Food Allergies, Dating, and Intimacy with Dr. Scott Sicherer and Sloane Miller, Part 1

In this insightful episode of Don't Feed the Fear, researcher/physician Dr. Scott Sicherer and author/food allergy coach Sloane Miller join Dr. Amanda Whitehouse for a panel discussion focusing on the complexities of dating and physical intimacy for individuals with food allergies.

The group discusses evidence-based guidelines for kissing and physical intimacy when managing food allergies. Dr. Sicherer shares findings from his research and provides practical advice for patients. The discussion includes common concerns and questions voiced within the allergy community, emphasizing the importance of open communication with partners and proactive planning to prevent allergic reactions during intimate moments.

Please note: This episode contains discussions on mature topics, including dating, intimacy, and emotional well-being in the context of food allergies. These subjects may not be suitable for young children. Listener discretion is advised. 

Listeners will gain valuable insights into:

• The science behind allergen persistence in saliva and its implications for physical intimacy.
• Practical steps to minimize the risk of allergic reactions during close contact.
• Strategies for discussing food allergies with partners to foster understanding and safety.
• Examples of ways to talk about this with children beginning at a young age.

To support this discussion, Dr. Whitehouse has created a free handout summarizing the key takeaways from this two-part series. Listeners can request this resource by contacting her through Instagram at @thefoodallergypsychologist or through her website: Connect — Amanda Whitehouse Phd.

This episode aims to empower individuals with food allergies to navigate their personal relationships confidently and safely.

Dr. Sicherer and colleagues' 2006 study: Peanut allergen exposure through saliva: Assessment and interventions to reduce exposure - ScienceDirect

Sloane Miller: www.allergicgirl.com

Special thanks to Kyle Dine for permission to use his song The Doghouse for the podcast theme!
www.kyledine.com

Find Dr. Whitehouse:
-thefoodallergypsychologist.com
-Instagram: @thefoodallergypsychologist
-Facebook: Dr. Amanda Whitehouse, Food Allergy Anxiety Psychologist
-welcome@dramandawhitehouse.com

Transcript

Speaker: 0:01

Welcome to the Don't Feed the Fear podcast, where we dive into the complex world of food allergy anxiety. I'm your host, Dr. Amanda Whitehouse, food allergy anxiety psychologist and food allergy mom. Whether you're dealing with allergies yourself or supporting someone who is, join us for an empathetic and informative journey toward food allergy calm and confidence..

0:28

Welcome back to the Don't Feed the Fear Podcast. We are here on the spring season.. We are talking about things that we don't want to talk about. I am trying to create a space here for the conversations that we tend to avoid, that we don't want to talk about because they're uncomfortable. We might not have as much information about. We might be uncomfortable asking, and today's exception might be the peak of that. We are addressing the intersection of food allergies and physical intimacy. This is a subject that is sensitive, but it's very important for people who are navigating relationships with food allergies. Parents don't want to talk to their kids about it. Our kids don't want to hear about it, especially from us, but it's very important for all of us to know. I have two amazing guests here to help me with this conversation. The first is the expert on this topic, Dr. Scott Sicherer. He is the director of the Elliot and Roslyn Jaffe Food Allergy Institute. He is the chief of the Division of Allergy and Immunology in the Department of Pediatrics and Medical director of the Clinical Research Unit. He is a clinician and a clinical researcher, he's written several books on the topic, the most recent of which is the Complete Guide to Food Allergies in Adults and Children that came out in 2022. And relevant to today's conversation, he is a co-author of a very important paper that was published in 2006 In the Journal of Allergy and Clinical Immunology about peanut allergen exposure through saliva. So this was the first paper to explore and document what is happening with allergens left in our mouth after we eat, so that we could get an understanding of whether there is risk in kissing. So I'm so grateful to have Dr. Sicherer here to talk about all of his knowledge with us, our other esteemed guest today is Sloane Miller. Sloane holds a master of fine arts degree, a master of social work degree, and a certificate in professional coaching, and she's a specialist in food allergy management. She is the author of the Memoir Allergic Girl, and she's the founder and president of Allergic Girl Resources, a consultancy devoted to food allergy awareness. She combines a lifetime of her personal experience living with food allergies with her professional expertise to connect with people about how to live safely, effectively, and joyously with food allergies. You can find her@allergicgirl.com. And it was Sloane's idea to have a discussion on this topic with Dr. Sicherer to explore the medical realities of food allergies in the context of relationships and physical intimacy and strategies for communicating that understanding to our children and helping them to communicate them to the people that they enter into relationships with you. So I'm so appreciative to Sloane for the great idea and excited to share this conversation with you. But first, please be aware that this episode does contain discussions on sensitive and mature topics related to physical intimacy Listener discretion is advised and we recommend not playing this episode with young children present.

Dr. Amanda Whitehouse: 3:16

So thank you everybody for joining us to listen. We wanted to record this panel conversation today for, parents, for any providers who were curious about how do I talk to. Kids and young adults about safety and their food allergies. When it comes to sensitive topics like relationships, dating, physical intimacy, it's a difficult topic. Sloane. You suggested that we do this and I think you had a lot of good thoughts on why this is a really needed conversation.

Sloane Miller (Allergic Girl): 3:40

Thank you so much, Amanda, and it's such a pleasure to be here with both of you today. And what I'm seeing in my food allergy coaching practice, and again, that's also a self-selecting group, I. So I think there's much, much more going on out there that is just not choosing to come in to talk about this or is not feeling that challenged, um, or having challenges privately. But what I'm seeing are these flection points of the beginnings of. Intimacy and curiosity about, um, romance and physical intimacy around, um, teenage hood, young teenage hood, right? So late middle school, early junior high. And then this other flection point around high school and early college and then post-college. And what I've seen in my practice in terms of people coming to see me, is delaying. Intimacy because they, there's so much fear and. Lack of clarity around real risks. What are the real risks from kissing? If someone's eaten your allergen, what do I do? How do I have that conversation? Who has the information? And then as, um, I. Young people are turning into young adults. Uh, how are you dating on Tinder, you know, in your twenties and having this conversation? Will you be rejected by future people because, oh, it's just too difficult. Um, and certainly younger people are having those thoughts as well, but that's what I'm seeing overall delaying intimacy because of lack of clarity around communication what the real risks are.

