Dr Douglas Jones is an internationally recognised global expert on adverse food reactions. He is the founder and director of the Immunity Group Australia, helping thousands of families worldwide to manage food allergy symptoms and treatment.
Together, Dr Jones and Emma explore the complex nature of food allergies, what we have learnt in the past, and how management and treatment is evolving to include not just immune system optimisation, but gut microbiome management.
Dr Jones unpacks this important topic, from the pathophysiology of food allergies, testing, and treatment options, and how individualising the treatment for each patient is paramount to achieve long-term effective outcomes.
Dr Jones recognises the burden of food allergies not just on the individual, but on the whole family, and strives to relieve this burden through educating and offering a holistic approach to treatment.
Covered in this episode
(00:25) Welcoming Dr Douglas Jones
(02:09) Australia’s allergy statistics
(06:32) Food allergy diagnose criteria
(10:47) Basophil activation test
(15:25) The drivers of food allergies
(22:09) Treatment options
(31:27) Oral immunotherapy - what is it?
(34:39) Treatment options
(39:44) Probiotics in treatment
(41:59) Dr Jones’ gut microbiome diversification protocol
(44:46) Diet and supplemental support
Key takeaways
- IgE is an antibody that the body makes that will interact with mast cells and basophils. Mast cells and basophils contain chemicals that ultimately will lead to an allergic reaction. If those chemicals remain inside the cell, nothing happens. However, when those chemicals get released, that's when they interact and that's when they cause the symptoms of allergy.
- The traditional ways to diagnose food allergy are centered on two methods;
- Skin prick test
- Blood test measuring serum IgE.
- Risk factors for food allergy development:
- Nutrition of the infant and mother
- Early life antibiotic/antacid use
- Caesarean birth.
- Allergy intervention includes the monitoring of vitamin D levels.
- Studies suggest that early life exposure to foods influence immune cells and may protect against food allergy development.
- Oral immunotherapy involves introducing a macroscopic amount of food to the allergic patient to retrain the immune system to tolerate the food protein. Overtime this amount is adjusted to increase the threshold of reactivity.
- Lifestyle interventions to improve food reactivity and overall gut and immune health:
- Exercise
- Sleep
- Meditation
- Relaxation techniques.
- Dietary and supplemental interventions include:
-Pre and probiotics such as lactulose
- Omega-3 fatty acids
- Vitamin D.
Resources discussed and further reading
Dr Douglas Jones
| Immunity Group Australia Website |
Oral Immunotherapy
| Research: Quality of Life of Food-Allergic Patients Before, During, and After Oral Immunotherapy |
| Journal: Administration of a probiotic with peanut oral immunotherapy: A randomized trial |
Gut Health
| Journal: Gut microbiota maturity mediates the protective effect of siblings on food allergy |
| Article: Low-Dose Lactulose as a Prebiotic for Improved Gut Health and Enhanced Mineral Absorption |
Food allergy prevention
| The Leap Trial |
Transcript
Emma: Hi, and welcome to fx Medicine, where we bring you the latest in evidence based, integrative, functional and complementary medicine effects. fx Medicine acknowledges the traditional custodians of countries throughout Australia, where we live and work, and their connections to land, sea and community. We pay our respects to the elders past and present, and extend that respect to all Aboriginal and Torres Strait Islander peoples today.
Joining us on the line from America today is Dr. Douglas Jones, who is both founder and director of the Rocky Mountains Allergy, Asthma and Immunology Clinic in Utah and the Immunity Group Australia here in Sydney. Dr. Jones is also the director of Allergy Microbiome Foundation, a nonprofit organisation dedicated to advancing the science of integrative prevention and treatment of allergic disorders.
Dr Jones is board certified by the American Board of Allergy and Immunology. Now, I first came across Dr. Jones when patients told me about his clinic in Utah, which offers treatment for food allergies. Today, we're going to discuss the advancements in allergy treatments in the US. And here. Welcome to fx Medicine, Dr. Jones. Thanks so much for being with us today.
