Dr. David Stukus (1s):

We now have wonderful randomized controlled trials that really support the earlier that we give allergenic foods to babies and keep it in the diet. Let them eat it. Don't rub it on the skin. That's our best path towards preventing food allergies.

Katie Ferraro (14s):

Hey there I'm Katie Ferraro Registered Dietitian college nutrition professor, and mama's seven specializing in baby-led weaning here on the Baby-Led Weaning Made Easy podcast. I help you strip out all of the noise and nonsense about feeding, leading you with the competence and knowledge you need to give your baby a safe start to solid foods using baby Led Weaning. Hey guys, welcome back. I know I say this every week, but I am so excited about today's interview. Basically the biggest person in pediatric food allergy is here to talk to us today. It's Dr. David Stukus. He is going to be chatting with me about Why are False Positive Results in Food Allergy Testing so Common?

Katie Ferraro (1m 1s):

Like this is mind blowing to me on what planet can you have a 50% false positive rate? And then doctors are still like mass ordering these tests. So I want to get it from the horse's mouth. Dr. Stukus is he's everything in food allergy, guys, board certified in allergy and immunology and pediatrics. He's the director of the food allergy treatment center at nationwide. Children's, he's an internationally recognized expert on pediatric food allergy, having multiple appointments, on pretty much every important panel and taskforce with the American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma and Immunology. His bio goes on and on. But the reason why I love him as a food allergy expert is because he's super active on social media and actually knows how to translate like all the nerdy research stuff into tips and tangible advice the parents can use on Instagram on Twitter.

Katie Ferraro (1m 50s):

There's literally no one more interesting than Dr. Stukus. He's at kids allergy doc today, though, we're talking about food allergy testing and the questions that parents have, Dr. Stukus is speaking frankly, about why do doctors over order food allergy tests? Why are oral food challenges at home actually the best test of whether or not your baby is allergic? And then what should you do if your baby does react? And your doctor recommends a ton of unnecessary food allergy tests, Dr. Stukus, his suggestion is run, but he does a great job of breaking down the complexities of food allergy tests. And I'm so excited to have the opportunity to chat with him today. So with no further ado, I want to introduce you to Drdavid, Stukus talking about Why are False Positive Results in food allergy testing so common.

Katie Ferraro (2m 37s):

All right, well, hi, Dr. Stukus. Thank you so much for joining me today.

Dr. David Stukus (2m 40s):

It's my pleasure to be here. Thanks for having me. This is, you know, a lot of fun.

Katie Ferraro (2m 42s):

Okay. So you are literally like everything related to food allergy, every book, every publication, I mean, your name pops up. I don't know a where you get all the time to do this and work and have a family. Can you tell us how you got into the marvelous world of food allergies and allergies in general.

Dr. David Stukus (2m 60s):

Well, thanks for your kind words and you're right. I I've had the opportunity to be involved in multiple different platforms to help educate surrounding food allergies, whether it's parents, general public or my colleagues through research and publications. So as an academic pediatric allergist, I work at nationwide children's hospital, which is affiliated with the Ohio State University College of Medicine in Columbus, Ohio. I am the director of our brand new food allergy center, which we just opened a few weeks ago. We've treated food allergies for years and decades, but we now have a dedicated center that we actually can just devote to all these families. And a lot of what I do is really trying to communicate evidence-based information and put it into clinical practice.

Dr. David Stukus (3m 41s):

It's conversations I have with families every day in the office setting. I spend a lot of time on social media as well, because I believe in the power of filling the void and combating this information. And then I take those lessons towards what I do with my research and quality improvement. And I unfortunate to be one of twelve allergists that I'm a member of the joint task force on practice parameters, where we actually write the clinical guidelines. So we, we review all the evidence and then we help educate our colleagues about what to do. So I'll stop there. But long story short, I really like trying to take complicated medical information, break it down into bite size pieces that people can understate.

Katie Ferraro (4m 17s):

And I love that you bring your message to social media as well, because I mean, no disrespect to your field, but there is so much gray area in the world of food allergies. It's so confusing to parents. And then sometimes when they reach out to medical professionals and are trying to, you know, let's talk to the leaders in the industry, it's like, you can't understand what they're saying, but your messaging is so clear. I was not surprised when I saw that you had coauthored social media for medical professionals, strategies for successfully engaging in an online world because man, they need it. A lot of times healthcare professionals can't speak the language that their patients are talking every day. And then all of the best research in the world. If nobody understands how to interpret it or put it into practice, it's kind of not worth it.