Dr. Amanda Whitehouse: 5:29

Yeah, I agree. And I think what I see happen is the delaying intimacy. Based on this fear and not values, and then somehow an individual's personal value is getting clouded with or shaped by their food allergies rather than what, what are my goals for my relationships and what are my values around age and timing of intimacy so, Dr. Sicher, talk about your research, please, what you know and where we stand today with the science on this topic.

Dr. Scott Sicherer: 5:57

Well, first of all, let me thank you for the invitation to join and to speak about this topic, which is actually a topic that I, I, I, I'm a researcher, but I'm also a pediatric allergist. I see children, I see teenagers, I see young adults. I see some non young adults. Uh, and this is a topic that does come up and I bring this topic up, at every visit actually with that age group and, um. I will have a parent leave the room if they want to, or if they don't want to, they can stay. Or if it's an 18-year-old or older, I will definitely have the parent, um, step out of the room for, for this conversation. And I've seen actually that when I bring the conversation up, um, the parent is act is typically very comfortable with it and the teenager may or may not be. Um, but, but it is a very common thing and I, and I, I don't ever, not. Talk about some aspect of this, usually about the kissing part of it. There's not a lot of research about, um, exactly what the risks are, but like everything else with food allergy, I. Part of it depends on, on the person's own allergy. Uh, if you're incredibly sensitive to trace amounts of a food, which is not the most common thing, the average person, for example, with a peanut allergy, reacts to essentially a peanut kernel or more of peanuts so that, you know, contextualizes things. I mean, not everybody is reactive to you know, virtually like dust amounts of it. And you know, that's something to discuss with your allergist, but. In a kiss, for example. If someone had been eating the food that you're allergic to, of the food is still in the mouth of the person who ate it after they've eaten it. Um, it will decline with time, but for some amount of time it's there. If the kiss is on the cheek, uh, and I actually give a scenario, I kind of change it to a grandparent scenario. So here's what I usually actually say to people. It's like, well, let's say your grandma had milk or your grandma ate peanut then gave you a kiss on the cheek. Um, maybe your cheek will get red, maybe it won't, but I would not expect a severe allergic reaction from that. I that's the typical, you know, scenario I would answer. Um, is there someone who's super duper sensitive where a kiss on the cheek after grandma ate some peanut butter would be a problem? Maybe. But for the vast majority of people, it's either gonna be a red spot or nothing. Um, many of my patients have had skin testing done. They get a bump where the skin test was. That's way more exposure than a kiss should be, right? So it's not something that should be a high risk scenario. Then I go on and I don't take a break like that, but uh, then I go on and I say, now, if grandma licked your eye, don't know why grandma was licking your eye, but your eye would probably swell shut because that's sort of like an open area and having your grandma had eat, eaten some peanut or some milk or something and, and then your eye, your eye might swell shut. I wouldn't expect that to become an anaphylactic reaction. There is exception to that maybe, but that's not typical. Kissing mouth to mouth and exchanging saliva. So some people call that french kissing or passionate kissing. Then it's a different story because now what They ate is in the saliva and now the saliva's in your mouth. So basically the food is in your mouth, and then anything's possible depends on how much was left in there. And, you know, there could be an even an anaphylactic reaction from that situation. So that's, that's sort of my overview. You can ask me more questions about it, but, but, but that's how I, I get the conversation going.

Dr. Amanda Whitehouse: 9:28

When you age up to older kids and you're having that conversation about kissing or French kissing, my kids call it movie kissing, You've laid the groundwork that there is a possibility of a reaction that will range quite widely based on a lot of factors. How do you advise them to enter into that safely with. The person they might be kissing as far as time and how much is consumed and all of those details,