Douglas: Yeah, thank you for having me. It's an honor to be on your show.
Emma: It's an absolute pleasure. Now, Australia is the allergy capital of the world. Food allergies are very common and estimated to affect around one in ten babies, one in 20 teens and one in 50 adults. Now, there's a significant public health issue with the annual cost of allergies to the Australian economy is more than $7 billion.
Emma: But Dr. Jones to get things started, why do you think Australia has such a high rate of allergies?
Douglas: That's a really great question and I think I don't know if we have the exact answer. There are several theories that would be floating around. One of them would be kind of further away you get from the equator, for instance, you may see food allergy incidence rise, you've got higher levels of vitamin D deficiency, for instance, .
That may play a role in that. And even though parts of Australia, like northern Australia is closer to the equator, a bulk of your population in Sydney, Melbourne, Adelaide, that area is really far south. And you know, I think that plays a role. There may be from my experience too, because I've treated hundreds of Australian families and I do see a large proportion that may be actually overdiagnosed.
So I actually wonder what these statistics actually would be. I actually did a kind of a cohort of patients where they came in collectively. There was like 36 families and they were avoiding well over 300 foods that they were told they were allergic to when we actually did what's called food challenges and I can get into that later. But when we actually went in and did some food challenges to discern if they were truly allergic or not, there was only 116, you know, out of those 300 foods that they were avoiding.
And so we found that the group was avoiding so many more foods than what they really needed to overall. So it's kind of interesting.
Emma: Yeah, it's really interesting. I mean, you have successfully treated over, I think, over a hundred Australian families for food allergies. They travel over there to Utah to see you, but you've now bought your pioneering treatment protocol to Sydney. We'll, get into that detail of that later. But can you tell us how that came about?
Douglas: Because of motivated food allergy mums. I'm telling you, if you want to get something done in the world, you put a food allergy mum in charge of it and you're going to get some movement. So, what happened is I was had been treating, you know, so many families prior to Covid.
And there was a family in particular that was ready to fly over. They had their place picked out. They had everything ready to go. And then the pandemic broke out. And obviously, Australia shut down. The majority of the world shut down. And then during that time, the family reached out to me and said, Have you ever thought of bringing a clinic here?
And I said, Yeah, I have. I've thought about it a lot. And we've looked at different avenues and, you know, there was different red tape and things that some challenges that I'd come across. And I said, you know, I haven't been able to solve that piece. And they said, Well, instead of us investing our resources and coming to you for you just to treat our children, what if we partnered together and we put that money towards trying to establish something here in Australia that we could that we could do?
And I said, if you are willing to do that, that would be fantastic and, you know, it may open the door for so many families. And so during the COVID months, sort of sitting around, we actually collectively put our thoughts together on how we might bring this option to families in Australia. And we worked together. So it was the food allergy family.
Emma: Yeah, I think that grassroots movement always is where it starts and then you get the momentum. I think that's just so profound.
Douglas: It is. And you know, it just takes that almost that desperation, you know, in families. But not only the desperation, but it was also a family that was looking to help others, not just their children, but but also put things to use and have that outreach to help other people.
Emma: Incredible. Beautiful thing. It is. Now emerging treatment options for food allergies is creating some very interesting conversations. I know for myself, both with colleagues and my patients and traditional thinking about the pathogenesis of allergy has centered on the role of these allergen specific IgG antibodies that sensitised mast cells causing de granulation and the release of inflammatory mediators. But now we've got some emerging theories and new research that can show us that there may be some new ways of thinking about this topic.
We're going to explore some of those soon, but can you explain to us the methods used to actually diagnose a food allergy?
Douglas: Yeah, the current way is the traditional ways that we diagnose food allergy are really centered currently on two methods. One is a traditional skin price test and the other is measuring something called allergen specific serum IgE. I guess that's a blood test.
