Let's Talk Allergies, Asthma, and School Policies: Dr. Ruchi Gupta Shares Her Expertise For All Families
“My professional and personal worlds collided when my one-year-old daughter had a severe allergic reaction to peanut butter. I experienced firsthand what the families of my allergy patients were feeling.” Today’s woman dreamer, Dr. Ruchi Gupta, a Professor of Pediatrics and Medicine at Northwestern University Feinberg School of Medicine, and the Founding Director of the Center for Food Allergy & Asthma Research (CFAAR), is world-renowned for her groundbreaking research in the areas of food allergy and asthma epidemiology. For Women’s Health Wednesday, she shares her expertise on all things allergies, and her strong passion for the field.
1) Tell us your background and what is the inspiration behind your passion for research, and in particular research in pediatric allergies and asthma?
When I began practicing as a pediatrician and researcher over 16 years ago, I met a family committed to improving food allergy (FA) awareness and management. They had two sons with severe food allergies and came to Lurie Children’s for support and to advocate for more research on the condition. As a junior faculty member conducting related research, I was called into the meeting to see if I could help. I instantly connected with the family as their passion to improve children’s lives was contagious, and their support and excitement for our strides in FA research continues to this day.
As I was primarily researching asthma at the time, I was incredibly surprised by the dearth of scientific data on food allergy and recommendations for families like theirs. The only major clinical recommendations in place were to avoid their children’s allergenic foods and carry epinephrine in case of an emergency. There were few (if any) policies or precautions taken in schools and other public places to keep children with FAs safe, and parents were left navigating a brand new lifestyle with this potentially life-threatening condition, mostly on their own. After gathering as much information as I could about the disease, I noticed that even basic prevalence numbers were lacking. I felt that I could contribute to this area of research and help make a difference for affected families, thus began my journey into the food allergy world.
Surprisingly, about three years into my research, my professional and personal worlds collided when my one-year-old daughter had a severe allergic reaction to peanut butter. I experienced firsthand what the families of my allergy patients were feeling. Everything that I learned through my research up to that point could never have prepared me for the daily impact of food allergy. My daily experiences only further cemented my drive to do as much as possible to keep her and all children with food allergies safe at every stage of life.
Now my daughter is 14 years old, and I have continued my research in this area to this day. At my research center, Center for Food Allergy & Asthma Research (CFAAR) at Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago, we continue our work with the passion to improve the lives of children and their families with allergic conditions.
2) You have extensively researched pediatric allergies. Based on your research, what is the prevalence and severity of food allergies in the pediatric population in the US? What are some of the most common allergies and symptoms in children?
Our research team set out to create and distribute a survey to over 40,000 households nationwide to shed some light on the gravity of food allergy in the United States. The data from this study, published in 2011, determined that an estimated 8% of children (1 in 13) in the U.S. were affected by food allergy. As food allergy became a more widely-discussed public health epidemic, we decided to re-distribute this survey to 40,000 children and adults, respectively, and the results were published in 2018 and early 2019. Our results still found that an estimated 8% of children in the U.S. had a convincing food allergy, though more than 11% reported having one. We also found the most commonly reported allergies in children are to peanuts, milk, shellfish, tree nuts, eggs, fin fish, wheat, soy, and sesame. Among these children with food allergy, 42.3% report a history of severe reactions, and 39.9% have multiple food allergies. Additionally, one in five children have sought emergency care for a food allergic reaction in the past year.
4) How do parents prevent / treat allergies in young children?
Back in 2017, the American Academy of Pediatrics released the Addendum Guidelines for the Prevention of Peanut Allergy in the U.S. These guidelines encourage the introduction of peanuts (between 4-6 months) especially in high risk infants after testing and discussion with their physicians. This was a significant change from the previous guidelines that encouraged avoiding peanuts or delaying introduction in infants. What spurred this change was a study conducted called the “LEAP” study that showed introduction from 4-6 months showed promise in decreasing the development of peanut allergy in infants.
Early introduction of allergens has been on the forefront of allergy prevention research in recent years, and my team is working on a number of initiatives in this area. One of our studies, called IREACH, is aimed to help guide pediatricians through these recommendations and ideally decrease the incidence of peanut allergy in children across the U.S. We are also working on a second study, called SEED, which will explore early infant introduction of peanut as well as several other common food allergens (including egg, wheat, cashew, and walnut) in the U.S. in over 1,500 infants across Chicago.
We hope to find more answers and make strides toward allergy prevention through these studies. In the meantime, it’s critical that patients have an epinephrine auto-injector prescription, and discuss with their pediatricians and allergists the right management plan for them after diagnosis.
5) What are some new advances in asthma treatment? How can technology assist with asthma control?
In recent years, there has been a lot of emerging technology aimed to improve asthma management and control. On my team, we conducted a randomized controlled trial utilizing sensors for patients asthma medications. These Bluetooth-enabled sensors fit on top of the child’s daily and rescue inhalers and would capture their use in real time. The usage connected to their parent’s phone and also communicated directly with their physicians so they could intervene if needed. For instance, if they were using their rescue meds more than 4 times in one day (indicating a potential asthma attack), their physicians would be notified and could reach out to provide follow-up care as needed.