Dr. Scott Sicherer: 9:51

Sure. Well there's two aspects to this. One is, um, the idea that you have to be thoughtful about it, You know, there aren't a lot of studies on this and the types of studies that are out there are not, you know, super perfect at figuring out prevalence, but roughly five to 10% of people, older people with food allergies report having had some reaction from kissing, and it was probably a surprise to them when it happened. They may not have thought about it until it happened. They may not have discussed it with someone before it. It's usually not severe, but it could be as we talked about. So as soon as I start that conversation with my sort of joking way of doing it to get the ball rolling, um. I think that, you know, someone's already protected because they may not have thought about it before, but once they think of it now, it could be part of the process. And what that means, and I do bring this up as we talk about it, it means that you wouldn't spontaneously start, and I'll use the term making out with somebody at a party who you don't have any kind of interaction with other than, Hey, I'm gonna start making out with you. They don't know you, they don't know your allergies, you don't know them, you don't know what they've eaten. It's not a relationship situation. Now, I had, uh, long ago a say to me, um, you know, boys wanna kiss me and they're gonna do whatever I tell them to do for me to be safe, for them to kiss me. Right? There was no concern that it's going to be a, a, a relationship breaker or something like that to have to say, Hey, I have allergies. We're, this is gonna be a little odd, but I want to talk to you before we would start, you know, kissing, uh, and, and so again, not having a, you know, in my day it was spin the bottle kind of thing, but not having just, you know, spontaneous kissing, but in a relationship then your food allergy is known. And so, uh, then I could give the instruction, right, of what would you tell a partner who you're going to be definitely passionately kissing with what should they do, uh, to make that safe. And so, so part of the conversation is not having spontaneous make out sessions. The other part of the conversation as well, if you are going to be passionately kissing, what are the safety rules? And so this goes to a study that we did many years ago. Where we said, Hey, you know, let's pick a food. And we picked peanut. We had people who are not allergic to peanut eat a full serving of peanut, like a peanut butter sandwich, ver amount of peanut, um, like two tablespoons of plenty of peanut. And then we measured the peanut protein in the saliva over time. We had them do things like chew gum. We had them do things like, um, brush their teeth. Almost anything. Uh, so first of all, you could measure plenty of peanut in the mouth after you've eaten a peanut butter sandwich. So, you know, the saliva does have peanut in it. It might vary person to person, but it's, it's plenty detectable and plenty likely to cause a problem. If I gave this, uh, extreme example of I just finished the sandwich and now I'm gonna spit in your mouth, um, that, that would have plenty of peanut and probably cause most people to react who are allergic to peanut. However, with time it dissipates. And we found that, you know, chewing gum, rinsing, brushing, these are all things that brought the amount down significantly and probably to the point where it wouldn't be a problem for most people. But sometimes for some of the people that were in our study, you could still pick up a little bit of peanut left. And so the thing that had the best outcome in terms of us not being able to detect the peanut in their mouth anymore was when they had not ingested anything else for a few hours and then ate a meal that. Or a partial meal that had no peanut in it, and then we tested their saliva and we couldn't find anything. So, so it is the case that, you know, chewing gum or rinsing out brushing and all that stuff helps a lot, but the time period and also eating another food, why would that be? So, you know, when you've eaten something and this was, you know, peanut butter, so I'm gonna give you other examples, but I. With peanut butter, you know there's gonna be some between your teeth and it's gonna leach out and you know, that type of thing. sure, the chewing gum gets more saliva going. You end up swallowing more, there's more saliva being generated and, and getting swallowed. So it's a dilution process there. Rinsing your mouth, brushing your teeth. These are all dilution processes whether you have brushed your teeth well or not might be a variable. Whether there was some peanut butter leftover from the last time you used your toothbrush, you know, all of those different nuances may be there. I think the reason that. Waiting that longer time is, it just gives more time for things to dissipate and then eating a a allergen safe meal. It gives you more time to have things pass around your teeth, pass over your mouth, um, have more saliva come. So it's really a, a combination of physical movement and, and di dilution effects. So that's what I tell my patients. It's like if you, you know, so you're in a relationship, you're going to be, you know, kissing passionately, uh, you are. Partner is best off not ingesting the food for a few hours and then having something that you also could eat that's safe. Now, questions that could come up if someone's thinking about this a lot would be, well, what if there's like a little kernel of a cashew stuck between their teeth that's gonna come loose while we're kissing? You know, these are all. Nuances, uh, that, you know, there hasn't been a study of every single food or every, you know, type of food or every consistency of food, but I think, you know, the, the general, uh, approach I gave you before about, uh, not eating it for a few hours, eating something else would probably solve most of those concerns because you would've already gotten, um, other food to knock out the food that had been there before.

Dr. Amanda Whitehouse: 15:37

Thank you for sharing that. A lot of kids then start to have. Like you said, the specific questions about what if, what if, and these outlying unlikely scenarios, like you said, the, the kernel stuck between the teeth. I know there have been some case studies where it is showing that it does happen, but can you speak to how rare that is in your professional experience and what you've heard from your colleagues?

Dr. Scott Sicherer: 15:58

Yeah, so anything that's unusual gets a lot of press. I. And so there, there are lots of concerns and you know, Sloan manages this as well. Like there are families who are individuals who have become so with, so with food allergy, and again, you have to talk to your allergist and everyone is different, but, for the, for most people, casual exposure isn't going to be an issue. And what do I mean by casual exposure? I mean, I do have patients who are worried, like, what if my child touches a peanut? Um, what if somebody breathes on them after they had a peanut cereal? You know, these are kinds of things that people worry about and it is important when you have food allergy to be cautious, right? Label, reading screen, extremely important. Having a very, uh, detailed conversation in a restaurant. And I spend a lot of time in our, you know, in, in my clinic talking about these topics you could ask me to talk about the more I'm gonna stop myself from doing too much talking on those topics. But for the most part, um. That's where the energy goes in. Getting a safe meal, doing a lot of talking, reading the labels every single time very carefully. But if you're worried that there might be something on a doorknob or someone's gonna breathe on you or things like that, that's getting too far, um, you're going to a baseball game, someone you know in the next row is eating something that you can't eat and you're worried you're gonna have an allergic reaction. For the vast, vast, vast majority of people, that is nothing that they need to worry about. And you just need to, you know, talk to your doctor. There might be age-related issues. There might be, you know, other aspects. But for the vast majority of of people, those are not things that they'd have to worry about. So within that context, um, I wouldn't want someone to be, you know, that concerned that they would be delaying having a relationship over this. Or that they would not be having, um, physical, uh, contacts. Um. Of kissing of sex or, or anything else based on, on a worry like this, it should be manageable and it shouldn't be high risk once you know the secret, so to speak. Right? Like, if you don't know about these things and you hadn't thought of it before, that's where a surprise might come. But, but knowing about it, I think is, is the biggest part of that. And I have. You know, additional conversations about many topics of casual exposure. Like I'm going, you know, with a friend to the baseball game, or I'm going to, um, be at a bar where there's, you know, nuts on, you know, in a bowl on the counter. All of these things, you know, typically we're focused on making sure that what you're eating doesn't have the, the food in it, the protein in it. It's not seeing it from a distance. We did a study with peanut butter where, because we, you know, there are people who were poor reactions and, and anything is possible and there could always be exceptions, but we took 30 children who were. Very strongly positive to peanut on testing and whose families felt that they reacted from casual exposure and we had them sniff peanut butter for 10 minutes. We rubbed the peanut butter on them. in this study we did it in a double-blind, placebo controlled fashion where they didn't know and the doctor didn't know when we were rubbing real peanut or fake peanut, or when they were sniffing real peanut or fake peanut. of the 30, uh, children who went through this procedure, um, there was only one reaction. To sniffing that was like breathing. Trouble, and it happened to have occurred during placebo. So they weren't actually sniffing anything. It was just nervousness. And in the touching part of the story, a third of, so we're rubbing peanut

Sloane Miller (Allergic Girl): 19:34

Yeah.