And both methods are really measuring the same thing. It's just doing it in a different way. It's both measuring the amount of specific IgE that the body is making. For those in the audience that may not know what IgE is, I'll just explain that briefly. IgE is an antibody that the body makes and it is something that will interact with some of the cells in our body; Two primary cells, one is called a mast cell, that you've mentioned. And then there's another one called the basophil. The mast cells and basophils, they contain all of the chemicals that ultimately will lead to an allergic reaction. If those chemicals are inside the cell, nothing really happens. We all have that. You have it, I have it. Everyone in the audience here are going to have those cells and those chemicals. The trick is when those chemicals get released, that's when they interact and that's when they cause the symptoms of allergy. Well, IgE, we're talking about it's kind of that key that essentially can unlock the door for that cell to open up and release the chemicals. And so that's kind of what we're measuring. It is not a perfect test, though, because while that's the basis, there's other factors that also can play into whether those chemicals get released. But that IgE really is kind of the one of the central figures. It's an easy thing to measure, so we do.
But there are some, you know, not so perfect aspects of the test because sometimes people can make IgE to a specific food, but they clinically, they don't react. And that's because of other factors that may be a play. So those tests are prone to what we call false positives, meaning the test may show a positive positivity, but the patient doesn't actually react. And that's where a lot of confusion comes into play because some people will say, Oh, why am I making this IgE? Or my test was positive, therefore I'm allergic. That's actually not necessarily true. We always have to interpret those tests, whether it's skin test or the blood test, we always have to interpret that in the context of the patient and the history of the patient. And really more than a test, so many times what's needed is a more in-depth conversation and a more in-depth understanding of the patient's history and whether it really goes into food allergy.
And we use those tests often to kind of confirm the history, if you will. So that's the basis of the most available tests.
Emma: Okay. I wanted to pick your brains on a test called the basal activation test, which measures that degree of granulation from mast cells. It's been using clinical research for a long time and some countries are starting to use it. It is not currently available in Australia. What do you think the strengths and weaknesses of this this test is? I'm sure at some point it will come to Australia, so it'd be great for us to get a heads up on that.
Douglas: Sure. I actually have this test in my lab in the United States and just a slight point of clarification, it's called the actual name is basophil activation test.
And a basophil is one of those cells that I mentioned before. There's the mast cells and the basophils. Those two cells contain the chemicals that release an allergic reaction. So there's actually a basophil activation test, there are also mast cell activation tests. They are even less available. Okay. But with both, what you're essentially doing is we can take those cells and bathe those cells and various concentrations of the food and we can actually see what concentration it takes of that food for the cell to open up to release those chemicals. So we can actually check that at a cellular level and a concentration level of when that cell actually opens up. So, it is more specific. There are many times when the IgE tests, for instance, are either negative or not correlating with the history when we can more accurately determine if somebody is truly allergic through a basophil activation test. So it does have a number of advantages. I think, it's kind of like doing what we call a food challenge, and what I mean by food challenge is that's kind of the gold standard test. And what we do with a with a food challenge is you bring a patient into clinic and we give them tiny amounts of the food, monitored under controlled conditions, and we gradually increase the concentration of the food that we're giving that person over time. And that's the gold standard for diagnosis because we're actually seeing right in front of our eyes what's happening to the person when they consume the food. Okay.
The downside to that is the risk, right? That's a lot of risk to a person, because if they're allergic, then they have a risk of reacting. Basophil activation test is basically like doing a food challenge, but we can do it in a test tube. So instead of actually giving it to the person and then imposing that risk on them, we can do that same thing to their cells in the test tube. And so what we hope in time, the more data we get, better we perfect the test is can it replace the oral food challenge, therefore eliminating the risk to that patient and just trying to get an accurate diagnosis? The downside with the test currently is it's not readily available to a lot of people, can be expensive and we need more data. We do need a lot more data to kind of flesh this out and get the confidence that we need to have it fully replace the food challenges. But I think that will all come in time. So it's it's coming. It's emerging.
Emma: Yeah, I think I can't wait for that because I see the enormous stress that those food challenges place on the mums, like the parents that coming to see me they very highly stressful moments when you take your child into hospital knowing that they are very likely to have some kind of reaction.