Katie Ferraro (4m 58s):

So thank you for making these really complicated topics accessible and understandable to your general parent, like myself, who is just trying to navigate through this world of food allergies with kids.

Dr. David Stukus (5m 9s):

It's my pleasure. And you know, it, I adopted a stance a while ago and I think it, it works out well of there is very little black and white in what we do with health and medicine. Anybody who stands up on a pulpit and says, you absolutely have to do this. I mean, they're either selling something or they're misguided, or they just don't want to understand the individual variation is highly variable. There are so many nuances involved. You can take a hundred people with peanut allergy and they're going to have different risks in regards to how much they need to eat to cause a reaction, different types of reactions. Some can tolerate certain products and not others. So what I try to do is just talk about risk. What are the risks? What are the benefits? And there's no right or wrong answer. And it really trying to meet people with where they are, you know, shared decision-making is sort of this hot term in medicine.

Dr. David Stukus (5m 52s):

And what that is is as the expert, it's my job to say. Here's what I think is the most likely diagnosis. The testing, the tests that I think may or may not be indicated here are the risks and benefits of different treatment options. It's my job then to elicit from the patients, with the family, what are your values? What are your preferences? What is important to you in your daily life? And then we try to come up with a plan together that really meets those needs. And then we reevaluate. Do we achieve the outcomes we wanted? Yes. Great. No. Then let's reevaluate and go with,

Katie Ferraro (6m 22s):

I like the idea of shared decision making, especially when you're navigating this scary area for a lot of parents, I literally just got off the parent call right before this interview with the mom she's in Canada. First time, mom, baby has hives from of number of different foods. Not in a lot of other symptoms. Went to her allergist, waited forever for the appointment to allergist tested for 50 things. Even though the baby had only reacted to milk and egg and peanut. And she was like, then tests were coming back and she's like, I went and got retested. That first almond had been positive. Now it's negative. She's like literally tearing her hair out. And the doctor said to her, which is unfortunate. You just need to stop worrying so much. And she's like, that doesn't seem right. But she said, I'm not in a position to like request a different opinion. I would wait six more months at which point my baby's a year and I haven't done these allergenic foods.

Katie Ferraro (7m 5s):

So I just love to hear that there are leaders in the field working with parents like yourself, like not only working on guidelines and publications, but actually working with parents in a clinic setting every day that really does shine through, I think, in your work, because some researchers are very far removed from the patient experience that they don't know how to interact with parents.

Dr. David Stukus (7m 23s):

Yeah. It's all about trust, right? And we want to be a good valued resource. We know we're not the only resource in people's lives. They have family members and freinds in their social circles and you know, whoever else they engage with. But if families can't trust me, even to trust me to say, I don't know when I don't know which I say quite a bit, but we walked through it. You know, then that's the most important part of the physician patient relationship with my opinion.

Katie Ferraro (7m 48s):

Can we talk a little bit about food allergy testing? Like how accurate is it? And then what are the chances? If you get your baby tested that the results will possibly be incorrect.

Dr. David Stukus (7m 58s):

The best test is what happens when you eat a food. Because if you have a food allergy and for today's conversation, we'll refer to food allergies as immunoglobulin E or IgE antibody mediated reactions. If you have a food allergy, every single time you eat that food, no matter what form you should have pretty rapid onset within minutes, rarely longer than a couple hours later, reproducible symptoms. Objectively, I should look at you and say, wow, you're having a food allergy reaction because various parts of the body are involved. Most commonly we'll see skin rashes or hives or itching. You can have swelling off of the lips or of the face. It can involve nausea, vomiting. You can have wheezing. You can have anaphylaxis, which is any combination of those systems symptoms that progress rapidly.

Dr. David Stukus (8m 42s):

So if you're eating a food without having any of those symptoms, you're not allergic to the food. It's as simple as that. So the best test that we spend our time trying to elicit is what happens when you eat the food. If you have chronic symptoms, you can't identify specific foods that are causing the symptoms or symptoms are occurring randomly. You probably don't have a food allergy. We see people all the time that have very sensitive skin eczema, chronic hives, not due to allergy as humans, it's human nature for us to correlate something we eat with symptoms that are occurring on a regular basis because we eat all day every day, especially when children are eating snacks and babies are eating every couple of hours sometimes. So it's normal human nature to say it must be because of something they're eating.