Dr. Scott Sicherer: 19:35

their back or we're, we're rubbing not peanut butter that had some histamine in it to make it itchy Anyway. And a third of the people who were rubbed with peanut got a little redness there, but that was it. And two thirds didn't even get redness because your skin barrier usually blocks that. Now your eye doesn't do that so well, which is why I gave that example earlier. you know, I use that information to just try to add some context. are other situations where like if you're milk allergic and you're near like a. One of those machines that boils the milk cappuccino or whatever. I mean, aerosolizing milk by boiling, it can cause an allergic reaction.'cause you're actually blowing it into the air. It's like someone with pollen allergy, it's in the air. It makes them sneeze and itch and can have problems. So it's not like food can't cause a problem through non ingestion exposure. It's just that it's usually. Like more unusual scenarios like boiling something like if you're allergic to beans and you're over a pot of boiling or shellfish, like if, if there's just cold shell shellfish on the table, I wouldn't expect particles to be. around. Just like they don't pop off of peanut butter. But if you're cooking shellfish, boiling it, frying it, or fish for that matter, then the steam coming off of that does carry protein and you could have symptoms. So I go through all of these different scenarios with people if they're asking and if they're concerned about it. And it's usually for people who are more reactive.'cause not everybody, like I said before, not everybody's super sensitive. Getting that question that you asked about case studies, so I think, you know, most people don't recognize that what happens in the medical lit literature is if you see something unusual, um, you, you write it up and you send it to a journal and maybe they'll publish it and those might collect. So if it's something that is like. Creating multiple of those, then you end up with case series, um, and then you might end up with like more and more information about it. But when things are pretty rare and unusual. And grab media attention, you end up with a scenario where I think that what we usually think of as a case report, so an example of that would be, um, many years ago there was a bunch of reports about someone who, where it was labeled as the kiss of death. You know, there was this teenager who kissed their boyfriend and died it made so much headline and everything, and then I. It caused a lot of, you know, worry among people, which, you know, it is what it is. But then like a long time after it came up like, oh, this person had very severe asthma. There was a not under control, it was an asthma attack and it had nothing to do with being kissed. There's a report of a death from, um, oral sex where. The giver had eaten peanut butter, and so the idea would be that mu uh, exposure to the penis from the oral mucosa of the person who ate the, the oral surface of the person who ate peanut butter caused a significant reaction for the person that they were giving oral sex to. However, you could read that report and say, are we sure? You know, there's one report like that, it seems like. That person's like, I would've thought like that person's penis should have become incredibly like swollen and rashy. And that's never mentioned in the report. So I'm not saying it's not a true case. I'm just saying that it's such an unusual thing. It made it to the news. Have I ever had a patient ever say that that happened? Maybe they wouldn't want to say it happened, but I haven't had anyone say it happened. When, when have reactions to foods, moms who are breastfeeding will often say, well, I've been eating that food. Do I need to stop eating it? a small amount of the protein that the mother is ingesting in immunologically intact form makes it into breast milk. But it's a very small quantity, and so that same baby who reacted pretty violently to peanut didn't react to the mother's breast milk. And or who reacted to egg didn't react to the mother ingesting egg and breastfeeding, even though there's some small amount in there. Are there case reports or reports of babies getting sick from the allergen that's in the mother's breast milk? Yes, there are. And there, there I would say is probably more reason to expect that there's some protein from the foods that the mother eats in the mother's breast belt to be there. Now, if we're gonna start talking about sperm o r ejaculate having the food that the person was eating in it, or if we're gonna be talking about vaginal, lubrication, having the protein that the person ate in it. Theoretically, yes, but the amount would presumably be close to not measurable drugs. Are not proteins.'cause proteins are large molecules. Drugs are often not large molecules, and they get into, um, juices of your body more, more easily than proteins do. So, for example, um, right? Like if you have an eye infection, usually get eye drops. It's harder for like a pill you take to help your eye. Actually, that goes for, for allergy too. I mean, when you take an antihistamine. It might help your eye but not so much.'cause it's harder for the drug to get into the secretions of your eye. But some does get there and so, but those are small molecules. Proteins are harder to do that. I see

Sloane Miller (Allergic Girl): 25:16

I do have, I do have a quick question. I just had an asparagus thought, just like a random asparagus thought, right? So if we're talking about, um, both vaginal secretions and seminal secretions, I. For, there are many of us who eat asparagus, and then like the next time you pee,

Dr. Scott Sicherer: 25:34

Yeah, that's an organic molecule. It's not a

Sloane Miller (Allergic Girl): 25:36

okay.