Douglas: It’s terrifying for the parent, for the child. And as an allergist, it's one of the most risky things we do. And I would love for this to become more available. I'm actually working on an initiative with a NGO in Australia trying to bring this type of technology and use it, how I do it to Australia. So we're kind of working on a couple of initiatives so we can try and get it there sooner.
Emma: Yeah, great. That's fantastic to hear. What do you think in your opinion, here's so many drivers for food allergies, but what do you think are the key drivers for food allergies to result?
Douglas: The biggest and really, if you look at what's out there in terms of various risk factors, a lot of times they talk about early, you know, the nutrition of the infant or the mum, early use of antibiotics or early use of antacids in a child, eczema, for instance.
So those are known kind of risk factors. But really all of those. Oh, and one other one would be C-sections also can pose a risk. All of those things that I listed, whether it's early use of antibiotics, antacids, C-sections, eczema, they all go back to one thing and that's the microbiome and the gut microbiome, for instance, all of those things disrupt or delay kind of that normal development of the microbiome in the gut of a growing infant.
And so we have this list, but really, I think the major driver is that disruptor in that microbiome. And we've seen actually there’s actually a really great study done in Australia where it showed the more siblings a child had, the less likely they were to develop food allergy. And it really had to do with the maturity of the younger infant or the younger children.it had to do with the maturity of their gut microbiome. So children with a lot of siblings, they're exposed to things, you know, the siblings are giving them, you know, different toys and exposing them to a variety of germs. What they found is it's actually really helpful in the maturity of that child's gut reducing it. Don't quite quote me on this, but I think it reduced the risk by like two thirds. It was a substantial number. Yeah. And when that child had older siblings.
Emma: Yeah. Incredible. Yeah. And you mentioned the microbiome and the profound impact it has here, but what about that maternal microbiome during pregnancy? You know, it does appear from the research that some bacterial species are protective while others mitigate more risk. What should we be aware of and what should we be advising our mums to be during pregnancy?
Douglas: I think the main thing with that is making sure the mum has a good, healthy diet. Good variety, you know, primarily if they can plant based, we don't tell them to unnecessarily avoid certain foods or, you know, unnecessarily take in certain foods, it’s just have balance, be healthy. And we definitely want to pay attention if that mum needs antibiotics, for instance, because that will negatively affect her gut health and microbiome. So we're very mindful of those things with the mum. I would also suggest they get their vitamin D level checked. Because that yeah, that plays a role. So yeah.
Emma: And so when we move on in that infant gut starts maturing and we start getting a high level of bacterial diversity in the gut, you know, any impairment in that diversity is going to alter then the amount of short chain fatty acids or the, you know, epithelial integrity of the gut. But in your clinical experience, how do you actually see that playing out in your patients?
Douglas: We see that all the time. We very much see this play out. And one of the things that's really interesting is kind of that gut/skin connection. there is an axis between the gut and the skin, and a lot of people don't realise this too, when we talk about microbiome, we often talk about gut microbiome, but there's also a microbiome on the skin, there’s one in the lungs, you know, and what's happening on the skin, though often may mirror what's happening in the gut. And so but we see this all the time, and I think it's critical in, you know, how this overall development is occurring in these children.
Emma: Yeah, I think there's so many aberrations that can occur along the way and that do happen well before a child actually exhibits any food allergies and symptoms of food allergies. And I think we're in a powerful position as clinicians working with women through pregnancy and those early infant years to really be optimising bacterial diversity and the microbiome. Yeah, it's almost like trying to work preventatively wherever, wherever we can.
Douglas: Yeah, I agree. And in fact, you know, one of those landmark studies was, was done to show, you know, for forever. We used to recommend to mums that they delay introduction of certain foods to their children. And what we found was that was probably creating more allergy. And there was a landmark study done out of the UK back in 2015.It's famously called a Leak Trial, where it told us we need to do early introduction of foods. And when we do that, have that diverse diet and we get those foods into the diet early, we can then influence those immune cells that you were mentioning in a beneficial way that may actually protect against the development of allergy and prevent it.
