do you yeah, combat that?

SPEAKER_01 37:01

Well, they want to open that can of worms. Oh, yeah, we're doing that. We're doing that today. Well, I should probably make a list of all the misinformation online. We we touched on the food allergy panels. I found someone whose account name I can't the username I can't remember, but they were basically like promising food cure, like food allergy cure. And I was like, and they were like, What your doctor won't tell you is I can cure food allergies. And I was like, really? Because I don't gain anything, like I would love nothing more than to have everyone's food allergy be resolved. It's it's literally right up there to me for quality of life like cancer. Like I those two diagnoses I would just want disappeared completely, just for day-to-day. That's amazing. And there's probably multiple others out there that are, you know, just as bad and stressful. But yeah, there's no cure, you guys, that I know of, and I would never gatekeep that from my patients, as you probably recently saw. I, you know, the hypoallergenic dog comes up all the time. There's no such thing as a hypoallergenic dog, just doesn't exist. It's a marketing term. So hypo means low, low, but guess what? All dogs produce dander, and so it doesn't really matter. And just because they shed less doesn't mean that they make less dander. There's no correlation to that. So honey treating allergies, like I see this all the time. I see all different types of myths, I see some crazy, crazy ideas of using the skin test to do different things, and it's just it's not true. I could literally be on social media for eight to ten hours a day.

SPEAKER_00 38:51

There's just so much like BS that I've seen, and especially with our current healthcare system and the person who's running it, there's just a lot of bogusness going on. On top of that, you know, you also again, like when you have an online presence like yourself, you probably get a lot of hate comments or DMs. How do you navigate that when those do come up?

SPEAKER_01 39:10

I think you have to ignore them. I that's just the easiest thing to do. Some are people that have followed me for a long time, and occasionally they'll say respectfully, can we talk about this? And uh and I have had some great conversations with people about things I never really realized, like the way I may have said something and how it was perceived. For example, I'll use a food allergy uh diagnosis. So when the LEEP trial came out, we were just all talking about how important it is and how you can you know prevent food allergies. Well, you can't really prevent food allergies if you reduce the risk of developing a food allergy, and just sometimes realizing the person on the other side of the screen doesn't have my doesn't know my tone and doesn't really know me as a human being in real life, and so trying to get your thoughts across in a way that doesn't offend anybody or doesn't bring upon guilt because of what you brought up earlier as well. I've been thinking about in the back of my mind as a parent, the guilt that comes with not knowing that X, Y, Z should have been done instead of like A, B, and C that you did. And it was never with bad intention, your parents guided at that time with the knowledge that was available at that time. So approaching that from a place of forgiveness for yourself, and then also with the intent that now I know better, so now I know I'm gonna look into this before I do the next thing.

SPEAKER_00 40:41

Yeah, that's a that's a good answer. I mean, it's always being on the internet as you and I both know, it can be a lot, so it's important to probably like also just like set boundaries with like you see. And then when you do get those hate comments, you can't like take them personal because they don't know who you are, they don't know who they are. I mean, they they're just a random person. If I would not say it to your face, they're saying it online because it's easier to do.

SPEAKER_01 41:04

Well, I mean, when I was when I was pregnant with my second child, I was posting a lot about vaccines, I guess. So much hate toward my unborn child, and so many ill wishes toward them, and it was really hard, like it was hard not to to take that, you know, because when you're pregnant, you're a hot mess anyway. And so I had to step away. There's been lots of times that I have um stepped away from my social media and just like taken a break and said, Okay, this isn't serving me, this is not healthy, I uh what I posted wasn't being perceived correctly. Maybe it was the way I said it, maybe I could have said it differently, but I'm also a human being, and that's also uncalled for because science is science, and vaccines are amazing and life-saving. And that doesn't mean that they don't cause adverse reactions, that doesn't mean that someone that suffered it wasn't important, that that's important for that one family. That child getting sick is important, and I don't want to negate that, but it we also have to look at it from a big lens of what vaccines have done for the human race, and that's pretty amazing. But then to like wish somebody that you don't even know ill to their unborn child, I was like, whoo, I need a minute.