Dr. David Stukus (9m 24s):

That's why they have the symptoms. So we spend all of our time focusing on the history. That's the best test. If the history suggests IgE mediated reactions, rapid onset, high of swelling anaphylaxis. And when we have food allergy testing that can help determine whether that's a true allergy. We have skin testing in the office setting, or we have blood testing. Both tests have very high rates of false, positive results. There's a lot of people who have elevated results that aren't actually allergic to the food. In fact, about 40% of all, children will have detectable IgE to milk a shrimp for peanut, but only about 5% are actually allergic. So if we rely on testing alone, we're going to, over-diagnose the vast majority of people.

Dr. David Stukus (10m 4s):

There's a lot of reasons why we get false positives. There's cross sensitization with airborne allergens of people may have allergies to these are just imperfect tests. Kids with eczema and lots of other allergies may have false positives because they have a lot of total IgE floating around which isn't harmful. But there's a lot of reasons why we get this background Potter. So the testing that we choose absolutely should be guided by the history that we obtain. Food. Allergy tests are not screening tests. They don't meet any criteria of what a good screening test should have. There's too many false positives. They can't predict future reactions for somebody who's never eaten the food food allergy tests. Don't tell us the severity of future reaction, but we do tend to believe negative results when we see them.

Dr. David Stukus (10m 45s):

So there's a lot that goes the kind of packs in there. I'll pause now to see if you have any questions that tease out from there. But testing alone is rarely indicated unless the history suggests food allergies.

Katie Ferraro (10m 56s):

And I did want to ask you that in a up question, as I understand it, there's a high rate of false positives, but if you get a negative result, that's pretty believable. Is that what I'm hearing you say?

Dr. David Stukus (11m 7s):

The negative predictive value is very high. We do see some false negatives, but then again, the history matters. If you said, Hey, Dave, you know, three weeks ago, I ate peanut butter and I ended up in emergency room and they gave me epinephrin three times because I had severe hives and wheezing and vomiting. But you have a negative test result. Why believe your history of the testing is negative, which is interesting. So maybe we need to find other causes or we can consider an oral food challenge. And that's something that we do on a regular basis where that's the best test. What happens when you eat the food? So come hang out with me for half of a day, half a day. When the history is indeterminant, when the testing is indeterminant, or whether you think of somebody with a known food allergy is developing tolerance over time, we can give them gradually increasing amounts in a very safe way.

Dr. David Stukus (11m 48s):

When we observe, if nothing happens after eating one or two servings, you're not allergic to it, put it back into your, expand your diet. Even if symptoms do occur, we confirm the diagnosis. We see some idea of how much do you need to eat to cause symptoms. And then if treatment is necessary, parents get that wonderful experience of, oh my gosh, I was always scared to give epinephrin and now they actually see how fast it works, how safe it is and how reliable it is.

Katie Ferraro (12m 12s):

I appreciate what you're saying, that the history determines the course of action. And so when you mentioned an oral food challenge for families with no history, with no risk, with no reaction, is it safe for them to do a quote unquote oral food challenge with their baby? If the history doesn't indicate that they might be allergic, is it safe to do that?

Dr. David Stukus (12m 32s):

So are you asking me if it's safe for parents to feed their babies? Yes. We have done an amazing job as pediatricians and allergists at simply scaring the hell out of parents everywhere. And the reason why is because 20 years ago, we thought it was the best advice to avoid giving certain foods. The recommendations were give no dairy into one, no eggs, still tube nuts, receive two to three. And if you're pregnant or breastfeeding, don't eat anything at all because you're going to cause your kid to have food allergies. Well, it turns out that there wasn't much evidence to support that. It made sense based upon our understanding of the immune system at the time as research and science has evolved, we now have wonderful randomized controlled trials that really support the earlier that we give allergenic foods to babies and keep it in the diet, let them eat it.

Dr. David Stukus (13m 21s):

Don't rub it on the skin. We want to let them eat it, expose it to the immune system, through the gut and keep it in the diet on a consistent basis. That's our best path towards preventing food allergy. So, you know, we have a lot to undo a lot of harm that has been done. A lot of psychology. That's been there that goes into this as well, but we really want to instill confidence. So yes, can parents feed their babies? You don't need my permission to do that feature. Maybe we don't get patients because you know, kids have, you know, they die the first time they eat peanut more often than not. They may get a rash or have some vomiting. Severe allergic reactions are very rare in infants and you can always lower risk by going slowly, try a few small bites, wait for five or 10 minutes.