Dr. Scott Sicherer: 25:37

so similarly, it's exactly this. So thank you for that example.'cause it's exact, exact same theme when you smell peanut butter. You smell a very strong smell. And a lot of people who are allergic to peanut get ill from that. I put it similar to a protective effect. Like if ibr, if I into a room with a gun and pointed at your head, you're gonna have a visceral response. You're probably gonna shake, you might, you know, you might wet yourself. You know, like anything's possible with that kind of fear.'cause you know that this is a dangerous situation. Right. And then if I showed you, well wait a minute. You know, this is a plastic toy. What are you worried about? You know. So, so yeah, there's a protective response when you smell peanut, but that's an organic odor that has no protein to trigger an allergic reaction. Now getting back to this example with, um, drugs, there are some reports of people having a reaction from secretions the person's body secretion goes to the person who's got the drug allergy, and they have somewhat kind of response to that. So that I would say is incredibly rare. Unusual, but it's more like likely than where it's the protein has to get into these places, so it's harder for the protein to get into those places. But the, but, but the example of breast milk is, is, is one of these things. So, so I would say that. You know, we have not generally told people, oh, you know, you can't, you know, sperm in you for like X number of hours since that person ate the food. You know, like that's not an instruction that we have. You know, typically given people, now you could say, well, gee, you know, like. How do you know for sure that that's not something to worry about? I guess I would say, I don't know. It's, uh, we did try to measure food protein in ejaculate before and just can't do it because there's too much gunked up protein there to be able to use an assay on. But, um, but in real life we haven't gotten this kind of scenario and it seems like it was, would be very, very unusual. the, the kissing is much more. Understandable. The food is in the mouth and so it's, you know, it's not really ha, it's not like it has to go through digestion and get processed, get to the bloodstream, find its way from the bloodstream to a secretion and you know, like there's so many extra steps there. I. So I think that that's just different. there are people who have allergies to sperm. Uh, actually usually the ejaculate fluid, not so much the sperm itself. And those allergies are also rare in and of themselves. Um, and they are treatable. either by using a condom so that there's not direct contact or by doing a desensitization therapy, which is kind of an unusual one, but gradual, uh, introduction to the sper of the sperm. but, but that's a different kind of thing. It's not attributed to what the person has ingested.

Sloane Miller (Allergic Girl): 28:35

So I, I wanna, can we go back, um, a few steps? Well, firstly, thank you so much for doing that original peanut study that basically all of us out here in the field are still using and. To help people understand. I use it personally. I use it with I, my partner knows the study because he knows once he eats my allergen, you know, that's probably it for the night. In terms of kissing, he also has a beard and food is, and particles are transmitted through the beard to my skin. I'm, I've sensitive skin and I will definitely get hives. From that. So it's usually a shower in a few hours from that study, which was very, very helpful. So thank you. Um, if we could go back to talking about spontaneity because for young people, young adults, um, people in their twenties who are able to communicate, like that young person who was like, boys wanna kiss me and I will tell them, what they need to do. Fantastic. Like that is an ideal conversation. It's like ideal, right? A lot of people are not like that. Um, of all genders are just not communicating that clearly and or they wanna be spontaneous. And I get that question a lot too about like how to be spontaneous and, and my phrase for that is like, I can absolutely be spontaneous with preparation. So that's my version of spontaneity. How, but how can we. How can we help young people feel spontaneous, um, and understand risk and understand what to do if, if in the tiniest chance there is a problem?

Dr. Scott Sicherer: 30:24

I think there's a few things there. So, kissing is not the only instruction. I'm talking to teenagers about. Um, we talk about alcohol. I always bring alcohol up, even when, so my joke on that one is like, whatever their age is, I say like, well, you've got. Six more years before you're legal to drink, but sometimes people accidentally get alcohol. Um, and so, you know, I open the conversation that way typically and point out that alcohol is a problem with someone who has a food allergy for reasons that the person doesn't. Think about actually. And so you know, if you are, so the first thing that people probably think about is, well, there's some allergen in the alcohol that I have to worry about. But the bigger problem is that if you're ine, well one of the bigger problems is if you're inebriated, you might eat something that you wasn't really safe.'cause you just like. Are not inhibited and, um, you may not realize you're having a reaction. And on top of all of that, alcohol acts as what we call an augmentation factor or a co-factor. It makes reactions worse. It makes the protein, uh, get into the body quicker. I. Without as much digestion, and so it makes a worse reaction. I explain to people like, if this much cashew is, you know, ingested without alcohol, it's almost like you ate that much cashew with the alcohol, and so it's a worse reaction. And so, you know, giving that kind of thing is also a spontaneity theme because you know, you have to think about where you are, what you're doing, You know, as you said, Sloan spontaneity, I'm, I could be spontaneous with some preparation. I mean, I think it's the same thing this way. So, you know, like if, if you're, if someone is coming up to you, you know, to give you a spontaneous kiss, you could say over here, you know, you might have eaten something I'm allergic to, or let's just, you know, elbow it since, uh, I have some allergies and, and just like you're laughing about it now the person who you know is. In charge, which is the person with the allergies could make it like a, a laugh, a laugh moment, you know, just to lighten it. But, you know, I, I don't think, you know, I, one of the things I say is that your friend, like when I say to teenagers. So, side, side point, right? Teenagers are at higher risk for fatal reactions, mostly because they may be less likely to tell a friend they're getting sick, uh, tell a friend that they can't eat this, um, try to hide their issue and then not use epinephrine, right? So with that in mind, I, I focus on, you know, people that you're. Interacting with your peers. Don't want you to be sick. They're, they, the last thing in the world they want is for you to start having allergic reaction in front of them. That is what they do not want to happen and it's way, they would be way more disappointed, not hearing you speak up for yourself and let them know that you have the allergies and what you need done then to end up with a problem. And so, you know, for you to say, Hey, I'm sorry I just can't find anything to eat here. Uh, I'm just gonna have a coke. Um, or to say, Hey, I'm sorry. I know you wanted to give me a kiss and a hug, but how about an elbow today? Because I'm worried about whatever. You know, they're gonna be happier to know that, um, and to not have something happen. They don't wanna be responsible for causing you to be sick. So, I I, I also throw that into my counseling.