SPEAKER_00 42:22

No, it's it's it's heavy. So I think you should. I think it's important to take breaks when you need to, but I mean it's you gotta protect your peace, whatever it means for you. And I'm sorry that you got those comments because that's so unsettling, and it's just like yeah, people on the internet are vicious, yeah. And I think I'm I think it's important again to just learn when it's okay, like to step back and be okay with doing that to protect yourself and you know just your your well-being, it's important to do that. So I ask this question to all my guests, and we can you kind of mention it a little bit, but I'd love for you to go more in depth about it. But you know, if you could design the ideal emotional and medical support system for theology families and patients, what would that look like to you?

SPEAKER_01 43:05

Okay. Two caregivers, because I think a burden that falls into one is very difficult and not fair. And like, you know, goodness, you know, something bad happens to that caregiver. They could they fall ill, they're out for a week, something like a surgery or like a medical condition happened, or they travel. You don't want that the family to not know what to do if the one caregiver who managed everything. So always two caregivers if possible. It may not always be a mom and dad, it could be a mix of a grandparent or an auntie and uncle, it could be two moms, like whatever situation it is. I would say definitely a mental health therapist because whether we want to admit it or not, this is a chronic, invisible, debilitating at times diagnosis, and it impacts your quality of life. Then you should be able to talk about it and you should have more tools. And skills to in your toolbox to handle situations as they arise. And some of them are unexpected. You may not even know. And so having whether you meet with them only once every three months because you feel so good, but just having someone in that toolbox is so important. And then a definitely a nutritionist, a dietitian. Uh someone that can help you make sure that you're meeting your optimal goals for uh well-being, because we need that. Food is life. And a physician that's up to date would be very nice to have. Could also be an advanced practice provider. Uh I think just having a medical team. Um sometimes you need a good solid nurse to help you with biologics and phone calls and all the the back end of navigating the insurance health system. You might even need a good case manager on that end. But that's all the insurance stuff. Mia, one thing that I don't always acknowledge online, but I really want to try to remember to acknowledge a little bit more, is also the sibling of the person that has a food allergy. And so support for them too, because their child has also affected by their parents or caregivers having to navigate an another child with chronic medical condition. And um and I think that they deserve their their attention as well. So a balance to include them because they're part of they're part of the little bit of a bigger circle, but they're a really important part of it. And they can they can stand up for you and they can learn from you and they can be an ally to the community. So let's not neglect them because their mental health matters too.

SPEAKER_00 45:45

I that's a beautiful answer. I like I really love that, and I really love how you also touched on the sibling aspect because I think oftentimes when you know pay a patient has a diagnosis that's like, you know, not great, whether that is allergies or even something as extreme as cancer, like it also weighs on the sibling too, to some degree, because you're now watching your sibling suffer, and the parents are probably putting more attention on the the sibling than yourself, whatever. I get there's so much that goes into it. So I think that it's so important to also have like, you know, your sibling matters too, they deserve to have attention as well and be taken care of. I think that your vision is is the dream. I really hope that one day we can live in a world where that's the standard for allergy clinics because it should be, because allergies affect like all aspects of life, and to have a care team that addresses all those different aspects, like eating, like the actual like nutrition part, the mental health part, the actual like medical part, that is just the dream. That's the dream, that's the dream. But in the meantime, all we could do is advocate for it. And so, again, I appreciate you for just you know for the work you do. For thank you, you know, posting on the internet is a scary thing to do, so it's just brave of you to do that as well. So thank you for taking that risk to put yourself out there for the world to see and to educate the the public because as someone that also posts on the internet, it's scary sometimes. It's it's scary out there. People are it people are mean and you know how many times I ask myself, what the heck am I doing?

SPEAKER_01 47:10

I was like, did I just make a video of myself like typing on a laptop? Did I just what am I doing?

SPEAKER_00 47:17

Did I really just do that? Like, why'd I do that? No, it's it's so that's such a universal experience for content creators. Like, definitely like resonate with that. But anyway, Dr. Raylan, thank you so much for taking the time again out of your busy schedule to be here on this podcast. For those that want to, you know, follow you, support what you do, where can they find you?

SPEAKER_01 47:34

Yeah, I'm on Instagram predominantly at this time at Pete's AllergyMD. And maybe if I have the bandwidth, I will expand to TikTok, but I'm just not there yet, girl. That's okay.

SPEAKER_00 47:45

That's okay. But for I'll make sure to link your Instagram in the description so those can support you. But for those are listening, thank you for listening to today's episode. I hope you all have a wonderful day, night, afternoon, wherever you're from, and I'll see you next time. Bye.