327: Demystifying Food Allergy Signs, Symptoms + Skin Rash w/ Dr. Ruchi Gupta

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Spotting food allergy signs quickly can be tricky, especially since they don’t manifest in everyone in the same way.

But it’s so important to be able to identify the symptoms of food allergies, because a whopping 1 in 13 kids have at least ONE food allergy. And that number is surprisingly high for adults, too.

Food allergies are an IgE immune-mediated reaction. Essentially, your body sees a particular food as an invader, so it goes on attack by releasing chemicals like histamine.

So if you’ve ever wondered what causes food allergies, common food allergy signs, and whether you can prevent them altogether, this episode is for you!

My guest is not only an expert in food allergies, but she’s also a mom raising a child with life-threatening food allergies. Her invaluable information and insight about what’s driving food allergies in kids and adults is really sobering, some of which may surprise you (as it did me).

My guest today is Ruchi Gupta, MD, MPH, 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 over 20 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 research on the epidemiology, economic impact, prevention, and management of allergic conditions, and strives to find answers and shape policies surrounding these conditions in order to reduce burden and improve health equity.

Do you have personal experience with a food allergy? Are you comfortable identifying food allergy signs should they arise? Share your questions, comments + experiences in the comments below!

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

In This Episode:

• Dr Gupta’s personal experience with food allergies
• What’s driving the explosion in food allergies (in children and adults)
• Differences between food allergies, food intolerances and food sensitivities
• Food allergy signs and anaphylaxis signs (you might overlook)
• Anaphylaxis treatment options (why to NOT use Benadryl if you notice food allergy signs)
• Shocking food allergy trigger (NEW RESEARCH)
• Updated food allergy prevention tips for parents

Quotes

“About 8% of kids have food allergy. Now that's about 1 in 13, or 2 in every classroom. So it's a lot.”

“If you only give Benadryl, it may mask some of the symptoms because it takes away maybe some of the rash and some of the itching, but the reaction continues to happen in your body.”

“One of the biggest hypotheses right now is if a food is introduced through your skin before your gut, then your immune system goes on the attack.”

Links

Find Dr. Gupta online | Instagram | Instagram | Facebook | Facebook | Twitter | Twitter

Find Yobee online and on Instagram

Get Dr. Gupta’s book, Food Without Fear

Healthy Skin Show ep. 269: Allergy Testing: Everything You Need To Know w/ Dr. Stacy Silvers

Healthy Skin Show ep. 321: Before You Invest in Food Sensitivity Testing (What You Need To Know)

Healthy Skin Show ep. 291: Can You Stop Eczema, Allergies + Asthma In Kids? w/ Dr. Chris Thompson

Healthy Skin Show ep. 265: Problem with Antihistamines That No One Tells You w/ Dr. Chris Thompson, MD

Healthy Skin Show ep. 262: Why Your Child's Risk of Allergies, Eczema + Asthma Is So High w/ Meenal Lele

327: Demystifying Food Allergy Signs, Symptoms + Skin Rash w/ Dr. Ruchi Gupta {FULL TRANSCRIPT}

Jennifer Fugo (00:08.268)

Dr. Gupta, I am so excited to have you here. Welcome to the show!

Ruchi Gupta (00:13.348)

Thank you so much. I'm very excited to be here.

Jennifer Fugo (00:16.044)

Well, I do have to tell everyone that you are a very close friend and colleague of Dr. Peter Lio, who is a Healthy Skin Show fan favorite guest. So I know that our guests, our audience will love listening to you. I'm so grateful that we got to meet this past summer, actually this past fall. Oh my goodness. Everything blurred. It was September/October. But I am really honored to have you here because I’ve not dove into this, what I would say a pretty serious topic about food allergies, especially when they can become life-threatening for individuals. And I feel like because you have personal experience, perhaps this topic, not that it means more to you, but I think you can relate to your patients and the people out there dealing with this more. So do you want to share why you're so passionate about food allergies?

Ruchi Gupta (01:13.926)

Sure, I'd be happy to. And yes, I did want to say Peter Lio is incredible. And I'm glad, he totally should be a fan favorite, and I will do my best to live up. But yes, my own personal story is quite interesting, because I started studying food allergies and within a couple of years of starting to learn it, my daughter was diagnosed with food allergies. My son was eating a peanut butter and jelly sandwich, playing with her. She was one, probably got some in her mouth and she broke out in hives and threw up and all of a sudden, you know I became a mother of a child with food allergies and I am part of this amazing community. And so that was the initial story and now she's 17, so we've kind of gone through all the stages, you know that really scary early stage of what is this? And how do we deal with this, because food is a part of everything we do all day long. And how do you keep your child safe or yourself safe every single meal. So you know we've gone through the school and you know, when they're not independent, to when they start becoming independent, to now in high school when they're super independent, and then going off to college next year, you know, and trying to pick a college because they're going to be completely on their own making their decisions. So that's why it is very personal to me.