Sloane Miller (Allergic Girl): 33:33

also, partners do not want to be the cause of sickness or witness something terrible happening, and so arming potential romantic partners. With information, with real risks and real information. Also, here's my EpiPen. This is what to do in case of emergency is, is a gift to say this is how to help me. And you know, it doesn't have to be a big deal, but there are real risks here and here's what to do. And it's like a three really, it's, it can be a three sentence conversation, which is one of the things that I talk about in coaching is that this doesn't have to be paragraphs and paragraphs. It's really. You are in charge of you and your body. You know the risks, you know what you're allergic to. As long as you know you are letting someone in to that part of you just in case. But also'cause no one wants to see you, hurt your friends, nor does, nor a romantic partner. They really don't wanna hurt you and any way they wanna be close to you and intimate with you.

Dr. Amanda Whitehouse: 34:36

I think that the way that Dr. Sicherer, described having those conversations. The way that people receive it is the way that they will then carry it forward into being the ones to initiate the conversation. So what you modeled and described about starting young and adding piece by piece as kids get older is I think how it more naturally happens in relationships too, right? When people have had those conversations, then they would communicate. Differently and a less amount of information to a buddy on the basketball team with them than they would to someone that they were dating. So I think we model that in our conversations, and I think you set a good example of that, Dr. Sicherer

Sloane Miller (Allergic Girl): 35:10

Well also even bringing it up about grandparent, because if we're talking to parents on this podcast about their young children and the parents are having, let's say, challenges with in-laws or their own parents accepting a child's allergy and saying, well, it's just I ate, I just had a peanut butter sandwich. A little kiss on the cheek won't hurt. I think. For parents to model that conversation. Well, actually there's some risk. It might cause some itching or some discomfort. And for even a child as young as two to say, no, what did you eat? Grandma, uh, or grandpa or aunt or uncle and, and teaching a child and, and we talked about this, um. About body autonomy, right? That and agency and the like. The soonest you can get those conversations going about, this is my body and this is my. Um, medical condition that I want to understand and know how to communicate the better. And I think parents can model that conversations they're having with grandparents for the child and help the child learn to advocate to adults around them, whether it's a teacher that wants to kiss them or a friend of the whomever it is, and they're like, no, no. What'd you eat? You know?

Dr. Scott Sicherer: 36:27

Well, actually your, you know, your example moved the age group down and so it is, um, it is a conversation with. like when there's food around, um, a, a, a well-meaning, uh, parent who ate something and then blows raspberries on the baby's belly, you know, is gonna find that they're blowing some hives onto the baby's belly. Um, again, may not be as serious, you know, exposure, but it's still, you know, is un unsightly. And then it's like, oops. And you know, as you mentioned before about the beard, you know, that's another example where sometimes dads will, you know, have something stuck or. For some reason, it's always the dads who are eating cashews and wiping their mouth on some towel in the kitchen. And then the towels used to like wipe something off the young child and then they have hives from that. So like those kinds of transfer of, uh, allergen, you know, again, they're not typically severe reactions, but they could be, you know, uncomfortable. And it does take. Conversations, we actually talk about ages and stages, and so you know, what we're giving, like what I'm talking to families about for an a, a baby versus a toddler who can grab food versus, you know, the middle where they start to have more autonomy and they're, you know, they, they have to be around more peers who are eating things and have, you know, decisions about what they can control or not. And then the high school years where it's a whole other story, you know, like each, each of these ages and stages has its own. Um, things to talk about for, for managing allergy. So kissing comes up in a variety of age groups.

Sloane Miller (Allergic Girl): 38:02

It does and and it should. It's enjoyable and people with food allergies. should have and hopefully have a full range of wonderful experiences, including intimacy that is at the level and the safety that they want. And one of the takeaways that I'm hearing from you, um, which is great, is that the, the real risk of anaphylaxis, of, of going into really severe fatality danger zone is really, really tiny. Is really, really tiny, and it's really an outlier. Did I get that correctly?

Dr. Scott Sicherer: 38:40

I think you do. So you always talk to your allergist. There's always an exception. There's, you know, people who are listening podcasts like this probably have a, you know, more, uh, significant past history. So, but I think talking in the context of your own allergies with your allergist, but I, I still would say that on a epidemiologic basis, um, it's what's what you're getting in your mouth and eating is the most. Significant risk and kissing presents the potential for that. Um, although again, most of the time even, you know, any kind of simple, you know, non saliva to saliva kind of kiss is not going to that significance of a, of a danger.

Sloane Miller (Allergic Girl): 39:19

And, uh, by, by the bye on a personal note. I have had a range of those experiences, um, where I will have from getting a cheek kiss from someone who has dogs and touches their dogs and then touches their face. I'm allergic and asthmatic to dogs instant hives. I've had experiences where a guy, we had the conversation, very clear conversation, he understood my food allergies. He had eaten cashews earlier in the day, and I talk about this in my book and I. was, we figured afterwards it was probably in his beard, but he didn't, he had, it had been hours, he had brushed his teeth, he'd eaten something else. We'd had dinner together of a safe meal and still I had hives everywhere and asthma. And again, it luckily it didn't progress. Um, and it was a mistake even though we had had the conversation and even though he, you know, it had been a long time, that beard, that beard is.

Dr. Scott Sicherer: 40:23

beard, beard. Beard is an extra

Sloane Miller (Allergic Girl): 40:25

be beard is an extra, or, and body hair is an extra scenario. However, again, it was a honest mistake. I had all my medications necessary. We, I took, I did what I needed to do to stay safe, and we had a very positive, it was a positive experience. It wasn't like he ran screaming from the apartment. He is like, what can I do? we need to do? And we, we figured it out. So. had a range of those experiences from saliva to beard. Um, and, I've had all the conversations too. And so I, I think the reason I'm saying this is because mistakes can happen. Even when you are the most careful and you've explained the risks and you've had all the conversations, and that's why you have your anaphylaxis action plan. That's why you have all your medications. That's why you've spoken to your allergist about the real risk for you. Um, and, and you just. That's part of intimacy is that sometimes things happen and that's okay, and that is not something to be afraid of. Uh, but that's, I think, part of the normal part of anyone's intimate experience, um, that things happen that are unexpected. And as long as you are spontaneous and prepared that you can have a safe and positive experience.

