Food and Environmental Allergies Are Nothing to Sneeze at

When Ranjeet Minocha, MD, Fellowship Trained and Board Certified in Allergy and Immunology, joined the Eisenhower Health medical staff in November 2018, he brought a new level of expertise to the Coachella Valley. In this issue of Healthy Living, we share how two of his patients have benefited. 

Ethan’s story

"Now I can pick out just about anything and take a bite with no worry. I feel very independent...it's almost as if I'm living a different life."- Ethan De Jesus
From infancy, Ethan De Jesus suffered from food allergies so severe that a single bite of a forbidden food could be fatal. The list of foods he couldn’t eat without risking his life was extensive: dairy, eggs, soy, wheat, rye, barley, oats, sesame seeds, poppy seeds, fish, shellfish, all varieties of nuts, coconut, mango, kiwi, passion fruit and melons. A bee sting could be equally lethal.

“Ethan’s immune system was so hypersensitive that exposure to even the smallest amounts of what would be harmless to a typical person became life-threatening to him in minutes,” explains his mother, Karen De Jesus.

Ethan recalls a time when he was around five that he tried a bite of American cheese. “I didn’t feel anything at first, then I vomited. Then, going to the car to get to the emergency room, I passed out on the grass. From just one bite.” 

An unimaginable impact

His dietary restrictions had an almost unimaginable impact on Ethan’s life and that of his family. 

“We never ate out, we packed lunches, made charts, arranged teacher trainings, had playdates at our house only, and always held our phones close fearing we would get a call saying our child was going into anaphylaxis,” Mrs. De Jesus continues. Anaphylaxis is an acute allergic reaction that causes the immune system to release a flood of chemicals that can send a person into shock — blood pressure suddenly dropping and airways narrowing, blocking breathing. Other symptoms include a rapid, weak pulse, skin rash, and nausea and vomiting.

Due to the risk of anaphylaxis, Ethan carried injectable epinephrine with him at all times, clipped to his belt. This medication acts to shut down the body’s allergic response by constricting the blood vessels, increasing blood pressure and decreasing swelling. 

Over the years, Ethan’s parents took him to numerous allergy specialists throughout Southern California. Incidentally, Ethan’s father, Emanuel De Jesus, MD, is an emergency medicine physician at Eisenhower. But beyond running tests that repeatedly showed him to be too reactive to eat everyday foods and advising the family to take the precautions they were already taking, there was little that could be done.

“At school, it was difficult, seeing kids eat things I’d never tried,” Ethan recalls. “And if I had so much as a stomachache or heat rash, the teacher would send me home immediately.”

When things started to change

As Ethan approached adolescence, however, things started to change — for the better.

“His immune system started to mature, and his allergies began to subside, enabling him to eat some foods he’d never had before,” his mother relates. 

“Gradually, some of my smaller allergies, like coconut and almonds — they’re still the only nut I can have — went away,” Ethan says. “Bigger allergies, like milk, got better when I was around 12 or 13. That was huge; I could finally eat ice cream!”

According to Mrs. De Jesus, another change for the better was when “Dr. Minocha came to Eisenhower.”

“Ethan was one of the first patients I saw when I came to Eisenhower,” Dr. Minocha says, noting that starting a food allergy program was one of his priorities in coming to the Health System. His assessment of Ethan’s condition was comprehensive. 

“We spent a lot of time discussing the variety of different food reactions experienced over the years and focused our attention on foods he was continuing to avoid, which was still quite an extensive list,” he says.

“Having established a baseline, we performed updated allergy skin testing to the foods he was continuing to avoid,” Dr. Minocha continues. “It’s important to determine if a positive test really matches up clinically to symptoms; sometimes a test is positive, but the patient has no symptoms to that particular food. This is what we call a false positive test.”

Testing has come a long way

“In conjunction with skin testing, we also obtain specific blood tests to help determine if a patient may have outgrown a particular food allergy or to make sure the skin test was not falsely positive. Blood tests for food allergies have really come a long way,” he explains. “There are now cutting-edge blood tests that separate out the various different allergenic components for a particular food. It has really revolutionized food allergy testing.”