So those are really those early months are critical and the weeks matter. And so I always tell people, you know, have a plan and let's get in and let's have those discussions early with your health care provider so that we are prepared and we're doing the right things and we have that diversification and we're doing a lot of those healthy things that we've talked about.
Emma: Mm. Fantastic. Yeah. Now I want to move on to treatment options for allergies. First, I just need to state that ASCIA, the Australasian Society of Clinical Immunology and Allergy, don't openly support oral immunisation therapy yet, but they also do not oppose it. Rather, they refer to the need to consider the suitability and evaluate the risks involved. Now, a review I read highlighted the importance of measuring health related quality of life as an endpoint in food immunotherapy trials and studies have shown an improvement in quality of life scores in patients that underwent oral immunisation therapy. And this highlights the massive impact food allergies have on individuals and their families, which we've alluded to already. And I really see this daily in my clinic as the ripple effects of a food allergy are just enormous. But I love this measuring health related quality of life, and I'd love to discuss treatment goals for food allergies and what is the end point or the goal of treatment in your opinion?
Douglas: And first, I love your background and the work that you put into preparation because this question is great. It's a great question. It's an important question and it probably gets to the heart of my passion. So ,what I currently do. So I thank you, first of all, for asking. And one of the things that I notice so I've been doing food allergy treatments with oral immunotherapy for over ten years.
And when I first started and a lot of the early literature, the sole focus was about, you know, reactions, epinephrine use, E.R. visits, hospitalisations and while that’s important, think just for a minute about the pandemic that we went through. The news media was relentless with these fear based messages of positive test hospitalisations. You know, E.R. visits, deaths, but what wasn't as pervasive was the quality of life. Yeah. You know, with all the measures that we're taking, what impact is this having on the quality of life? And if you apply that similar principle to food allergy, for instance, again, a lot of the early studies it was about reaction appears, E.R. visits, hospitalisation, all of those things. But when I first started doing food allergy treatment, for me, the important part was getting someone to eat the food safely. One of the benefits that I found is as we desensitise them physically, not only the patient, but the mum and the dad and the family, they go through a psychological desensitisation. They literally will have personalities change. They will have that burden, that massive burden lifted. And that is probably the most rewarding part of what we do is not only getting people to be safe from, say, accidental exposures or being able to eat the foods safely, but it's that freedom from burden. The burden that's been lifted. And I didn't really understand the magnitude of the burden that these families carry from a psychosocial standpoint until I saw it lifted from someone.
And then I was like, Wow, that's impactful. And when you talk about to the last part of your question, what's the end point? I let the families decide that, you know, what we want to do is just reestablish the sense of normalcy and somebody will say, well, what's normal? Well, that actually varies depending on the person what, what's normal or what they what one person wants maybe different than somebody else. But what we want is for them to just feel that sense of normalcy, a sense of freedom, a sense of relief. And now a beautiful thing is, 11 years later, we have multiple options that we can offer to people, at least in the United States, and we give them the choice. It's like, hey, you have oral immunotherapy. You may have something called sublingual immunotherapy. You may have something, it's called Xolair, it's a injectable medication. You know, there's all kinds of options. And some people like one, versus the next. And it's nice to be able to just meet someone where they are. Yeah, ask them, where do you want to go? And we got them there. And because it's their journey, it's not necessarily mine, it's theirs. And we want to walk alongside them and get them to that area where they feel that sense of normalcy in life.
Emma: I love that end goal of whatever feels normal for that family, but the words desentisation, remission, tolerance. These are words that I kept reading in the literature. I mean, what is the difference between them? Because I want to just clarify the wording here.