Dr. Amanda Whitehouse: 41:43

You used the word earlier, Sloan, that it's enjoyable, and I also think it's beyond that. To have close relationships is an essential part of the human experience and of having a healthy, well-rounded life. I certainly don't mean to say. Everyone must have a relationship. Some people choose not to, and that's okay. But for the most part, I think it really is central to our wellbeing. Not just romantic relationships, but to feel safe and connected to people without this layer of fear and protection. And that's not really a healthy way to navigate relationships. So to find a way through that I think is really important socially and emotionally.

Sloane Miller (Allergic Girl): 42:15

Yeah. Yeah, the avoidance, certainly when I was a kid. Um, and. You know, EpiPen didn't exist. Epinephrine existed and epinephrine was given in the hospitals, but EpiPens didn't exist yet. So, um, what I was told by the allergist was, avoid, avoid your allergen and if you have exposure, go to the hospital. That's what, that was, what was happening in the seventies and early eighties. And what I did was, um, I globalized that. Avoidance and ended up avoiding a lot because of my allergens. And that's what really prompted me to start my practice and write this book because didn't wanna live like that anymore. I didn't wanna live. An avoidant lifestyle. And I didn't want avoidance to be my only coping mechanism. And, um, and to your point that yes, this is part of a whole human the whole breadth of human experience and that we need more tools in our toolbox other than avoid, of course, avoid your allergen. Of course, however, as a global coping mechanism, there are other, there are other things that you can do.

Dr. Scott Sicherer: 43:31

Well, I mean, just to very briefly, uh, pick up off of that point, um. The past couple of decades, there wasn't much more out there other than avoiding and having a backup plan of, of epinephrine. And now there really are more conversations going on in doctor's offices because there are possible therapeutics, whether it's uh, you know, an injected biologic like Omalizumab or doing oral immunotherapy. Uh, and there's a lot more in the pipeline that's coming there. You know, there are, um, other, other options other than just avoidance for people. For, for many of the people with food allergies, happily.

Dr. Amanda Whitehouse: 44:08

Yeah, which is very exciting My son, has done a combination of OIT and Slit, and so these conversations. Us. He's only 13, but obviously we start young and we talk early. These conversations are quite different because there's still risk. We're managing it. But as you said, it's so individual to each patient, depending on their history and what they've done. So back to the importance of their doctors talking to them about it. I love the way that you described that you do this. In my experience, this is not happening very frequently. Uh, no one's had that conversation with my son. A lot of my clients, I'm the first one to mention to them, you know. What do you know? What's your plan? Please go talk to your doctor about it. What are your thoughts on that?

Dr. Scott Sicherer: 44:49

I, I think I'm like always having this conversation and I, I know that the parents, I. Love that, you know, this is being discussed during their visit. Um, so again, some kids might be embarrassed. Um, you know, especially starting around, I probably, I probably start doing around age 13, 14 ish. Um, it drives me crazy when someone disappears for several years and then comes back and hasn't seen that.'cause I say like, you, you should have a yearly visit. And what goes into the mind of many families is well. Like, I'll skip a year for tests and then they end up skipping two or three years because they're like, well, it's just the tests. And they don't remember that we talked for an hour. So it's like, well, tests are tests, but you know, the discussion about the allergy is the more important part of the visit in my point of view. So, so it gives me the opportunity to talk about all of these other things. And this is, I mean, I also talk about. Drugs. Um, and I joke about that, that, you know, well, not heavily joke, but it's sort of like there's drugs out there and, you know, that could also, uh, cloud your, you know, ability to pick up the right food or make you more hungry to eat the wrong food and then not realize you're having a reaction. So I. That only took three seconds for me to say, but like putting all of that into a package jail, I don't know what to tell you about. Every allergist doesn't cover it. There's, you know, there's a, a lot that has to be done in, in a visit and there's a lot to talk about, um, I guess for a family listening to this, or a parent or anyone listening to this to feel comfortable bringing it up with your doctor. Um, not to put the burden of starting the conversation on the family instead of on the doctor, but, uh. You know, there's the, the literature is out there and it is part of most of our instruction forms, and it's in a sentence somewhere, almost everywhere that the doctors can see. But whether they find the time to do it, I guess, is, is, is the question here? we're we, the three of us could spread the word and, and

Sloane Miller (Allergic Girl): 46:46

I think for a lot of families, like I never raised this with my allergist, my pediatric allergist or my adult allergist, they never raised it with me. And I think there's probably an assumption like it's being taken care of elsewhere, like your GP or a pediatrician is doing it, or so. So a question, so a, you're saying it's appropriate for families to bring it up? Um, now if your allergist, your pediatric allergist, or your regular allergist, if you're an adult, doesn't know the answer, it, would it be your gp, would it be like, like who has the information? I.