Jennifer Fugo (02:36.708)

So in terms of the prevalence of food allergies, I think in general, we have seen this alarming trend, especially in kids, but there are also adults who can develop food allergies. Can you talk a little bit about that trend? What's the prevalence of food allergies in children and even in adults, if you have stats on that?

Ruchi Gupta (02:59.258)

Oh, of course. I mean, this is what our research lab does. And so 20 years ago when I started, we didn't have those numbers. And so one of the first studies we did was to better understand the prevalence of food allergy, the public health impact in the US. And what we know now is that about 8% of kids have food allergy. Now that's about 1 in 13, or 2 in every classroom. So it's a lot. And kind of to your point, it has become an epidemic. We didn't see this. And what you'll hear a lot is, when I was young, we didn't have this, and when I went to school everyone took PB&J to school, you know, and so what happened in a generation. So for kids, 8%, and let's talk a little bit about what are those common food allergy. And so we have what we call a top nine, and some of the ones that everybody knows, peanuts and, you know, all the tree nuts, and shellfish, and fin fish, milk, egg, soy, wheat, and sesame is starting to really ramp up and we're seeing it as an up-and-coming allergen. Now, you can be allergic to anything, but those are the most common.

And adults, what you asked, it's also surprisingly prevalent. When we conducted our first adult study just a couple years ago, it was because we've been talking about kids so much, and we think about kids. But when we asked adults, do you have a food allergy, interestingly, one in five said yes. 20%. Yes. I mean, it was shocking. When we cleaned it, what we realized was about 10% truly had symptoms of food allergies, but 10% is a lot too. But the problem in adults, and I do the same, we don't take as good care of ourselves as we do our kids. And so, you know, only one in 20 adults were going to see a doctor. So they're not getting it diagnosed. Even the ones with true symptoms, they would eat the food, have a reaction, and then avoid it, right? Thinking they had a food allergy. So this was one of the areas of misconception that we were trying to help people understand. But the answer to your question is about one in 10 adults seem to have a true food allergy.

And the top nine are the same, but the number one allergen in adults is shellfish. Almost 3% of US adults have a shellfish allergy. And then it's milk, peanut, and then the rest that I mentioned. The other interesting thing about adults, and then I'll let you ask me the next question, but the other really interesting thing is about 50% of adults who had a convincing food allergy said they developed a new onset food allergy as an adult. So, you know, we often think this is a childhood thing and then you grow up and some kids grow out of it and some kids continue it into adulthood. But what we were finding are new onset allergies in adulthood, 50%. So a lot of adults listening, if you have developed a new food allergy, you are not alone.

Jennifer Fugo (06:01.78)

No, it is quite, as you say, I know actually a number of people who have developed allergies, like all of a sudden will eat like something with shrimp and they'll end up the mouth starts swelling and they're, you know, feeling like the throat is getting tight and whatnot. But I do want to clarify things for listeners because I think this is important. As you know, a lot of people use that term food allergy, but unfortunately, some people really mean a food sensitivity or a food intolerance. So we're using and mixing up these terms inappropriately, which I think at times dilutes the concern and care that potentially someone, say in the food service industry or maybe at a school, because your daughter's going to go to college, might not necessarily, if they're not educated on it, might not understand the severity of a true food allergy. So from an immune system standpoint, what is going on with a true food allergy compared to these other issues?

Ruchi Gupta (07:10.062)

That is a great question and so important. So from an immune standpoint, a true food allergy is an immune-mediated reaction. So an IgE immune-mediated reaction that happens in your body. And what is happening is your body is seeing that food as an invader. And we can talk about how that happens in a bit. But your body sees this food as an invader and goes on attack.

