Like many of us with food allergies, I have gone from doctor to doctor looking for the right fit.
I am happy to say that a few years ago I did.
And even though Dr. Marc Meth’s offices were (and still are) about an hour and 20 minutes away from where I was living at the time, the drive (and now flight) was/ is well worth it.
So the other day I decided to call him up to ask a few questions. And although he just got married, has a new beautiful baby boy, and is filled from dawn ‘til dusk with appointments, he without hesitation fit me into his schedule to chat.
That’s not only the sign of doctor that cares about his patients, but the sign of an all around good person.
Have Epi, Will Travel (HEWT): In your years of practicing medicine as an allergist, have you seen an increase or decrease in the number of patients you have and in the general severity of allergies?
Dr. Meth: I’d say over the last several years it’s probably been pretty similar. But there’s no doubt been an increased prevalence of food allergies over the last probably 20 years.
HEWT: Any idea why that’s happening?
Dr. Meth: No one really knows for sure. The most common theory is called the Hygiene Hypothesis. The current belief is that we’re over sanitizing our environment and that’s leading to the body directing antibodies towards antigens or proteins – like the peanut protein – that we normally wouldn’t have targeted before. As opposed to those antibodies being directed at parasites. The area that appears to be most involved is the microbiology of the gut. What used to be tolerated in certain individuals is no longer tolerated.
HEWT: What’re the different ways of testing for allergies?
Dr. Meth: One way is via a skin test and the other is via blood testing.
HEWT: Which method is the most accurate or conclusive?
Dr. Meth: They both have their benefits and drawbacks. We tend to do skin testing in the office which allows us to give a patient the results within 15 minutes. When we trend food allergies over time, we tend to do so via blood testing. So skin testing is best to establish that a food allergy exists and a blood test is the best way to trend it.
HEWT: When you say trend it, what do you mean?
Dr. Meth: I mean to see if the person may outgrow it over time.
HEWT: Why do patients at times receive false positives on their skin or blood tests?
Dr. Meth: People who have eczema or a lot of food allergies already are the most common group to develop a false positive. They’re simply more prone to making non-significant allergic antibodies which can create a false positive on a test. The people with a lot of environmental allergens can make false positives as well. This is because the proteins in many pollens are similar to the proteins in several types of foods. I never diagnose someone with a food allergy without having both a positive test and clinical symptoms that are consistent with a food allergy.
HEWT: When you say clinical symptoms, what do you mean?
Dr. Meth: I mean hives, swelling, wheezing, itching, or anaphylactic shock. I need both a test and a good clinical history.
HEWT: So if you have your good clinical history, your clinical symptoms, and your positives, would you still give a food challenge? Or is that reserved only for new negatives?
Dr. Meth: There are a few reasons I would give a food challenge. First is if someone was previously definitely allergic to a food and then their testing turns negative. And I’ll tell you most commonly, the age group that grows out of food allergies are children. The most common allergens to outgrow are milk, wheat, soy, and egg. And usually those people are allergic beginning in early infancy and then outgrow it. The ones that are usually not outgrown are fish, shellfish, peanuts and tree nuts.
I will also do a food challenge if the patient’s history is questionable. If I’m questioning whether or not they have an allergy at all- regardless of their test result – I’ll do a food challenge. If their clinical history is borderline and their symptoms are borderline I’ll do it. Meaning if they complain of stomach pain or a lump in their throat — those are subjective symptoms. Hives, lip swelling, etc. are not subjective. I need non-subjective symptoms and a positive test to be convinced of an allergy.
HEWT: Can you explain a little bit about airborne food allergies?
Dr. Meth: Some people are extremely sensitive to the protein of their food allergies – like peanuts. But I will tell you that the percentage of people that are that sensitive – meaning that they will have an allergic reaction to the airborne peanut protein – is actually very small. And there’s no way to know until the reaction happens. You can’t test for it. There is no test to definitively say what a person’s symptoms will be when they eat or are exposed to a food.
HEWT: If one child in a family has a food allergy, is there a direct correlation in the likelihood that a second or third child will have an allergy too?
Dr. Meth: It’s all genetics in that…yes, if you have one allergic child there is an increased risk that the next child will have allergies. But they may not. And to what is also not definitive. The next kid might have environmental allergies, or asthma, or nothing. But yes – allergic genes come down from the parents.
HEWT: What’s going on with the current peanut immunotherapy and vaccination research?
Dr. Meth: There’s a lot being done right now to try to develop tolerance such as immunotherapy. There’s extensive research being done towards immunotherapy for peanuts, and it has shown efficacy to desensitizing people to peanuts. However, these protocols are not FDA approved and continue to be research-based only. And no one really knows long-term how long you’ll need to be on this peanut protocol. It is not, as they say, “ready for prime time treatment” yet. But it has shown efficacy in trials. They’re also researching patches and vaccines, but there is nothing close right now to FDA approval or widespread availability.
And that’s where I left our conversation. Dr. Meth is truly the newly-allergic patient’s dream. He will take the time to sit with you and talk it all through. He understands how scary and confusing this stuff can all be and better yet, he makes you feel comfortable. Dr. Meth is located in Los Angeles, California.
If you have any other questions you’d like me to have answered, feel free to email me via the contact page.