Douglas: I think part of the confusion is we don't know what to call it because we really can't use the word cure because the moment we use the word cure, we impose liability. So, you know, if something happens. It's really we really hesitate using the word cure. So we have to come up with a different word, some may call it remission, something they call it sustained unresponsiveness. Some try to differentiate. Some may lump it in the same category. So, it can get quite confusing. What we're really trying to do, though, and it's funny, I'm the President of a nonprofit organisation in the United States, and we do education, food allergy education for allergists, for their nurses, for their teams. We try to establish best practices. And we had a specific workshop just on this question alone. And yeah, so again, well done on your preparation because this is a hot topic, and you'll actually continue to see these terms maybe evolve as we go along. But what we're really trying to do is when somebody does a treatment like oral immunotherapy or sublingual immunotherapy, part of the downside of that treatment is they have to continue to consume the food that they're allergic to most of the days and that can get cumbersome. It can get tiring for for some patients because they're having to consume the same food every day, kind of like a medicine. And so the biggest question is can we desensitise, if you will, or get a person in a state of sustained unresponsiveness to where they don't have to eat the food every day, and can they stop consuming it and still be safe? Really, that's the concept is can they stop eating it, still be safe if they have an exposure or they consume it later? And that's really the question that we're getting at.
And what's interesting is in our discussion most recently, we said, you know, a lot of these terms, what'll happen is no matter what, we will always recommend to somebody, even if they achieve this sustained unresponsiveness, which in a lot of centers what it would mean as you put somebody through a test where they have done the treatment, they then avoid the food for a solid month. And then you challenge them to it to see if they remain unresponsive. That's kind of how you challenge that. Even if somebody passes that, let's say, for discussion, somebody their oral immunotherapy, we got them to a place where we thought they could have sustained unresponsiveness. Let's take them off the treatment for a month. Let's re challenge them a month later and see if they still are not reactive. Even if they passed up the recommendation that the doctor is going to give them is they still want to want them to have exposure to that food on a pretty regular basis. Otherwise they may revert. So what we talk about is getting them to a point where they're taking the food not for treatment but to prevent a reoccurrence.
Emma: I mean for, for the audience, oral immunotherapy for food allergy is one option that is gaining popularity here in Australia. But can you just give a synopsis of what it is and the mechanism of action?
Douglas: So oral immunotherapy is where you start off with microscopic amounts of the food that somebody is allergic to. It's usually diluted into a solution. They put it into some kind of solution. Some people may put it in an atypea type of a powder or capsule form, but the concept is you get that food protein down to a microscopic amount and you start giving it to the patient. In my clinic, for instance, in our protocols, we actually start them at a dose that's so low that the body really can't react to it. There's a certain threshold amount that somebody has to consume to react. We actually go less than that. And so you start re training the immune system, so you give microscopic amounts that will induce some changes in the immune system. Over time, you then challenge them to a little higher amount, so where adjusting the threshold by which somebody reacts. We're altering that immune system in a really beneficial way so that the threshold that it takes to unlock the door with those mast cells and basophils is altered to such that the threshold is so much, it really doesn't matter how much you're consuming, that door is not going to be unlocked. And really that's it. And you do get down to that cellular change, you know, within the immune system.
And one thing that I think is absolutely beautiful about this whole process is you can take quality food, just quality food. And that food with somebody in their body may interpret that food as dangerous. And so they create this potentially life threatening response. We can take a microscopic amount of food, and when we use it correctly, we can alter that. So the body doesn't recognise that as dangerous anymore. It recognises it, recognises it as nutritious. It's good, it's healthy. And I think. How powerful is food? How powerful is that? That you can take it from that extreme to a more normal situation and have the nutrition that's really that it's there for?
Emma: Yeah. Food is medicine. That's one of my favourite angles of treatment.
Douglas: We don't need more pharmacies, we need more farms.
Emma: Yeah, I couldn't agree more. Yeah. Let's talk about some emerging treatments. Let's just touch on a couple of. We here in Australia don't have these available, but we need to be aware of what's going on around the world in this, in this area. So the first one was a program called a Tolerance Induction Program at the Food Allergy Institute in the US, which aims to induce remission. So I found that incredible because, as you said, remission is sustained unresponsiveness so you can eat the food freely after treatment has ceased. What is their overall approach?