So it releases all kinds of chemicals, things like histamine, and really just goes full attack on this invader they're seeing. Now, how that's different from a food intolerance, which is also very common, lactose intolerance, everybody knows about, and gluten sensitivity. And we hear these terms now. What's happening there is you are missing an enzyme in your gut to be able to convert, you know, lactose, lactase, that type of thing. And so what happens there is you usually get symptoms, but they're usually gut symptoms. So you'll have like cramping and bloating, diarrhea, sometimes vomiting, you know, so very specific symptoms. Lethargy, you know, people talk about feeling tired after they eat gluten. So those symptoms are very, very different than food allergy signs because when your immune system reacts, you can have a reaction in any organ system. So a lot of times we talk about skin, food allergy rash like hives, swelling, itching, but you can get throat closing, you can get trouble breathing, chest tightness, you can get the GI symptoms, vomiting being one of the most common, drop in blood pressure. Your body takes over and is attacking and it can go into what we call anaphylaxis, which is a very severe reaction that happens rapidly, and can lead to death even though it is very rare. I want to put that out there because people get very fearful, but this cascade can be really severe.

Jennifer Fugo (09:13.644)

And the one thing I also learned from you in the presentation you gave is that a food allergy reaction may not be immediate. Like I think if someone ate something and maybe 10 minutes later, or not even that long, they'll start experiencing these symptoms. So is it possible that there could be this delay of onset of anaphylaxis for somebody who might actually be initiating this type of immune response?

Ruchi Gupta (09:40.146)

Yes. So in a true food allergy, once you eat the food, the most common food allergy signs are that they will start having a reaction. A lot of times right when they put it on their tongue, they'll feel it. You know, they'll feel something's wrong and some tingling and they'll start feeling it in their mouth. The progression of that, so we usually say within the first two hours, you usually have symptoms. But the majority of times it's in that first 30 minutes, and very rapid. The problem is, is sometimes it'll be mild. If they only had a tiny bit or you know, didn't have a big exposure, caught it, and have a reaction. It may be hives, just a couple hives, or they vomit once and they're feeling better. Or a food allergy reaction can expand and go into different organ systems.

So I think that's why food allergies are so confusing is you can have a rapid onset, you can have it, you know, potentially after an hour. And then the other thing is once you do have that food allergy reaction, a subset, 10 to 20%, can have a secondary reaction hours later, and it can come back. So that's where I think food allergies become so complicated. But I think the most important thing for people who are listening is just watch those symptoms, because if they are multi-organ, it is really, really important, or if you feel like they're getting worse fast, it is really, really important to get that epinephrine autoinjector and get it in your system because that will help stop it the fastest.

Jennifer Fugo (11:19.504)

And it sounds to me like from what you're saying is that if you believe that you may be having this type of food allergy reaction, it's best to not be alone. Like don't go home on your own. It sounds like it's better to be around someone else who could possibly check in with how you're doing.

Ruchi Gupta (11:39.33)

Absolutely, oh my goodness, if you feel like you're having a reaction and you're alone, please tell people around you, you know, and get support. Don't, you know, be worried about it and do it on your own. But know how to use an epinephrine autoinjector on your own, you know, for yourself because giving that to yourself is really important. And then if you're still feeling signs of food allergies or anaphylaxis, you need to get medical attention. So yes, absolutely. Notify people around you.

Jennifer Fugo (12:06.541)

Yeah. So I will also share, I actually shared this on my Instagram when I was attending the Food Allergy Research Allergy Summit. And I realized that regardless of my training, I admittedly don't have somebody directly connected to me in my life who has food allergies, I don't personally have food allergies, that a lot of the information that I came into the conference thinking was correct was really actually quite outdated and not correct about food allergies. So it was extremely sobering to me to realize that I don't know as much about this as I should, but also just from like, it's my hope that if people listen to this, even if they are in the same boat as me, that perhaps they will help. You never know, you might be the person who identifies or recognizes, like you said, somebody potentially having a food allergy reaction or anaphylaxis, and you at least know what to do. So, with that being said, one thing you shared is that Benadryl is actually not that helpful when it comes to stopping the progression of anaphylaxis, which I thought, I always keep Benadryl in my medicine cabinet thinking if somebody starts to go into having food allergy reaction, I have Benadryl, and that is not quite true. So what do we need to know about that?

Ruchi Gupta (13:33.474)

Yeah, but you're not alone and the reason is, because so much has changed in our understanding of food allergies in the past 20 years. I mean, when I got into this, same, Benadryl was kind of the go-to for a reaction. Then what we started seeing is that if you only give Benadryl, it may mask some of the symptoms because it takes away maybe some of the rash, you know, and some of the itching, but the reaction continues to happen in your body.