Dr. David Stukus (14m 1s):

If nothing happens, give a little bit more, a little bit more, a little bit more. And then if something does occur, you call your pediatrician, your allergist.

Katie Ferraro (14m 7s):

I really appreciate your down to earth approach in recommending food first, because we are kind of moving into this arena in food allergy prevention, where I think there are a lot of brands out there trying to scare parents into thinking that babies can't eat food-based versions of these potentially allergenic foods. So the irony is not lost to me. Are you asking me if it's safe for my baby to be fed food? I am not joking you every single day. I get messages as I'm sure you do as well from parents who ask that very question like there, the fear factor is so high with this when the absolute or overall risk is actually quite low and not discounting how serious food allergies are. But for so many parents, they listen because this is also scary. I'm just going to get my baby tested for everything.

Katie Ferraro (14m 49s):

Before I try any of these foods, is that good approach.

Dr. David Stukus (14m 53s):

What's a terrible approach. It's going to cause more anxiety because you're going to get, you're going to find false positives. Eventually, if you do enough of those tests on enough children, you're going to find false positives. And it's really hard for a lot of parents to overcome seeing that positive result and understanding what that means, what that doesn't mean. So an elevated IgE test only indicates sensitization. It doesn't mean you're allergic. If you're eating a food with sensitize your tolerance. In fact, if somebody is eating a food and their tested for that food, when they're told to stop eating that food because of an elevated IgE that can actually create food allergy. And this just makes me so angry because there are well-intentioned physicians everywhere doing these tests on babies with eczema or other symptoms that aren't related to food allergy at all.

Dr. David Stukus (15m 33s):

They tell parents to take the food out of their diet. By the time I see them months later, and we try to reach, produce it. They have an allergic reaction. They actually caused an allergic reaction when somebody who is tolerant with sensitized, by telling them to take it out of their diet, that's a real problem. That's one example of why these tests are problematic. They're now at home version of these, which is a terrible idea, just, you know, sort of quote, unquote scan for 200 different food allergies or food sensitivities, which also is not actually a medical, you know, tested as validated in the evaluation, food sensitivity. That's the IgG testing, but none of these are screening tests. So we shouldn't be using them in that manner at all.

Katie Ferraro (16m 9s):

No, I love it. Thank you for saying that. It's like sometimes it's nice to hear someone else say the same thing that you've been saying in much better terminology without using any profanity. So thank you for doing that, but no, I do feel the same. I honestly, it was just working with a pediatrician and we were talking about a good friend of his is pediatric allergist. And he's like, you know, there's just this notion of testing all the time and all the time. And he's like so many of my colleagues who are pediatricians, if they don't specialize in this, they just recommend blanket testing across the board of, it only causes more anxiety. It wastes time, it wastes resources, it wastes money and it causes so much anxiety for parents. Would you say that there is a not to be dramatic, but an epidemic of over-testing for food allergies when it's not indicated?

Dr. David Stukus (16m 50s):

Yes. There's a choosing wisely series started by the American Board of Internal Medicine. A couple of decades ago. They partner with specialties. Number one on the list from the allergy choosing wisely series. Number one of things not to do, do not order indiscriminate, IgE testing or IgG testing for a large panel of foods. Number one of the list of things not to do because it causes such real harm. These tests are rampant. We got our institution to actually remove all food allergy panels from our laboratory services over a year ago, this was a huge win. You can absolutely still order blood IgE testing for any food.

Katie Ferraro (17m 22s):

When you take it off the floor, that's awesome. You can't order it.