Take eggs, for example. They’re in a surprising number of food items, including baked goods, batter-fried foods, mayonnaise, pasta, pancakes and waffles, even prepared meat products. Historically, if you were allergic to eggs, you would avoid any and all products containing eggs.

“We’ve learned that there are multiple different proteins within an egg, and the allergenic component is different in a scrambled egg or French toast than in baked egg products,” Dr. Minocha says. “Blood testing today allows us to differentiate between these various forms. And by being able to tolerate one form or another, patients can liberalize their diet and enjoy foods they once avoided.” 

Through a combination of this sophisticated blood testing as well as skin testing, Dr. Minocha determined there was a good possibility that Ethan could eat baked egg products. 

“We decided to do what’s called an oral food challenge,” Dr. Minocha says. “It involves eating a serving of the allergenic food in a slow, graded fashion under medical supervision. A food challenge is the most accurate test to determine whether a food still needs to be avoided. We knew there was a possibility he could have a severe allergic reaction, but we felt those odds were low.”

Over several hours in January 2020, with Dr. Minocha monitoring him, Ethan consumed portions of three muffins containing different levels of egg — without an allergic reaction. 

“Here was a 14-year-old who’d never ingested any egg-containing products; he’d never eaten a donut, cake, brownies — the things we take for granted,” Dr. Minocha says. “After passing that food challenge, we started having him incorporate baked egg products into his diet for the next several months. We know that individuals who tolerate baked egg products are far more likely to then tolerate eggs in a raw or lightly-cooked form. We then had Ethan begin to incorporate these other forms, like scrambled eggs or mayonnaise, which he did with no reactions.”

“It was so exciting,” Ethan recalls. “All my life I thought eggs were so cool, so foreign.”

A new normal

Today, at age 15, Ethan is reveling in his new “normal.”

“Now I’m only allergic to nuts, except almonds,” he says. “When I used to go to the store, I could only eat a handful of things I actually wanted. Now I can pick out just about anything and take a bite with no worry. I feel very independent. It’s almost as if I’m living a different life. I think back to when I was a kid. I was a different person then.

“The best part is just the confidence, knowing that people around me don’t have to worry about [me],” he adds.

“Not a lot of people realize how impactful food allergies can be on a child’s life,” says Dr. Minocha. “It’s not just about the food they have to avoid or the fear of an allergic reaction; the social and psychosocial ramifications are often more profound.”

Ethan’s parents also celebrate their son’s newfound freedom — as well as their own from the fear that they’d lose him to the accidental intake of something as common as an egg.

“To watch our son carefreely eating pizza with his friends without me being afraid for his life is remarkable,” Mrs. De Jesus says. “Dr. Minocha’s medical care for Ethan has changed our lives.”

Deborah Greco’s story 

"I started getting better sleep right away because I wasn't all stuffed up and mouth breathing. And now I'm able to see cates without an allergic reaction."- Deborah Greco, DVM, PhD
Being a veterinarian who’s allergic to cats sounds like a cruel cosmic joke. But that’s precisely what happened to Deborah Greco, DVM, PhD, DACVIM, of Desert Veterinary Specialists.

As all those initials after her name suggest, Dr. Greco is a highly trained specialist who achieved Diplomate status (board certification) in veterinary internal medicine. In fact, she’s the only veterinarian with her advanced credentials within a 100-mile radius of the Coachella Valley.

But her worsening allergies — including to cats, which are ten times more allergenic than dogs — were seriously impairing her ability to function professionally and personally.

“I’d been a professor at Colorado State’s College of Veterinary Medicine and Biomedical Sciences for 12 years before going into clinical practice at The Animal Medical Center in New York City for about five years,” Dr. Greco relates. “Then, I was diagnosed with breast cancer and decided to go into industry.” She worked for more than a decade for Nestlé Purina®, traveling extensively, before returning to her home state of California and resuming clinical practice.

