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Ask the Expert: Allergy Partners

The physicians at Allergy Partners of Fredericksburg are like detectives. When an otherwise harmless substance in the environment causes an individual’s immune system to mount a response that brings discomfort and adverse health impacts, these board-certified allergists  spring into action. In a safe and controlled setting, they lead patients through the testing necessary to identify the allergens causing the reactions, and work with patients and their families to formulate a plan for diagnosis, treatment and management.  


As our March Expert, Dr. Jonathan Mozena, M.D., a board-certified physician who has practiced with Allergy Partners of Fredericksburg since 2007, offers information for parents about common food allergies, and how Allergy Partners works with families to treat and manage food allergies in children. 


How prevalent are food allergies in American youth, and what are the most common foods that cause allergic reactions? 


Food allergies have dramatically increased in prevalence over the last 20-30 years. Egg and milk allergies are the most common. Although 90% of children will eventually outgrow their egg or milk allergy only 15-20% of individuals will outgrow an allergy to peanut or tree nuts.  


The most common food allergies include: 

·       Peanuts 

·       Tree nuts 

·       Shellfish 

·       fish 

·       Eggs 

·       Milk 

·       Soy 

·       Sesame 


What has changed in recent years about our understanding of how food allergy works, especially in children? 


In the early ‘90s and 2000s, the recommendation was to hold off on introducing potentially allergic foods until children were much older. During that time, we witnessed a significant increase in the incidence of food allergies, particularly peanut, in children. From 2005 to 2015, the prevalence of peanut allergy among children in Western countries actually doubled, according to a pivotal study known as the Learning Early About Peanuts—or LEAP—Trial. The LEAP Trial taught us that children exposed to peanuts early on were significantly less likely to develop peanut allergy. Consequently, the pendulum has now swung in the other direction and physicians are now stressing the importantance of early introduction of foods -between 4 to 6 months of age—as this is felt to represent an ‘immunologic window’ by which to develop tolerance to otherwise allergenic foods. 


What are some tips for introducing hyper allergenic foods safely at 4 to 6 months? 


When introducing new foods to infants, you want to make ensure that it is not a choking hazard. A smooth, non-chunky peanut butter diluted with breast milk or infant formula is a good starting point. We still recommend strict avoidance of honey in infants under 12 months due to the presence of botulism spores in honey, which can pose a severe health risk to infants, so do not use peanut butter that contains honey. We also suggest introducing just one potentially allergenic food per day. That way if there is any sort of reaction it will be easier to determine the cause. Give a small amount of the food and watch the child over the next 30 minutes for any signs of allergic reaction. The most common manifestations of a food allergy include hives or itching with less common symptoms including vomiting and breathing problems such as coughing or wheezing.  Food allergy symptoms typically occur within minutes of ingestion though reactions can be sometimes be delayed up to 30-45 minutes. Suspicion of a food allergy should prompt emergent medical evaluation.  After an initial reaction is treated it is imperative to follow up with a board-certified allergist for evaluation and instruction on how to avoid and treat future reactions. 


Once introduced, the food should remain regularly in the child’s diet. So for peanuts, that might look like a little bit of peanut butter on the finger, or mixed with formula or breast milk, and then as long as there is no allergic reaction, you continue to give it at least three times a week. That is what the data supports for preventing food allergy. 


How do you work with families to help them figure out what is causing what may look like an allergic reaction in their child? 


The most important part in determining the cause of a suspected food allergy is the clinical history or story. Oftentimes, what a parent or even another doctor might think is a food allergy can be something else entirely. There are a lot of adverse food reactions which can mimic food allergy.  Additionally, viruses and vaccines can sometimes trigger rashes and hives which can mimic a food allergy. The important thing to know about food allergy is that it is consistent and reproducible meaning that every time you eat that food you are going to see a reaction. A comprehensive medical history in combination with allergy testing (skin testing and lab work) is the gold standard for diagnosing and quantifying a food allergy.   


What are some new treatment options for food allergy? 


We believe that 2024 will be a milestone in the treatment of food allergy. Oral immunotherapy (OIT) has been available for a few select foods such as peanut however usage of these treatments have not been universally incorporated into practice by allergists secondary to safety concerns.  New protocols such as sublingual immunotherapy (SLIT), where lower doses of food allergen given under the tongue, that help induce tolerance and have a much lower reaction rate have shown great promise. Finally, the FDA approved in 02/24 the usage of Xolair to treat food allergic individuals aged 12 months and older. For individuals with more severe allergy, we are hopeful that the usage of Xolair with OIT or SLIT will allow us to treat patients that we previously have not been able to treat in a safe and effective way. It is an exciting and optimistic time for the treatment of food allergy. 



What makes Allergy Partners of Fredericksburg a good fit for families? 


The physicians at Allergy Partners of Fredericksburg are board-certified in Adult and Pediatric Allergy which means that we are able to see the entire family. Allergic issues such as environmental (seasonal) allergies, eczema, asthma and food allergy have a strong genetic component where oftentimes several members of the family have these issues though not necessarily the same problems. We are part of the largest physician-owned national allergy and asthma specialty group which allows us to communicate with colleagues and experts across the country to tap into their clinical experience when faced with a difficult or challenging problem. Another benefit of being affiliated with a national organization of allergists is when patients move to a different geographic area they are often able to establish with another physician from Allergy Partners which gives them access to their medical records which helps facilitate a seamless transition. 


To learn more or to schedule an appointment for an evaluation for allergy or immune problems, visit  




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