Dr. David Stukus (17m 25s):

Oh, these, these panels are pushed by the companies who make money off of them. They're not medically beneficial and they cause harm, but they're market out there and they they're marketed as being beneficial, but they're not why on earth, if you worried about peanut allergy, would you get a panel that includes rice and corn and milk and egg, and then the results come back and they scare you. You don't know what to do with them. And at least a big problems. I

Katie Ferraro (17m 46s):

Know it was the other day. It was a parent telling me about an allergy have to rice, which is, as I understand it, like the most hypoallergenic food, you basically like can't be allergic to rice. Is that true? I mean, I'm sure you can, but like

Dr. David Stukus (17m 59s):

I have yet to diagnose that

Katie Ferraro (18m 1s):

Say no, never someone will say, I know someone that had a rice allergy. Can we talk about, you were mentioning a little bit like the risk in the real number. And I think, you know, for parents again, who are not, not everyone listening has advanced degrees in allergy and immunology and of, but they want to know the numbers. If you put a hundred babies in a room and they all try peanut, like what's the overall risk? Like what percentage of babies? Not even just knowing if they have food allergies and I understand how hard it is to even get that correct data, but like what percent are going to have a severe allergic reaction? Like, is this really something parents should be just as anxious about as they are anything numerically you can put into context?

Dr. David Stukus (18m 37s):

Yeah, I love that question. So if all parents are worried about feeding their baby because of risk for allergic reaction, we are that is overly conservative because if you take a hundred babies, 95 of them will never develop any food allergy period. But if you take a hundred percent of those parents that are worried about their kids are going to be having an allergic reaction, boy, that's a problem. Only 5% of you need to worry about it. 98 of them will never have peanut allergy. 97 will never have milk allergy. 98 will never have egg allergy. So the vast majority are never going to have to worry about this, but all of them are treating this as if it's, you know, a life or death situation of feeding their baby. As far as severe allergic reactions with first introduction, that's extremely rare.

Dr. David Stukus (19m 18s):

Yes, it does happen. But again, more often than not, you're going to get a rash or maybe you're going to have some vomiting. There's going to be some sign that, oh boy, this isn't what I expected to be. Or something's not right here, especially if it's reproducible over time. So that's a really important concept. And I'm glad you asked about that because you know, for most people out there, it's not an issue. And if you really want to worry about this, the babies who have truly persistent eczema. So eczema is a chronic skin condition. Hallmarked by loss of moisture from the skin, really dry skin. When you get the inflamed patches inside the elbows behind the knees, on the torso and the cheeks and things like that, those babies that develop early eczema around one to two, three months of age and it remains persistent. It's not these little patches that pop up here and there and come and go.

Dr. David Stukus (19m 58s):

When you put moisturizer cortisone on it, it's really the truly persistent eczema. Those are the babies, raising their hands, saying, pay attention to me. I'm at highest risk to develop food allergy. Those are the ones I worry about. And those are the ones we don't want to do testing on. We just want to feed them as early as they're ready to tolerate solid foods and keeping their diet. That's how I move the needle. That's how we prevent food allergy from happening.

Katie Ferraro (20m 18s):

And thank you for clarifying persistent eczema because everybody's baby is a special snowflake. They hear eczema, all babies have some degree of eczema parents like that's me not doing any allergenic foods because my baby's at high risk, but the way you describe it is clearly persistent eczema. And I think that's kind of the operative, right?

Dr. David Stukus (20m 36s):

Yeah. It's not the stuff that comes and goes. It's, you know, if you have a good daily skincare regimen, lots of good unsensitive moisturizers, and you're doing that every day and you need anything more than over the counter anti-inflammatory medication, because those spots just, they don't go. They don't get better. If I could share pictures with you. I mean, it's pretty unmistakable. I walk in a room immediately. I'm like, oh my gosh. Yeah, this is persistent eczema.

Katie Ferraro (20m 58s):

It's hard on a podcast. We do a lot of visuals on Instagram and, and workshops and stuff. Just showing what the allergic reactions look like because parents are like, oh, like a few dots on the face. That's different than a baby having full blown body hives with, you know, profuse vomiting. Like, so I think it helps just put things in context to look at pictures, especially pictures of what these different skin situations look like on babies with different colored skin. We do a lot of education. Cause you know, red rays, itchy patches on a black baby is going to look different than it is on a white or a hispanic baby.

Dr. David Stukus (21m 28s):

Absolutely. Yeah. And you know the other thing, while we're talking about rashes, it's a common thing for babies, lots of babies of sensitive skin and frequent rashes that aren't due to allergy contact rashes from variety of foods. So a lot of parents out there think strawberry is a common cause of allergy. It's not, I'd never diagnosed legitimate strawberry allergy.

Katie Ferraro (21m 45s):

Yeah. It's like Tomato ascorbic acid.