So slowly as we started seeing more people have these severe reactions and being given Benadryl and not getting better, you know, and then not observing it, the whole field kind of changed their stance. So what you heard is kind of what people thought. But now what we say is don't give Benadryl unless it's a very, very mild reaction, like if they touch something and they get a couple hives on their hands or something like that. Observe the person having the reaction, and if it is getting more and more severe, if they are feeling it, because you know as an individual, I've seen my daughter, she knows, this is bad, or this is really something that's gonna expand, just give the epinephrine. An epinephrine autoinjector, so you know before we only had one, we're very fortunate now to have multiple types. So you know we still have the EpiPen, there's the Auvi-Q which talks to you and tells you what to do, there's generics now that you can get. And, exciting news on the horizon, there is a sublingual, and there are two different groups making a nasal epinephrine. So hopefully in the next year, you'll have other delivery methods.

But get that epinephrine into them as soon as possible because it will stop it. And epinephrine is so safe, people fear it, but it's your own adrenaline. In Europe and other countries, they call it adrenaline. It's what you have in your own body, which is also working to help relieve you, but this just helps it go faster.

Jennifer Fugo (15:43.052)

And the other question I did want to ask around this was about Zyrtec, because you mentioned Zyrtec and how that might be perhaps better than Benadryl. Can you explain that?

Ruchi Gupta (15:55.838)

Yeah, so Zyrtec and Benadryl, I mean, they all are antihistamines, Benadryl's diphenhydramine, Zyrtec and Allegra and Claritin, those are three very common antihistamines. The thought is they're all pretty similar, but Benadryl is sedating, right? It makes you sleepy. And these others are not. So sometimes a lot of allergists have switched to advising to go with one of the non-sedating ones, because what we would see with Benadryl is then, if it's a child, they would get sleepy and fall asleep, and then you don't know if they're continuing to show food allergy signs/reactions or not. So that was the reason, but all of those do the same thing, it's just one makes you sleepy.

Jennifer Fugo (16:46.284)

Yes. And again, this is just so fascinating because as you said, how doctors recommend stopping these food allergy signs have changed. I'm going off of information, I'm in my 40s, so like you said, when I went to school, there were very few food allergies and that's what you were told. Oh, Benadryl. You have a problem? Take Benadryl and now that's not quite the case. And one other surprising thing that I did want, and I think it's important to share about, was that I didn't realize there was this real big fear of using an EpiPen. Like a lot of, I was really taken back at the number of people in all of these different talks who were so apprehensive of having to inject themselves or a loved one injecting them. What do you find is the main driver of this fear?

Ruchi Gupta (17:38.514)

Yes, shots. People don't like needles. And I think that really scares people. And the idea of giving yourself a shot or putting a needle in you is, I think, what brings up a lot of that fear. The other thing is, you know, right now, if you give epinephrine, we say then you have to go to the emergency room. That's also challenging for a lot of people to do. So it almost makes it sound like, oh no, this is gonna be a big, severe, whole day episode that I'm gonna have to deal with. But I think the needle fear is often one of the big ones. It's gonna hurt, or I've never given anyone a shot, or that kind of thing.

But what we've seen is once you do it, the fear really goes away, because it doesn't hurt, and it actually makes you feel better. You know, like the needle's really tiny, and it goes in, and medicine's in within a second, and they start feeling better right away. So you'll hear stories from people who have used it, who are now very, very comfortable using it. So I think it's getting over that first fear of using it and then after that people who have had multiple episodes are very comfortable. So encourage people not to let that stop them, but in another year hopefully they'll have other methods and other ways of using it. And the other thing I would say is do not not use it because of the emergency room. I'd rather people use it and then, you know, call their doctor or watch, then delay it because of having to go to the emergency room. So the sooner you use it, the better the outcome.

Jennifer Fugo (19:18.832)

And you work in a research lab to understand food allergies, which is so cool, so you're in this all day long. Is there anything that could help listeners understand why people are developing these types of reactions to certain foods?

Ruchi Gupta (19:37.814)

Yeah, that's one of the biggest questions we get asked, is why? You know, why are we seeing such high amounts? And we know it's everything's genetic environment, but genetics don't change that fast. So what is it in our environment? A lot of things that we talk about in the environment, you know, are around now this whole microbiome idea. You know, so originally we said to clean, but being too clean is influencing your microbiome, right? So your microbiome, I think most of your listeners probably know what that is now, but it's all these bacteria and viruses and fungi that are in our gut, but they're on our skin, and they're all over us, and they have a big part to play in our health. And so if we disrupt that microbiome in certain ways, we think it may be leading to things like food allergies.

