In Conversation: Dr. Ruchi Gupta
The Sean N. Parker Center for Allergy and Asthma Research at Stanford University partners with leading allergy researchers from all over the world to advance a cure for allergy and asthma. In this interview, 17-year-old Matthew Friend interviews collaborating researcher and world-renowned allergy expert Dr. Ruchi Gupta for the Center’s Fall 2015 Teen eNews edition.
Dr. Gupta is Associate Professor at Northwestern University Feinberg School of Medicine and the Director of their Food Allergy Outcomes Research Program. She is also an Attending Physician at the Ann & Robert H. Lurie Children’s Hospital of Chicago. Dr. Gupta has led landmark epidemiology studies illustrating the prevalence and economic burden of food allergies and is currently partnering with the Sean N. Parker Center for Allergy and Asthma Research at Stanford University to evaluate the prevalence of food allergies in adults. She has also done a significant amount of work with schools and young adults in the allergy community, and is the author of The Food Allergy Experience.
Thank you so much for taking the time today! We are excited to spotlight you in our Center’s Teen eNews edition. To begin, can you tell us how you originally became involved in the area of food allergies?
Dr. Gupta: Thanks for having me! I started researching food allergy twelve years ago when I met the Bunning family, who are also featured in this eNews edition. They came to Lurie Children’s Hospital wanting the hospital to conduct food allergy research and I had just moved to Chicago to work on asthma after my fellowship. I was impressed with their passion, which inspired me to begin my adventure in food allergy. As I started looking into the topic area, I realized that there is so much we don’t know. For example, unlike asthma, we didn’t know basic statistics of “who” had food allergies. I felt that I could make a contribution.
Just three years later, my daughter was diagnosed with food allergies. She was playing with my son, who happened to be eating a peanut butter and jelly sandwich at the time. He was five; she was one. And when he touched her face, she broke out in hives. This was my introduction to food allergies from a parent's perspective. Since then, I’ve not only been very interested in the clinical and epidemiological side, but also in how food allergies impact both families and communities and what we can do to help mitigate the impact.
That is my story for getting involved in food allergy research. It’s a 24/7 job for me because I live it every day of my life. I see patients with it, I conduct research in it, and I come home to it. It is something that I am incredibly invested in and passionate about. I am doing everything I can to try to make a positive difference in this world.
An often quoted figure that came from one of your studies is that 1 in 13 children, or roughly two per classroom, have food allergies in the United States. Can you tell us more about the importance of epidemiology studies like this?
Dr. Gupta: Studies like this allow people to visualize and understand the extent of food allergy and its impact on children and teens. In that same study, we found 40% of children with food allergy had experienced a life-threatening reaction. We all know how common and serious food allergy is and this study puts data behind our claims. Epidemiology studies like this can help society to better understand that food allergies are a big deal and are a fairly common condition for US children and teens.
Another significant epidemiology study we conducted was our economic impact study. We found that $24.8 billion a year was spent on food allergies in the United States by families, including direct medical costs. That’s an additional $4,184 per child. Most of the additional cost borne by the family is in the form of purchasing allergen free foods and the cost of lost labor productivity. For example, mothers who need to change or give up a job to be more available to their child in case of an accidental ingestion or food allergy emergency is an economic cost for that family.
These epidemiological studies are critical for understanding food allergy and give us an idea of the extent of the problem. “How many kids have allergies? How many adults? Who outgrows their allergy versus developing a new one? How many allergic reactions or anaphylactic reactions are happening? Where and how?” These are all questions that still need to be addressed or re-evaluated.
We are currently working with the Sean N. Parker Center for Allergy and Asthma Research at Stanford University on an adult prevalence study. We have pediatric numbers, but we are really missing adult prevalence numbers. Adults will be interesting to study because we will be able to see who is continuing their allergies from childhood and who is developing new allergies. This study will also help us to further understand the onset of food allergies, as well as any environmental factors that may contribute to the development of the disease. So I am really excited about conducting this study and I really appreciate the Sean N. Parker Center for Allergy and Asthma Research in supporting this type of research.