“I owned cats when I lived in Colorado and could tolerate them fairly well,” she continues. “When I started working in industry, I rarely saw cats. Once I got back into clinical practice and started treating them again, it seemed as though I’d lost any tolerance I once had and was having pretty severe allergic reactions.”

Debilitating allergic reactions

She also was having debilitating reactions to other environmental allergens such as pollen, grasses and mold; exposure would cause severe sneezing and coughing that would, in turn, trigger sinusitis (inflammation of the nasal sinuses). This would often turn into a bacterial infection requiring antibiotics, which would then “wipe out my gut bacteria.”

Her allergies put a crimp in her travel as an in-demand lecturer. She recalls a time she visited Charleston, South Carolina, in the spring. “I’ve lived in various places and got sensitized to the local flora. But I became so physically ill during pecan bloom time in South Carolina that I had to fly home on an emergency basis to see my doctor and get some relief.”

“I was at the point that I needed an inhaler,” Dr. Greco says. “The chronicity of it wears you down, then you have an acute reaction like that and can’t breathe. I’d had thyroid cancer in veterinary school and the surgery damaged my laryngeal nerve. My larynx is the size of a Cheerio so I can’t breathe when I get stuffed up.” 

To manage her rhinitis symptoms — congestion and sneezing, itchy, watery eyes, cough, runny nose — she would take antihistamines or nasal sprays but didn’t like the way they made her feel. She finally decided to see an allergy specialist, Dr. Minocha, in early 2020.

“Our testing confirmed that Dr. Greco had allergies to cats, dust mites and a variety of pollens,” Dr. Minocha says. “While allergies can be minor for some, for others, like Dr. Greco, they can be debilitating, severely compromising their quality of life.”

A new approach to allergy shots 

While medical therapies such as nasal sprays and antihistamines were an option, Dr. Greco wanted a solution that would target the source of her allergic sensitivity instead of simply mask her symptoms. She asked Dr. Minocha about allergy shots.

“Allergy shots are the only way to directly combat the body’s inappropriate response to an allergen,” Dr. Minocha explains. “We inject increasing doses of the substance a patient is allergic to, retraining the body not to overreact. This desensitization creates a state of tolerance that can last many years. 

“Shots have been around for more than 100 years and their effectiveness has been clearly established in treating allergies as well as preventing new ones from developing,” he adds. “They’re the mainstay of treatment for many people with allergic rhinitis and asthma.”

Their main drawback, however, is the time commitment involved. 

“To desensitize the body to relevant allergens, we’ve historically asked patients to come in weekly for almost a year to get increasing doses of what they’re allergic to,” Dr. Minocha explains, referring to the buildup phase of treatment. “It takes almost that entire year before patients start getting clinical benefit, which can deter patients from starting or staying with the treatment. For patients like Dr. Greco, whose work and travel schedule can be incredibly hectic, that kind of time commitment is just not possible.”

But Dr. Minocha is one of only a handful of providers in Southern California, and the only one in the desert, to offer what’s called accelerated allergen immunotherapy.

Faster, more convenient treatment

“We’ve been able to reduce one year’s-worth of allergy shots down to as few as five weeks. Patients are seeing benefit in just a matter of days to weeks and we’re now able to reach a much broader audience,” he says. Equally important (see Physicians’ Roundtable on page XX), the accelerated protocol demonstrates a safety profile similar to the longstanding conventional protocol and some studies have suggested that it may even be more effective too.

Not surprisingly, nearly 100 percent of Dr. Minocha’s patients opt for the accelerated shots, including Dr. Greco, who says she began experiencing improvement almost immediately.

“I started getting better sleep right away because I wasn’t all stuffed up and mouth breathing,” she says. “And now I’m able to see cats without an allergic reaction.”

For more information about Eisenhower Health’s food allergy program or the accelerated protocol for allergen immunotherapy, please call 760.346.2070 or visit EisenhowerHealth.org/AllergyRelief. These services are available for adults and children. 
 

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