Douglas: Very similar, very similar concepts to how I understand it. They're not real transparent with their approach, but from what I understand, it's very similar conceptually to oral immunotherapy. It's just often they may start with other similar foods first before they're, you know, getting to the actual food. I could be wrong on that. Again, it's hard to fully understand their program. Those of us in the medical world aren’t privy to a lot of their information. But I think overall, the concept is very similar to oral immunotherapy. From what I understand.
Emma: Okay. And you mentioned the drug Xolair, which is the first medication in the US approved by the FDA that can protect against multiple food allergies. I know it's a monoclonal antibody. And, you know, I've really seen an increased use in these drugs to treat things like eczema, like chronic eczema, rheumatoid arthritis. Now we don't have this available here, but what are your thoughts on this drug and how do you see it fitting into as a treatment option?
Douglas: Yes, great question. I've actually used it in food allergy in conjunction with it for like ten years. There's a couple of different ways that it could potentially be used. So the current FDA approved label in the United States is to be used as what we call a monotherapy, meaning you just give, it's an injection.
So it's a subcutaneous injection, meaning you kind of put it in the fat spaces, you know, in the arms or the stomach. So it's a small injection and it's either given once or twice a month, depending on the person's IgE level and their weight. And but the idea is so this is an anti IgE antibody. So what that means is it is it's an antibody that blocks IgE, which is again, that that gatekeeper for the basophils and the mast cells. So if you're blocking that or mopping it up, it again raises the threshold by which somebody is going to react. And so by giving just once or twice a month injection, it can offer protection to people against the accidental exposures. So when you use it as a monotherapy meaning just that once or twice a month injection, no other treatments involved, the people still avoid the food, they're still avoiding it. But if they have an accidental ingestion, the data would suggest that they're going to be protected from, you know, a life threatening reaction. And so it just gives I kind of liken it to you carry your epinephrine injector, which would be like an airbag in a car if you're if you're in an emergency. I liken Xolair as buckling the seatbelt. You know, So it's that extra measure of protection.
Emma: Yes. Yes. So but it's not retraining the immune system. It's not working in that way. So you would need continued treatment?
Douglas: Correct. Yeah. So and that's a that's a really good point is it's not changing the immune system. Now, I've used it actually in conjunction with oral immunotherapy. And when you use it that way, you can actually speed up the process and it, in my experience, gives less side effects to the process. And in that case, because we're changing the immune system with the oral immunotherapy, you know, you just use the Xolair for a defined period of time. That's that's an off label, kind of off FDA label usage. They are doing clinical trials on that piece, Right. You know, right now. Hopefully that data will be available in 2025. But yeah, Xolair by itself doesn't change the immune system. It is a treatment that would have to be ongoing.
Emma: Yeah. Okay. I also want to talk about Dr. Mimi Tang's research and potential treatment for peanut allergy. She's a well known Melbourne paediatric immunologist, allergist, and I vividly remember her study that came out quite a few years ago showing how oral immunisation therapy combined with probiotic therapy, helped induce a level of immune tolerance to peanuts. And I know her company, Proto Therapeutics, are working on a drug protocol that combines oral immunotherapy with probiotic therapy. What do you think of this two pronged approach of this combination?
Douglas: Yeah, I think, first of all, it's something we've done for the last decade in the States, you know, using utilising probiotics, not just probiotics, but we actually use prebiotics and probiotics combined with oral or immunotherapy, works really well. So it's something that, you know, we've seen for over a decade. I think kind of the downsides to it is it only has one strain of bacteria. So lactobacillus Rhamnosus which can be a key bacteria. But our gut also likes variety. And sometimes, you know, so and there's also some other areas where you add the prebiotics in as well and we've found it really helpful We've found it nice to be able to customise that. So, we'll do like microbiome mapping prior to starting our treatment and we'll get kind of a specific readout of that person and we can actually individualise or customise those pre and probiotics that we're using along with our oral immunotherapy. Plus, we can do about any food, not just peanut. So, I think conceptually the product is great. Again, it's something we've done for a decade. I do. Me personally, I prefer taking a more individualised approach to the person and meeting their needs based on what their microbiome shows.