Dr. Scott Sicherer: 47:21

You know, we're speaking about a niche area within allergy that as you, as you asked me, is this a common thing to ha be a problem? And among adults, you know, five or 10%. So, so the majority of people who have food allergy maybe never thought of this, never experienced a problem with it and never will. For me, who specializes in food allergy, it's a part of every visit that I have with a teenager, among other things that we talk about as teen for teenagers. So, you know, all I can say is I wish it were a more open thing if, if a, if a listener said like, where could I read about stuff like this? I mean, probably, I don't know. Uh, if your book has it, my book has it. Um, you know, it does, but you know, then you'd have to know to, to read more. A t the Jaffe Food Allergy Institute, we do a weekly, I'm sorry, a monthly, uh, community engagement thing like on Zoom or in person. Actually tonight when we're recording this thing, we have a bunch of our, um, researchers are doing, uh, in a live presentation of our research work and what's out there for treatments. Uh, now and in the near future. We similarly have. Um, these talks on exactly this topic. Um, I I do an ask me anything other thing. So, so I think there are places, if you're interested in looking, you're gonna find the information. If you're just paying attention to an occasional newspaper article that might be blowing things outta proportion, then the answer is talk to, talk to your trusted allergist about it. I do think the board certified allergists are the right doctor to know this information, and I think probably most of them do. They may just not have time to have this conversation or think of it when, when the family, when they're trying to teach, when to use the epinephrine, how to use the epinephrine. Do you call nine one one? Do you not call 9 1 1? What about the label reading? I mean, I do spend. Way more time talking about label reading and restaurant. I spend more time than any of those other topics.'cause that's the trickiest part for most of, most of my patients is, is, is through the restaurants. I could talk about that for an hour. So, so I think, you know, this might take back seat to some of those other things and I don't think it should take back seat, but, but you know, we are in sort of like a. A topic that maybe doesn't come front of mind to most of the families when they're in the office wondering like, is the test gonna be better this year? Or, you know, what do I do if there's an allergic reaction and they're not thinking about this? Which as we're admitting is not the highest risk aspect of living with a food allergy, but is something that could be impactful on quality of life. I will say that. Um, in these conversations, the, the deeper questions, so to speak, the ones that are not just about kissing. So the ones that are asking about, you know, oral sex, um, and stuff like that, those typically don't happen unless the. Parent is out of the room. So

Sloane Miller (Allergic Girl): 50:06

Yeah.

Dr. Scott Sicherer: 50:07

so I usually get the ball rolling with kissing and stuff while the parent's still there. And then after the parent's out, I'll say, do you have any other questions? And if there are other questions, it's usually what we've already covered today. Um, it's, it's like, well, do I have to worry about sperm, vaginal secretions? And, you know, that's, that's usually the, the next thought that people start to have.

Sloane Miller (Allergic Girl): 50:29

I, wanna make a plug, just a quick plug for Centers of Food Allergy Excellence because also, um, and this is my personal experience. I've had wonderful allergists, but they're allergist immunologists. And food allergy is not their specialty necessarily. And so, um, I think it's, if you can get to a food allergy center of excellence near you in the country, that that will really, um, support your family and understanding these issues and, uh, on a deeper level as well as have an allergist at home near you that you can see. But.

Dr. Scott Sicherer: 51:10

Yeah, it's a good point. I mean, I, I would say that all allergists are trained to take care of food allergy, but you're right that it's not necessarily the focus for all allergists. And so, you know, food allergy research and education or FARE, does have like this FARE clinical network that, uh, lists about 50 places that are extra thoughtful about food allergy. And a lot of my patients actually have two allergists. They have me or my colleagues here at Jaffe Food Aller Institute. Also their local allergist who maybe is spending more time with them for their hay fever or asthma. And then, you know, they'll have their once a year visit for the food allergy. And, and there are a lot of things involved with a good food allergy evaluation. There's, uh, super medically supervised feeding tests and a lot more talking and things like that. So, so yeah, I think your point well taken.

Dr. Amanda Whitehouse: 51:59

Do you wanna leave us with any last thoughts

Dr. Scott Sicherer: 52:00

I mean, for me, I think I'm, I think I've covered everything that you guys were interested in talking about, and I, I'm, I'm glad, uh, we focused on this area, which is incredibly important and probably under discussed.

Dr. Amanda Whitehouse: 52:13

I agree. Sloan, any last thoughts that you wanna add?

Sloane Miller (Allergic Girl): 52:16

Thank you. Thank you both. Uh, I'm so glad to see and hear and have shed more light on this topic. And I'm, I'm really thrilled that you bring this up, um, with your clients and with your patients rather. And I. I would hope that this encourages more families to know that this is something that they should be bringing up, uh, to their, um, allergist to explore it. That there is stuff to be explored here that's really good information and that your kids do wanna know and will need to know as they age.

Dr. Amanda Whitehouse: 52:51

Thank you so much to both of you for taking the time to share your thoughts and your experience and your insights. I appreciate it so much.

Sloane Miller (Allergic Girl): 52:58

Thank you.

Dr. Scott Sicherer: 52:59

for the invitation.

Dr. Amanda Whitehouse: 53:00

Yeah.

53:00

Thank you for joining us for part one of this two part series on food allergies and physical intimacy. Stay tuned for part two next week where Sloane Miller and I will be back to dive deeper into these topics Together we'll explore how to apply the advice that Dr. Sicherer gave us in real life situations. How to communicate it effectively with our children and how to address the social, emotional, and mental health aspects of navigating relationships and intimacy with allergies. In the meantime, if you want to keep learning, you can read Dr. Sicherer's book, the Complete Guide to Food Allergies and Adults and Children. You can read Sloane Miller's memoir Allergic Girl, and you can reach out to me for the free guide that I've created for you based on this series of talks to help you navigate these conversations and situations. You can access that by following me on Instagram at the Food Allergy Psychologist and messaging me asking for the free guide. Or you can visit my website at the food allergy psychologist.com and reach out to me through the contact option I appreciate you listening, and we will talk again soon. the content of this podcast is for informational and educational purposes only, and is not a substitute for professional medical or mental health advice, diagnosis, or treatment. If you have any questions about your own medical experience or mental health needs, please consult a professional. I'm Dr. Amanda White house. Thanks for joining me. And until we chat again, remember don't feed the fear.