You have done some terrific work with schools and educators, especially in the Chicago area. What inspired you to get involved?
Dr. Gupta: The reason that I wanted to work with schools was because it was the number one thing I kept hearing from parents as their biggest source of stress. You feel in control of your children’s food allergy at home but then you have to send them away to school. At school, someone else is in charge of taking care of them, which can be very scary and stressful for parents.
Personally, my daughter was going into a Chicago Public School (CPS), not too far from you, Matthew. I really wanted to work with their school system to better understand their food allergy policies and how we can improve them. I had worked with CPS previously on studies focused on asthma and I knew a lot of people there, so we were able to start working together very effectively on this topic. Our collective goal became to protect children with food allergy while they are in school.
What specific projects and research have you done with Chicago Public Schools and other schools?
Dr. Gupta: One area where we became very passionate about was in emphasizing the need for stocking undesignated epinephrine in schools. In 2010, a 7th grade student passed away from a reaction to food allergies in a Chicago Public School. After this tragic accident, the CPS system worked hard to make sure this never happens again.
CPS was the first large urban school district in the country to implement the policy to stock emergency epinephrine. We evaluated the use of stock epinephrine during that first school year (2012-2013) and found that the undesignated stock epinephrine auto-injectors were administered 38 times to students and/or staff. More than half of those were administered to individuals who did not have a previous history of life-threatening allergy or anaphylaxis. CPS’ experience helped show the importance of this issue to the rest of the country and how to best implement policy surrounding this issue.
We had another big research opportunity when CPS gave us access to their database to look at Emergency Plans, or 504 Action Plans. We found that only 1 in 4 of the students who had asthma, and half of the food allergic students had health management plans on file. Those numbers were significantly lower among minority and low-income students, which is concerning due to CPS being composed of almost 90% minorities and about 86% economically disadvantaged students. This is a population that we know has food allergies, but unfortunately, doesn’t have access to the resources needed to obtain a physician-diagnosed allergy, an action plan, or to get an epinephrine auto-injector in place at school. CPS has been great in working with us to improve awareness for low-income populations.
We are now working closely with other schools to build an electronic system so that we can follow food allergy reactions in schools. The registry will allow us to track how many allergic reaction cases are taking place in schools, where in schools these reactions happen, and the context in which they are occurring. We are starting with Chicago schools and then we want to take this nationally. Ultimately, we want to have a standardized system for the whole country to use to be able to track allergic reactions occurring in schools.
Where does all of this great inspiration come from?
Dr. Gupta: I get all of my inspiration from families and their stories and passion. Working with families is kind of my “little incubator of ideas,” which gives me the opportunity to understand first-hand where the big holes in research are.
For example, we kept hearing about bullying from families afflicted with food allergies. Specifically, how kids with food allergies aren’t treated well and are left out by their peers. However, it is very understandable how a seven-year-old kid, who has no experience with food allergies would not understand how food could hurt someone. This led us to develop food allergy education for peers.
We are developing educational videos made by food allergic kids to educate their peers about what food allergy is and how to support their classmates. We plan to make one for elementary school students, one for middle school students, and another one for high school students. We hope schools will use these videos to help educate students at the beginning of the school year on food allergies.
We also just completed a study looking at food allergy in teens. Teens stated that many of their classmates and friends would not know how to treat or even recognize a food allergic reaction. However, they also said that having a food allergy had made them more responsible and empathetic in their daily lives.
Finally, we are also working on a college study to develop methods to help students with food allergy stay safe in college. We are working with FARE and other groups to develop and test the intervention.
What would you tell a teen or young adult who wants to get involved or make a difference in this field?
Dr. Gupta: Get involved in whatever way you see fit! Teens and young adults are capable of making a huge difference. Whatever you feel you can do, you should do. You can become involved in research or educate your peers and communities. Many of the best advocates are teens or young adults who are passionate about food allergy in their schools, communities, and even nationally. If you want to become more involved, please contact me and get involved. Speak up and be an advocate.