Applying Food Allergy Science to Your Food Allergy Life11.14.2015

JESSICA MARTIN, PH.D.

World’s Collide: Scientist meets food allergy mom

Halloween 2009~1 month before 1st anaphylaxis

Growing brain cells in a dish!

Two Parts1. How to Evaluate Scientific Sources with Confidence

2. How to Apply the Science to YOUR unique situation

Part 1: How to Evaluate Scientific Sources

“Have you heard? Dishwashers cause food allergies?!”

The media is the primary way that most people learn about new research.

Media vs. The science

The Guardian, 2.23.2015

Reviewed.com, 2.27.2015

Pediatrics, 2015, 135 (3): e1-e8

Primary source of information:Secondary or tertiary sources of information:

CBS News, 2.23.2015

Used with permission by:Jorge Cham

AMPLIFICATION & LOSS OF INFORMATION

Photo by: Florian Seroussi (Creative Commons License

The Primary Source “Peer-reviewed”science

Science at odds with a fast-paced, electronic media-driven world?

SCIENCE◦ Slow & Steady publication (peer-

reviewed)

◦ New findings framed in the context of existing scientific knowledge

◦ Self-corrects old ideas

◦ Fact-based

◦ Emphasis on consensus

SCIENCE IN THE MEDIA◦ Fast publication (may or may not be edited

by credentialed science/health editors)

◦ Emphasizes one new study at a time

◦ Old stories with wrong ideas linger on the internet.

◦ Emotion-laced facts

◦ Emphasis on “fair and balanced.” ◦ Coverage may over-emphasize outlying ideas.

Beware your own bias;

Beware of others’ biases.

◦ We are ALL biased (even scientists).

◦ Have you heard of the Double Blind Placebo-Controlled Food

Challenge?

◦ Why is this the “gold standard?”

◦ Many types of “cognitive bias” exist…

we’ll cover one.

Image source: http://res.dallasnews.com/interactives/2014_January/foodallergies/

Confirmation BiasWe ALL have ideas –◦ What is the cause of the allergy epidemic?◦ How can allergy be prevented?◦ Can we take action to reverse an allergy?

We tend to consume information that confirms our favorite ideas and minimizes contrary ideas.

We gravitate toward sources/people who “think like us.”

Hygiene HypothesisYour thoughts?

Sources of information – can you identify any bias?

This step establishes how much weight to give each of your sources◦ You

◦ Friends on Facebook or Twitter

◦ News media

◦ Patient support and advocacy groups (e.g., WA FEAST, FARE)

◦ Scientists/researchers & primary peer-reviewed journal articles

◦ Clinicians (e.g., allergists)

After identifying possible bias, which sources do you trust most?

How to evaluate information in the media.

1. Does it link to original, peer-reviewed articles?◦ If no – be very skeptical.

◦ If yes – check out the article abstract(s) for yourself!

◦ Does the article match the actual study?

◦ Beware of cherry-picked data.

2. Is it a reputable source for information?◦ New York Times (and others like it) have credentialed science editors.

◦ Random health site or blog on the internet? Likely not.

3. Do organizations with a medical board (e.g., FARE) comment on the topic?

4. What do other reputable sources have to say (hint, hint… your allergist)?!

CORRELATION ≠ CAUSATION

A common way that headlines & reporting get it wrong

Source: http://io9.com/on-correlation-causation-and-the-real-cause-of-auti-1494972271

• Beware of articles that say “CAUSE”

• Key phrases that the study is a “CORRELATION”:• “associated with”• “may cause”• “linked with”

NYT

You can search like a scientist, too.

Most non-scientists• Google• Generally secondary/tertiary

sources

Scientists• Research database (e.g.

PubMed.gov, Google Scholar)• Peer-reviewed articles (many

primary sources)

How to evaluate a scientific study1. Not all studies are created equal.

◦ Peer-review is NOT perfect.

◦ Just because you find it on , doesn’t mean it is solid science.

2. Is the journal reputable (i.e. – not Journal Obscurus established 2 year ago)?◦ Journal of Allergy and Clinical Immunology (JACI), Annals of Allergy Asthma and Immuno, etc.

3. Do the authors work for an established, credentialed institution?

4. Do any of the authors have an established publication record in the field?

5. Is it current (less than 10 years old). If not, does it fit with consensus of more current scientific studies?

Takes a lot of practice! Your Doctor’s are experts at this!

