May 2017

Sayantani "Tina" Sindher, MD

We welcome Dr. Tina Sindher to the Sean N. Parker Center for Allergy & Asthma Research at Stanford University. She joined our team in January 2017 and is very excited about expanding her clinical research in food allergies at the Center. She also has important advice to share regarding antihistamine use in patients with food allergies.

What is your background?

I received my Doctor of Medicine from the State University of New York (SUNY) Downstate Medical Center in Brooklyn and completed my Pediatric residency at Albert Einstein College of Medicine, Children’s Hospital at Montefiore in Bronx, New York. For my fellowship training in Allergy and Immunology I attended Children’s Hospital of Philadelphia. During my fellowship, I participated in clinical trials using epicutaneous immunotherapy (EPIT), which delivers allergens via the skin, for the treatment of children with IgE-mediated milk and peanut allergy. In addition to research with common IgE-mediated food allergy, I was involved in research on less common forms of food allergy, such as food protein induced enterocolitis (FPIES) and eosinophilic esophagitis (EoE). FPIES mainly affects infants and young children who consume milk or soy and symptoms are mainly confined to the gastrointestinal tract leading to vomiting and/or diarrhea. EoE is a disease that has only recently been recognized. In EoE, eosinophils (a type of immune cell) builds up in the lining of the esophagus (the tube connecting the mouth to the stomach) and causes inflammation. Symptoms include vomiting and trouble swallowing, among others. Both these diseases are relatively rare and often difficult to diagnose.

What made you decide to join the Center?

I joined the Center because I wanted to be involved in clinical trials involving children with food allergies. Dr. Kari Nadeau is a world-renowned physician and researcher in this field. When offered the opportunity to join the Center, I enthusiastically accepted. During my fellowship training in Allergy and Immunology, I routinely diagnosed children with food allergies and came to realize the difficulties they faced. I would receive anguished phone calls from parents when their child was reacting after accidentally consuming a known food allergen. Their constant worry whenever their child was out of the house and exposed to foods that were not made in the home was eye-opening. I realized that there was a great need for more research and more treatment options for food allergies. My experiences in the clinic and hospital with patients with food allergies inspired me to pursue research in this field.

How do you divide your time at the Center?

As Clinical Assistant Professor of Allergy and Immunology in the Department of Medicine, Division of Pulmonary and Critical Care Medicine, I divide my time between research at the Center and outpatient clinical care of children and adults at the recently opened allergy clinic at San Jose. My clinical expertise includes management of a number of allergic disorders in addition to food allergies such as allergic rhinoconjunctivitis, eczema, drug allergy, and difficult-to-control asthma. At the outpatient clinic, I see both children and adults and soon hope to start seeing patients with immunodeficiencies as well.

I am excited about the many clinical trials on food allergy and asthma ongoing at the Center, including rare forms of food allergy such as EoE. As an extension of clinical research, I will be working on basic research questions focused on finding the underlying tissue, cellular, and molecular changes that occur in patients with these diseases, as these changes might give us important clues for preventing or treating these diseases.

Dr. Tina Sindher speaking at a Lucile Packard Foundation for Children's Health event in Los Angeles, April 2017

What are some of the rewards and challenges of working at the Center?

We only have limited openings for our clinical trials and this is very frustrating. The challenge is to find ways to increase our ability to treat all those who could benefit from treatment. The Center is constantly increasing the number of trials that are being conducted and we have ambitious plans for further increases.

The most rewarding part of the job so far has been participating in “peanut parties.” After a child with peanut allergies successfully completes a desensitization trial, the entire staff eats peanut M&Ms together with the child — there’s a lot of cheering and encouragement. Watching a child who had avoided peanuts his or her entire life eat peanut candy without reaction is truly rewarding. It is no small feat.

What advice do you have for patients with food allergies?

Patient education and participation in the management of food allergies is critical. Early detection of the signs and symptoms of food allergies can help prevent severe reactions.