Emma: You are speaking my language. Sorry to cut in. As a naturopath we are truly passionate about individualised care and I am going to ask around your microbiome diversification protocol because that's, I think, what you were just mentioning. And this really speaks to my language, the language of our audience. So if you could just tell us a little bit more about it and what you've learned over the last ten years.
Douglas: Yeah, and again, I appreciate that. I think I think this is why, you know, we have some good synergy because so many of my colleagues, what they want to do is they want to have a protocol and they want to fit all these patients into this protocol and they want to fit this patient into this product. And my approach is I think we really to adapt the products and the protocol to the person. Yeah, it needs to be the other way around. We need to see what/ who that individual is. And that's kind of my approach with our microbiome diversification program is really trying to understand the person, the individual, their needs, what their make up in, and then how can we individualise what we're doing to better address what they actually need as opposed to trying to fit them into a set program .that may or may not really be what they need. And so we like to do the microbiome mapping. We like to really dive into the testing. We like to really understand the person. And it's not just even gut health. We look at mental and emotional health because stressors, not just the patient but the parent, the parent .stress is a very key component to this. So we want to just to look at the person as a whole and then adapt and adjust our protocol, our food program to meet their needs, whatever that is. And again, meeting them where they are, guiding them to where they want to go. And the last part that I'll say on that is we don't need a pharmacy to do it. Like we don't need a pharmaceutical product to do it. We can actually do it with natural whole, you know, good quality food and good quality products and good, you know, quality measures of even relaxation and meditation and exercise and sleep and, you know, all the things that go into good health plays into this. And, you know, we can really use, again, the farms to help us.
Emma: And do you have any favourite prebiotics or probiotics or foods that you see working particularly well for this demographic?
Douglas: Lactulose in terms of a prebiotic, I mean, I do like it when we can glean things from actual foods versus supplements. But you know, if we can grab it from those natural foods, that's great. You know, lactulose when it's combined with, there's a bacteria out there that there's some great studies that show when they come together form something called Butyrate. So butyrate is a I don't know if you've heard of that or work with that, but you know, those resistant starches and the butyrate are very beneficial to the gut and the microbiome and are anti-inflammatory. So I like any of those.
Emma: Yeah, yeah. Fantastic. And I mean, there are nutritional interventions like, you know, vitamin D, Omega-3's that all have incredible amount of research on how they modulate immunity, reduce inflammation. You know, do you routinely use things like omega-3's and vitamin D?
Douglas: Yes, and I'm glad you reminded me on that. That is a critical piece to what we evaluate. So I'm checking vitamin D levels in all our patients and I’ve found it extremely helpful and in our treatment program. So yeah, that's vitamin D, omega-3's. Any, any of those pre and probiotics that are going to boost up Butyrate within someone, those are all just fantastic products.
Emma: Yeah. Amazing. I think that we have a lot of things in our tool kit and I am now absolutely convinced, Dr Jones, that you were a naturopath in a a previous life because you think like a naturopath, the way that you're using food as medicine and treating the individual.It's it's absolutely incredible. And I really can't wait to see how your program progresses here in Australia. We will absolutely put links in the show notes so that people can find you and follow you and contact you if they need any support with their allergies.
Douglas: That's beautiful. Thank you. I appreciate it. And really appreciate your work and all you're doing. So thank you.
Emma: Absolute pleasure. Dr Jones, thank you so much for joining us. Everyone, don't forget that you can find all the show notes, transcripts and other resources from today's episode on the fx Medicine website. Fxmedicine.com.au. I'm Emma Sutherland. Thanks for joining us. We'll see you next time.
Emma: This podcast is intended as health care practitioner education only, and it is not a substitute for medical advice diagnosed this or treatment.
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