Part 2: How to Apply the Science to YOUR Life!“FACTS ARE NOT AUTONOMOUS. THEY GAIN MEANING FROM THE FRAMEWORKS WITHIN WHICH HUMAN BEINGS INTERPRET THEM.”

-Thomas Levenson

No One-Sized-Fits-All Approach

◦ Tools to evaluate information for yourself, to apply it to your situation.

◦ Know that some food allergy studies may not apply to your situation

◦ Even doctor’s can have differing opinions!

◦ This is why it is so crucial for YOU to understand/evaluate science for yourself!

Creative commons – photo by Flickr user LaserGuidedLeads to informed discussion with your allergist based on YOUR UNIQUE situation!

Major categories of scientific studies1. Basic Science Research

2. Clinical Research◦ Allergy epidemiology

◦ Allergy prevention & causes

◦ Allergy treatments & cures?

◦ Best practices for living with food allergies◦ Preventing reactions

◦ Responding to reactions

How do these study categories apply to YOUR Situation?

Image source: http://www.sydneyvital.org.au/our-research/translational-research-diagram/

Basic science Translational Science Clinical Trials Approval for Clinical Use

1. Discovery of antibody structure (early 1960s, Edelman & Porter)

2. IgE antibody discovery, the allergy culprit (1966, Ishizaka)

3. Anti-IgE therapy proposed – Translational Studies & Clinical Trials (Late 1980s)

4. Anti-IgE therapy (Omalizumab/Xolair®) FDA-approved for allergic asthma (2003)

5. Anti-IgE therapy to treat multiple food allergies (in clinical trials now!)

How does basic science research apply to YOU? May be a long time from now…

EpidemiologyCharacteristics of food allergies in a population of people.

These are the statistics we often cite to people!◦ 1 in 13 children have food allergies

◦ Food allergies are growing rapidly

◦ Food allergies cost the U.S. economy tremendously

Why do we care about these studies?◦ Advocacy for needs of the food allergic.

◦ Local, State, and National

◦ Gain research dollars for research.◦ Clues for further research questions.

Gupta et al (2011) Pediatrics 128(1): e9-e17

Download facts and stats sheet with peer-reviewed referenceshttp://www.foodallergy.org/document.doc?id=194

Allergy prevention & causes

These studies most likely don’t apply to those who are already allergic.

◦ “LEAP” Study is a prime example.

◦ Can you go back in time and introduce peanut early?

◦ LEAP evoked strong emotion in the allergy community.

◦ How did it make YOU feel? NEJM (2015) 372: 803-813.

Allergy Treatments & Cures?

Very active area of research.◦ Some of YOU may be part of SEAFAC

studies?

These studies very much apply.

Examples:◦ Oral Immunotherapy (OIT)◦ Viaskin Peanut Patch◦ Chinese herbal formulas (FAHF-2)

Current standard of care (REACTIVE)

Future of food allergy care (PROACTIVE)

SCIE

NC

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Photo by: Alain Carpentier(creative commons license)

Photo by: Keith (creative commons license)

What you can do with these studies:1. Participate in clinical trials?2. Advocate for these studies?3. Financially support these studies?

Best practices for managing food allergies:Why certain recommendations?Active area of research

Very much applies to our situation

Examples◦ Why administer epinephrine quickly?

◦ Hand-washing vs. hand-wipes vs. hand-sanitizer.

Why do we care?◦ This is how we live and respond to food allergies.

◦ Use evidence to advocate our needs!◦ Print the peer-reviewed articles

◦ FARE’s fact sheet has many of these references.

J. Allergy and Cl Immuno (2004) 113: 973-976.

On the Radar – Quality of LifeAnxiety & Food Allergies: A Major ConcernHow to minimize reaction risk without affecting quality of life.

Dealing with anxiety in food allergy (growing area of research).

Why are these studies important?

1. Look for warning signs

2. Not only allergic, but caregivers too!

3. Discuss concerns with allergist and/or primary care providers

Knowledge gained by science continues to evolveKnow how to be a good consumer of science.

◦ We view scientific findings through our own experiences. We are biased.

What is “true” today, may not be true tomorrow.

Science allows us to make appropriate health decision & advocate our needs.

◦ Experts (e.g. allergists, nurses, etc.) are an integral part of this process.

“Facts are not autonomous. They gain meaning from the frameworks within which human beings interpret them.”-Thomas Levenson