This is a great step in the right direction for asthma management as a whole to ensure families are staying on top of their medication usage and receiving timely care to prevent asthma attacks. We saw promising results with this technology, and found that asthma control and caregiver quality of life improved significantly throughout the trial. You can read more about it here: https://pubmed.ncbi.nlm.nih.gov/33386336/
6) What are some school, college and workplace policies that need to improve / change for people with food related conditions and / or asthma?
Understanding the prevalence and severity of food allergy in the United States has thankfully prompted conversation surrounding prevention strategies, management, treatments, and policies, and we have made major strides in improving safety and awareness.
This shift in conversation has been especially important in schools, where children spend so much of their young lives under the care and supervision of their teachers and school staff. As many as a quarter (25%) of first time allergic reactions occur in school due to young children trying foods for the first time or accidental ingestion, the development of inclusive and protective school policies has been critical. I have had the pleasure of working with the CPS school system to improve policies in schools such as having stock epinephrine available for students,and self-carrying and administration policies so students can protect themselves as needed. Although we have seen better progress in elementary-high school, there is definitely a need for better policies on college campuses.
As students with food allergy transition to college, there are many more touch points involved that leave them at risk for an accidental reaction. To combat this, we’ve conducted research on college campuses to better understand the needs college students with FA have to improve their daily lives on campus and keep them safe. We hope to create better systems for college orientation, clubs/sports, dorm life, and dining halls to ensure there are protections in place for students with FA. To read more about this study, click here: https://pubmed.ncbi.nlm.nih.gov/29679763/
7) As a dreamcatchers platform we have to ask, what is your personal and / or professional dream?
My dream has always been to improve the lives of children and their families living with allergic conditions. I’m deeply connected to this area in both my personal and professional life and hope that one day food allergy will be a problem of the past.
My favorite comic strip that’s hanging in my office serves as my mission statement.
The first frame shows an adult telling a child, “When I was your age, there were no food allergies.” The next one, set someday in the future, shows that same child all grown up, telling a younger kid, “When I was your age, there were food allergies.”
Can we eliminate the burden of allergies for the next generation? It's a long shot, but it’s what keeps us going. With such remarkable treatments and research on the horizon, I look forward to seeing great progress in making this a reality!
My other dream is to empower young people to dream. I want to support students to believe in themselves and achieve greatness. To this end, we have developed the health leaders program and a summer internship program. By empowering the next generation we can ensure a bright future.
For the student health leaders program, we invited 100 public high school students interested in health care careers for 4workshops focused on becoming empowered health leaders in their communities. The students researched health topics common in their schools and neighborhoods and connected with their peers from all across the city to create educational PSAs on these topics. They also heard from different experts in the medical and public health fields, toured the medical school at NU, and worked on personal and professional goal development. It was an incredible experience from start to finish and each student showed such passion for being a change-maker in theircommunities. I hope to continue seeing this program expand and reach as many interested students as possible as we support them on their journeys. To learn more about the program, visit: https://www.feinberg.northwestern.edu/sites/cfaar/education/student-health-leaders-program.html
As for the summer internship program, every summer, we invite up to fifteen high school, undergraduate, graduate and medical students to participate in the CFAAR Summer Scholars Program. This 8-week program allows students to strengthen their skills in epidemiological, clinical, and community-based food allergy and asthma research. Students receive hands-on research experience including but not limited to: shadowing recruitment and study enrollments for our studies, strengthening their skills in conducting literature reviews, interpreting data and writing scientific manuscripts, practicing public speaking, and assisting with survey development and dissemination. In addition, students also attend weekly didactic sessions to learn from our team members on various research and medicine topics.
It's such a pleasure mentoring students interested in pursuing research and medical careers and I love encouraging them to ask critical questions about how to improve care, management, access, and health equity regarding food allergy and asthma. These students are the future of medicine and supporting them to continue expanding their knowledge is incredibly important to me. To learn more about the internship program, visit: https://www.feinberg.northwestern.edu/sites/cfaar/education/summer-internship-program.html
My two favorite quotes from Maya Angelou include-
“When to learn, teach; when you get, give.”
“Do the best you can until you know better, when you know better do better.”
Thank You Ruchi for Sharing Your Expertise and Insights with us! We are excited to have you in our empowered women’s network!
Bio: Ruchi Gupta, MD, MPH, is a Professor of Pediatrics and Medicine at Northwestern University Feinberg School of Medicine and a Clinical Attending at Ann & Robert H. Lurie Children’s Hospital of Chicago. Dr. Gupta has more than 17 years of experience as a board-certified pediatrician and health researcher and currently serves as the founding director of the Center for Food Allergy & Asthma Research (CFAAR). She is world-renowned for her groundbreaking research in the areas of food allergy and asthma epidemiology, most notably for her research on the prevalence of pediatric and adult food allergy in the United States. She has also significantly contributed to academic research in the areas of food allergy prevention, socioeconomic disparities in care, and the daily management of these conditions. To reduce the burden of these diseases and improve health equity, she and her team develop, evaluate, and disseminate interventions for families and conduct work to inform local, national, and international health policy. Dr. Gupta is the author of the Food Allergy Experience, has written and co-authored over 140 peer-reviewed research manuscripts, and has had her work featured on major TV networks and in print media. She and her team strive to improve the lives of children and their families through their research and hope to continue finding answers and shaping policies around allergic conditions. Learn more about their research at cfaar.northwestern.edu.
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