Food allergies: causes, prevention, and treatment with immunotherapy | Kari Nadeau, M.D., Ph.D.

**Peter Attia** (0:11)
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My guest this week is Dr. Kari Nadeau.
Kari is the Chair of the Department of Environmental Health at Harvard's School of Public Health, a Professor of Climate and Population Studies and the Interim Director of the Center for Climate Health and the Global Environment. Kari's research focuses on the study of immunologic mechanisms involved in the causes, diagnoses and therapy for allergies and asthma.
Kari earned her MD and PhD from Harvard Medical School in 1995, completing her doctoral work in biochemistry and immunology. She's a member of the National Academy of Medicine and has co-authored the book The End of Food Allergy, the first program to prevent and reverse a 21st century epidemic. In this episode, we talk about how the immune system works when it comes to fighting bacteria and viruses. Now you might think, well, what does this have to do with food allergies? Well, of course, it's because the same immune system that correctly helps us fight off bacteria and viruses incorrectly gets wound up when it comes to food allergies. So unfortunately, you do need to understand how the immune system works in the correct way to understand how it can go rogue. So from there, we deep dive into food allergies and we distinguish them from food sensitivity. So I think many people listening to this will have some sort of food sensitivity. And of course, that's also potentially mediated by parts of the immune system. We'll talk a little bit about that. But really what we want to focus on are true food allergies. And this can range from mildly inconvenient to outright life-threatening and debilitating. It's really that latter area that we want to focus on. So we talk about early exposure. We talk about what sort of immunotherapies are available. Many people, for example, listening to this will understand that there are certain people that have peanut allergies. If you have a peanut allergy and you don't carry an EpiPen, you can end up losing your life. Well, I wanted to understand why that's happening. I want to understand what parents might be able to do to reduce the risk of that developing in their kids. And of course, for those who already suffer from those things, I want to understand what are the immune-based therapies that can effectively take a person who in the presence of even microscopic quantities of those allergens produce a lethal anaphylactic reaction and how can immunotherapy make those people safer in that presence? And this is the kind of work that Kari has been doing. And for that reason, I've wanted to have Kari on for some time.
We also talk a little bit about air pollution, which was a real bonus for this discussion for me, because when I reached out to Kari initially, I thought we would only talk about food allergy. But as you may have heard me talk about on previous podcasts, I have a real interest in getting deeper down the rabbit hole of air pollution, specifically PM 2.5. We go into all of that in this episode, so be sure to stick around for that part as well. So without further delay, please enjoy my conversation with Kari Nadeau.
Kari, thank you so much for joining me today. I don't remember the last time we were together in person, but I feel like it's been probably eight years or so. Is that possible?

**Kari Nadeau** (4:03)
I think so. It's been eight years and lots has happened, Peter, especially COVID. So it's nice to see you again.

**Peter Attia** (4:09)
Yeah, yeah. I've always appreciated the amount of time you used to make for me when I used to wander into your lab at Stanford, just to pick your brain.
Again, I've always thought that the work you were doing was so exciting. And I know that it ties into so much about what people are interested in around food allergies, even to some extent, food sensitivities.