Allergies and Allergens: Food, Seasonal, and Drug Allergies with Dr. Aleena Banerji
Let’s talk All Things Allergies. Today’s woman dreamer, Dr. Aleena Banerji is an Associate Professor at Harvard Medical School, Clinical Director, Allergy and Clinical Immunology at Massachusetts General Hospital, and the Director of the Drug Allergy Program. She shares her personal story and why she chose to pursue allergy medicine, as well as her expertise and perspective on the most common allergy questions, including desensitization, the exponential rise in food and nut allergies, allergy testing, and common symptoms and conditions to look out for. Thank you Dr. Banerji for this valuable insight!
What is your background and why did you decide to specialize in Allergy and Immunology?
I am an academic physician, which means that my interests span patient care, training the next generation of doctors and clinical research. Specifically, I am an Associate Professor at Harvard Medical School, Clinical Director of the Allergy and Clinical Immunology Unit and Director of the Drug Allergy Program at MGH. I studied biomedical engineering and attended medical school at Northwestern University in Chicago followed by an Internal Medicine residency and Allergy/Immunology fellowship. I have been on faculty at MGH since 2005. I have a special interest in drug allergy and angioedema including patients with hereditary angioedema.
I love the field of Allergy/Immunology because of the meaningful impact I can have on patients' lives whether it is improving their seasonal allergy symptoms so they can enjoy time outside or helping a cancer patient receive life-saving first-line therapy despite an allergic reaction . I really feel I am able to make an impact on my patients' burden of disease and improve their quality of life.
What are some common conditions you see in the office as an Allergist/Immunologist? How can some of these conditions be evaluated and managed in the office?
We evaluate and manage many different allergic issues including hives, rashes, immune system problems, food allergies, asthma but my specific areas of research are drug allergies and angioedema (swelling).
The first step with allergy skin testing involves pricking your skin with an allergen (food, drug, environmental etc) and then looking to see if you develop a local reaction in 15 minutes. We call this a “wheal and flare” reaction when the testing is positive. With certain drugs and environmental allergies, if the skin prick testing is negative, there is a second part called intradermal skin testing. This second step involves injecting a small amount of the allergen underneath the skin and again monitoring for 15 minutes to see if a local reaction develops.
We also perform oral challenges to foods and drugs to help people understand their allergies (this may be after skin testing in specific situations). On oral challenge involves introducing the food or drug in the clinic and making sure that someone is not allergic. Oral challenges are the gold standard to prove someone is not allergic and are usually done when there is a low likelihood of true allergy.
Drugs allergies that we can evaluate include antibiotics, aspirin, NSAIDs, insulin, local or general anesthesia, chemotherapeutic agents, monoclonal antibodies and checkpoint inhibitors. When we evaluate a patient with drug allergies, we review the clinical history and then decide if they would benefit from skin testing, a drug challenge and or desensitization.
We have heard a lot about desensitization. How and why do you use 'desensitization' to help treat allergies in a patient?
Drug desensitization is a way of safely giving a medication to someone who is allergic to the medication. Desensitization temporarily allows someone to take the medication despite being allergic by tricking the immune system into tolerating it. Desensitization involves starting with an extremely small amount of the medication that someone is allergic to and then over several hours (rarely days), giving increasing amounts of the at regular intervals (such as every 15 minutes) until the full dose of the medication is reached. Desensitization should only be performed under the guidance of an Allergist/Immunology who is trained in managing an allergic reaction as it may occur during desensitization.
Some common examples of where drug desensitization is really important is when it’s not possible to avoid a specific medication despite an allergy. This can include situations like giving the best antibiotic to treat a life-threatening infection, using aspirin to a patient with heart disease, using anesthesia in someone that needs to have surgery and making sure that a cancer patient can receive first-line chemotherapy. We are able to evaluate drug allergies in many of these cases and help someone stay on this very important medication despite a prior possible allergic reaction.
With the exponential rise in food and nut allergies in children and adults, what advice do you have for prevention and for people suffering from these allergies?
Food allergies including peanut and tree nut allergies are increasing in the United States and it is a major public health concern. The reasons for this are not completely clear but we hypothesize that the rise is potentially related to multiple factors. However, food allergies can be very dangerous and cause anaphylaxis so seeing an Allergist/Immunologist can be very important.
In terms of prevention, there is a lot of ongoing research and a few emerging key concepts. The most recent thinking is that early introduction of highly allergenic foods like milk, peanuts, eggs and tree nuts is thought to be very important, maybe even by 4-6 months of age. In fact, delayed introduction is thought to be associated with an increased risk of developed food allergies in certain cases.
For people suffering from food allergies, we can evaluate the history and determine if skin testing, blood work or an oral challenge in the clinic would be helpful next steps. Additionally, there are emerging data and studies on the use of oral immunotherapy (similar to desensitization) in patients for food or nut allergies. However, this should be discussed with your Allergist first. While there is a good rate of success, not everyone is a good candidate and food oral immunotherapy can be associated with allergic reactions. If appropriate, the Allergist/Immunologist will also prescribe an epinephrine auto-injector and instruct the individual on how and when to use it.
Bio: Aleena Banerji is an Associate Professor of Medicine at Harvard University and a clinical researcher with a strong reputation in the field of drug allergy and angioedema. She is also the Clinical Director at Massachusetts General Hospital. Dr. Banerji serves as the Director of the Drug Allergy Program, which she built to better manage patients with drug hypersensitivity reactions. To date, she has authored/co-authored over >70 peer-reviewed papers including manuscripts published in high-impact journals such as NEJM and JAMA. Dr. Banerji graduated from Northwestern University (Evanston, IL) with a BS in Biomedical Engineering before undertaking her medical training at Northwestern University (Chicago, IL). Following her graduation, Dr Banerji completed her internal medicine residency training at the University Hospitals of Cleveland/Case Western Reserve (Cleveland, OH). She then joined Massachusetts General Hospital in 2003 for her Allergy/Immunology fellowship training and became a member of the Allergy/Immunology faculty at MGH in 2005.