So some examples that people talk about a lot are how things have changed in our environment. We have more antibiotics early in life, maternal antibiotics, and then to infants in that first year of life. We have more C-sections where the baby's not going through and getting mother's bacteria. The way we eat has changed, right? Like a lot of the people talk about the processed foods and potentially pesticides, and all the things that may go into our body and disrupt our microbiome.

Another big thing is just medicalizing infant feeding. So a really big study, a big finding, was looking at, you know, in the year 2000, when we started seeing higher rates of food allergy signs, the American Academy of Pediatrics said, oh no, you know, there's something going on here. Let's advise not to eat peanut products till babies are three years old. Okay? So, peanut, egg, wait, let's wait. And so what happened is pediatricians like myself who were training around that time started telling people not to introduce. Then in 2008, there was no data showing that was true or false, so they took it away. But pediatricians still kept saying, don't introduce. Then in 2015, the LEAP study was published out of London, which showed that actually introducing peanuts early may prevent peanut allergy because your gut, your body, when you're an infant, your immune system is being introduced to that food. So then guidelines changed immediately. And so now we have ways to potentially prevent food allergies. But getting from your why to what have we done in society? By delaying it, did that actually increase how many people in the US are developing these foods? So multiple, multiple reasons, probably not just one.

Jennifer Fugo (22:26.224)

No, and I know Dr. Lio has spoken, I don't know if he's discussed it here on the Healthy Skin Show, but he also talked about with babies specifically becoming sensitized possibly. Can you just touch on that? It might not be from eating the food, it could be from applying or coming in contact with the food on your skin.

Ruchi Gupta (22:49.118)

Yeah, that's right. Thank you for bringing that up because one of the biggest hypotheses right now is if a food is introduced through your skin before your gut, then your immune system goes on the attack. So if that peanut protein, and I know I'm guilty of this, and I know mom guilt is very prevalent, but when I had my daughter, you'll be nursing and you'll be eating healthy nuts, right? You think that's a very healthy snack. But that protein may be falling on their eczematous skin, she had severe eczema, and then the immune system sees it before your gut sees it and thinks it's an invader and goes on attack, and switches your immune system to this pathway, this food allergy Th2 pathway instead of the normal pathway. So the idea was if we can get it into the gut first before it comes in contact with the eczematous skin, then maybe we can protect them and get them on the right immune pathway.

The other thing that Peter probably talked about is that's why it's so important if your infant has eczema, like mine did, severe eczema, to get to your pediatrician, get to a dermatologist, and really take care of it. Because what we're hoping is, by protecting that skin barrier, those proteins will not be able to get in and be recognized as an invader. So definitely protect that skin barrier.

Jennifer Fugo (24:20.02)

And it sounds like in terms of halting food allergies, this is something parents should be aware of to possibly help their kids avoid developing food allergies in the first place. Do you have any other thoughts or tips that could be helpful for parents?

Ruchi Gupta (24:35.214)

Absolutely. I mean we're learning so much about prevention. So first, if they have severe eczema, if your baby does, get to your pediatrician and start talking about it, and get to an allergist, get to a dermatologist, the earlier the better. Second, introduce peanut products early to your infant. So now we're talking like, they are ready to eat, usually around four to six months, so when they're ready to eat, you know, don't start with it, but one of the early foods should be peanut products. And then we're doing a large study in our center looking at the eight foods, the eight most common foods. So we're looking at, you know, milk and egg, peanut, tree nuts, and getting them into babies and seeing if we can prevent multiple food allergies.

But the recommendation right now is just feed your baby. I think we've medicalized feeding too much. You know, waiting three to five days doesn't make sense, because you're going to get so little food in your baby early. You know, wait a day, if they're going to have a reaction, it's not going to take three days to see it. And so get high diversity of foods into your baby early. So don't worry about this whole medicalization we've done. And then, yes, introduce those foods, protect the skin. I would say those are the two biggest things.

Jennifer Fugo (25:53.52)

Awesome. Well, I did want to touch on the fact that you also have this really beautiful product called Yobee. I feel like we have to do this whole other conversation on the scalp microbiome, because of your research this product exists, do you just want to talk a little bit about that? And everybody can go and find that. We'll put a link in the show notes, but it's yobeecare.com is where you can find the product. So what is Yobee for?