If you or your child are diagnosed with food allergies, you should always carry an epinephrine pen and learn when and how to use it. You should also educate yourself about the common types of antihistamines, which are frequently used to treat symptoms of allergy. I encounter many questions from parents and patients on the role of antihistamines. Antihistamines are routinely used for a variety of childhood concerns and are generally considered very safe to use. They can help relieve allergy symptoms which may be caused by environmental allergies. Antihistamines are also extremely helpful for children who develop sudden hives with no known triggers, also known as idiopathic urticaria.

If using for food allergies, parents and patients should be in close communication with their physicians about the role of antihistamine in their emergency action plan, since antihistamines can help with some symptoms but does not reverse life-threatening respiratory symptoms.

Antihistamines work by preventing a molecule called histamine, which is released during an allergic reaction, from attaching to your cells and causing symptoms such as itching, sneezing, runny nose, and watery eyes. Their onset of action is quite fast, going into effect within minutes to an hour. For daily use, we recommend the use of antihistamines such as loratadine, cetirizine or fexofenadine because they generally cause less sedation in children and require only once-a-day dosing. If your child routinely takes antihistamines, it is important to keep in mind that the antihistamines need to be stopped prior to a visit with an allergist if they’ll have skin or other testing. As each antihistamine is metabolized at a different rate, the following table provides some guidelines on when to stop an antihistamine prior to an allergy testing appointment.

Antihistamines and when to stop prior to allergy testing

Generic name  (commercial name)

When to stop before allergist visit

Onset of action

Age group approved for/ Availability


Common side effects (% frequency)

Diphenhydramine (Benadryl) At least 3 days (60 hrs) 

15-60 mins

All ages/ OTC

chewable tab, tab, syrup

sedation; agitation in children (frequency of adverse reactions unknown)

Hydroxyzine (Atarax/ Vistaril)  At least 5 days (100 hrs)

15-30 mins

All ages/ Prescription needed

tab, syrup

sedation (frequency of adverse reactions unknown)

Loratadine (Claritin)

At least 6 days (140 hrs)


1-3 hrs

>2 years of age/ OTC

chewable tab, tab, syrup

Headache (12%), drowsiness (8%); nervousness in children (4%)

Cetirizine (Zyrtec)

At least 2 days (40 hrs)


30-60 mins

>6 months of age/ OTC

chewable tab, tab, syrup

Drowsiness in adults (14%);

headache in children (11-14%)

Fexofenadine (Allegra)

At least 3 days (72 hrs)


2 hrs

>2 years of age/ OTC

chewable tab, tab, syrup

Headache (5-11%),

Vomiting in children (4-12%)

Desloratadine (Clarinex)


At least 6 days (135 hrs)


1 hr

>6 months of age/ Prescription needed


Dispersible tab, syrup, tab

Headache (14%), irritability (12%), diarrhea (15-20%)

Levocetirizine (Xyzal)


At least 2 days (40 hrs)


1 hr

>6 months of age/ Prescription needed

Tab, solution

Diarrhea (infant: 13%, children: 4%), Drowsiness (3-6%)


Ranitidine (Zantac) At least 1 day (15 hrs)

1 hr

All ages/ OTC

Effervescent tab, tab, syrup

May cause confusion (frequency of adverse reactions unknown)

Famotidine (Pepcid)


At least 1 day (17.5 hrs)


1 hr

All ages/ OTC

tab, reconstituted suspension

Agitation (14%) and vomiting (14%) in children <1-year-old; Headache (5%), dizziness (1%)

Interview by Vanitha Sampath

Vanitha Sampath received her PhD in Nutrition from the University of California at Davis. At the Sean N. Parker Center for Allergy and Asthma Research, as a medical writer and content manager, she enjoys being in the midst of groundbreaking research in asthma and allergy and is committed to communicating the scientific advances of the Center and spreading awareness of its mission and vision. 

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