Dr. David Stukus (21m 50s):

Yes. So strawberries, tomatoes, ranch, dressing, salad, dressing, citrus, fruits, bananas, cinnamon, anything that directly touches the skin could potentially cause red irritation in those areas. That's a contact rash that does not progress towards an allergic reaction. These are all very low allergenic foods last week. I think I met 15 families. I had pineapple tomato oranges, but only certain types of oranges, blueberries or raspberries. And it was reassuring. And every time I'm like, I'm so glad you're here because I want to help clarify with you risk because I don't think they're actually when she didn't even really need to come. Right? Like let me be honest with you. No they didn't, but I'm always thankful when they do. Cause I I'd much rather have a 15 minute conversation with somebody where testing is not involved and give them peace of mind than having them go home and be afraid to feed their baby.

Katie Ferraro (22m 33s):

Then go home and unnecessarily remove massive food groups of foods from their diet and their baby's diet. And that's what's happening. I think a lot of with this kind of fear-mongering again, not understating the importance of true severe food allergy and how life-threatening it can be. But for the vast majority of parents, I really think it's important to have Frank conversations that no, this is not something you need to be worried about. Yes. It's scary. But let me show you what you would actually see if the baby had a full blown, allergic reaction and the likely to be an allergic to pineapple is, you know,

Dr. David Stukus (23m 3s):

Right, right. Yeah. And that's one of the things we do. Why we built our centers. We have the space now for if you're concerned for it. You know, sometimes people look at me like, all right, I hear you, Dave, thanks for taking the time. And sometimes I'll even say, look, the easiest thing in the world for me to do would be to spend, to put a hundred different food allergy tests on your child and not have this conversation with you, but I'm taking the time to have the conversation with you because that's the right thing to do here. Food allergy testing is on indicated. But even at that point, if they still don't have the confidence, come hang out with me, come spend time here, bring whatever food you want, hang out in a room and feed your baby. I'll be here. I'll be in and out. I'll give you that, that confidence and that reassurance. So that's something that we love to offer families.

Katie Ferraro (23m 40s):

So again, a little bit tongue in cheek, but like the easiest thing for me to do would be to just give you a hundred food allergy test that happens the time. What do you recommend to parents who are like in that position? Okay. My pediatrician checked every single box on the lab thing basically to test for every single food. Should I do it? Yes or no. I know this is like a case by case basis and you can't give individual medical advice, but like what do you suggest for those parents who are worried about possible over-testing

Dr. David Stukus (24m 4s):

Oh yeah. So I would say run don't do it honestly. No, there's zero, zero clinical indication to ever do a large food allergy panel test. None ever whatsoever ever.

Katie Ferraro (24m 15s):

I love it. Awesome. Dr. Stukus could you please tell us where we could go to learn more about your work about your center? Because I think parents are going to be like flocking to all of your places after hearing this interview.

Dr. David Stukus (24m 25s):

Well, thank you. So you can find me on social media, on Twitter and Instagram. I'm @allergykidsdoc. And then if you just search Nationwide Children's Hospital Food Allergy Center, you'll see our nice webpage and you'll see our mission statement and all that fun stuff, as well as you know how to get referrals and making appointments. So when I love interacting with the public, I love helping parents with what I see are common concerns, a lot of misconceptions. And if there's anything that I can personally do, I'm more than happy to help.

Katie Ferraro (24m 51s):

And thank you so much for taking the time to meet with me on this podcast and our audience, because I know you were probably the busiest person in the food allergy world. And I can't tell you how much it means to have you just kind of bring us down to earth with regard to some of this food allergy testing nonsense, to be honest in many regards, but thank you for clarifying it. It's been really helpful.

Dr. David Stukus (25m 10s):

It's been my pleasure. Thank you so much for inviting me. I hope this is helpful to everybody.

Katie Ferraro (25m 14s):

You guys, how cool is Dr. David? Stukus I've always admired his work, but like I'm so honored that he came on the podcast because he's like numero UNO in food allergies. And I love that. He's going to tell you straight up, like no, if your doctor is trying to test for 50 things with your baby reacted to one food, you got to run, not walk. Like he keeps it real. I'm going to link to everything Dr. Stukus was talking about in today's episode on the shownotes for this episode you can find at blwpodcast.com/125. Dr. Stukus rhymes with mucus. Don't forget it. He's on Instagram at @allergykidsdoc. He makes food allergies interesting. And that's pretty hard to do so. Thanks for listening. Check them out at blwpodcast.com/125, and I'll see you guys next time.