Ruchi Gupta (26:21.458)

Yes, thank you. So again, you know, a lot of these stories are personal, but my daughter was born with terrible cradle cap, which I'm sure people can relate to listening, and severe eczema, which I mentioned. And back then there was very little we could do, and still there's not a lot, steroids is a big part of it, and it's terrible. And I'm sure on your show you've talked about it, how hard it is for parents, itching all the time, uncomfortable. So as a pediatrician and a researcher, just kind of went to work, she became my guinea pig, and we tried a lot of stuff. And we found a group of ingredients that worked really well. It was probiotics. So probiotics mixed with honey and turmeric and vitamin B12. And Peter Lio helped come up with this recipe. But we tried it on her. When we tried this, her cradle cap went away. It was gone. And it worked so well that I started giving it away in my ped's clinic. And we gave it to everyone who came in and we had really good success over 10 years.

And so now 10 years later, we want to share it with the world. And what we found in those 10 years is not only did it work for babies, it works great on kids, it works great on adults because what it's doing is helping to balance your scalp microbiome. So we have it. It's Yobee. It's a jar. It's like a thick solution, you mix it with a little bit of water, add it to your scalp, massage it in. We have a scalp massager, you can use the massage it in. It's really, really helpful, it wakes up your scalp. And then because people really like shampooing and conditioning, they asked if we could make some natural shampoo conditioner. So we did that as well. And then a lot of people apply it to their skin, so we came out with the skin cream. And all of them have those four ingredients, PROBYOME. And it's just a healthy way to keep your scalp and skin microbiome balanced. So yeah, try it, give me feedback, I'd love to hear. Works really great for dry scalp, dandruff, but works for all scalp types.

Jennifer Fugo (28:30.54)

Awesome. And before we wrap up, I do need to share with everybody, you have an amazing book by the way, it's called Food Without Fear. It is available everywhere. And it's a great resource for parents, adults, whomever, to better understand how, you said you wrote this during COVID. And, you know, this is a great resource for people who are wanting to learn more about the food allergy topic and to better understand how to navigate this space, because there's a lot of overwhelm, there's a lot of confusion around identifying food allergy signs quickly and what to do if or when you feel like you’re heading towards anaphylaxis.

I will say being within that community at the FARE event and getting to hear the anxiety, the stress levels, the confusion, it was touching to me to see the advocacy that is going into trying to help this community. Because, it's not to put down other skin conditions, but food allergies can be life-threatening. And so I can understand the fear that, just to be able to eat, right, just to be able, for some even just to be in the same room with something, can be really scary and overwhelming. So it's an excellent book. We'll put a link to it in the show notes.

And then you did share with me as well that if someone is in the Chicago area and they’re looking for a trained allergist who is a part of this Northwestern system, because you're in the research lab and you do see some patients, but they might not be able to get to you specifically, but some of your colleagues. Can you just talk a little bit about what CFAAR is?

Ruchi Gupta (30:15.63)

Yeah, CFAAR is the Center for Food Allergy and Asthma Research. And, you know, one of our big areas outside of research is helping the community. So please, at cfaar.northwestern.edu, write us, we would love to help you find good care. And in Chicagoland, but we do know people all over the country. So I don't want to limit it. I get requests for every state out there, and we will help support you, because getting good care is the first step. And that's also part of the book, because so few people get diagnosed. One of the reasons we wrote that is it really explains all types of conditions. And like you said, I mean, we talk about food allergy rashes and other food allergy signs throughout the body as well in there and how important it is, because a lot of these conditions are related. Oral allergy syndrome. What do I have? When you're like, what is this? And it'll help you figure it out. And that was the goal. And then you can go to your doctor and say, look, I really do think it falls into this category. Because there's GI conditions, you know, there’s intolerances like we talked about, and then there's immune-mediated conditions. There's other things like eosinophilic esophagitis and FPIES, a lot of things that are coming up that are related. So I kind of go through all of that investigation in the book. So, yes, please, I really love it. I am part of this community and anything I can do to help support your listeners, I would love to.

Jennifer Fugo (31:45.904)

Well, thank you so much, Dr. Gupta, for being here. And it sounds like we have a lot more to discuss, so I hope that you will be back. And I will definitely make sure to put all of the links of everything we discussed in the show notes to make it really easy for listeners to be able to find you and connect with other professionals who can really help them, and your Yobee and your book. I mean, there's so much stuff that you have for the community, it's wonderful. So I appreciate you being here.

Ruchi Gupta (32:14.658)

Thank you so much, Jennifer. I'm very honored to be here.