Committed to helping Asian Indian kids with food allergy
“I have increasingly been seeing children with food allergies in my clinic and in my social circles, with many of them having severe, life-threatening allergies to multiple foods,” says Dr. Chitra Dinakar, the Gies Endowed Faculty Scholar and Clinical Professor in Food Allergy, Asthma and Immunology Research at the Sean N Parker Center, Stanford University. According to Dr. Dinakar, who was until recently a Professor of Pediatrics at the University of Missouri-Kansas City and Director, FARE Center of Excellence at Children’s Mercy, Division of Allergy/Immunology at Children’s Mercy Hospital, what she saw in her patients had a direct similarity in with recent data that food allergy is considered to be the second wave of the allergy epidemic with up to 8% of children having food allergies in the USA.
Dr. Dinakar was deeply concerned that “a significant percentage of them were of Asian Indian origin, and whose parents and grandparents had no history or knowledge of food allergies. Moreover, some of them had allergies to foods that were not commonly reported in the USA population (e.g. urud dal), and hence were finding it challenging to get appropriately diagnosed and treated.”
These concerns and studies prompted Dr. Dinakar, who had completed her fellowship in Allergy/Immunology at the Cleveland Clinic Foundation, Ohio, and has been at Children’s Mercy since then to review the scarce literature published on this topic and her search revealed the possibility that Asians have higher odds of food allergy compared with white children, but significantly lower odds of formal diagnosis.
Dr. Dinakar who began her new career in January 2017 at the Sean N Parker Center, Stanford University, found that immigrant populations tended to develop the diseases of the society they migrated to. Australian-born Asians had higher odds of developing atopic disease when compared to Asian-born immigrants, and foreign-born children had an initially lower prevalence of atopic disease, which increased after residing in US for more than10 years.
“I also discovered that there is a significant knowledge gap regarding food allergy trends in the Asian Indian population in the US,” Dr. Dinakar says. According to her, Asian Indians have an ethnically unique diet and may have ‘unusual’ or ‘different’ food allergies than the “Top 8” (milk, egg, wheat, soy, peanut, tree nuts, fish, shellfish). Additionally, there are no standardized tests to diagnose these unique food allergies or recommendations regarding cross-reactive patterns and foods that are a must-avoid. To her surprise, the allergist also found that Asian Indians as a demographic population is typically left out of most large-scale studies since they do not meet the standard research inclusion criteria for “minority ” or “medically underserved” groups. “I therefore believe it is critically important to recognize, diagnose, and treat these unique allergies in this understudied population to optimize nutrition and growth,” says Dr. Dinakar.
Dr. Dinakar chaired the Joint Task Force Practice Parameter Workgroup on Yellow Zone Management of Asthma Exacerbations. She has served on review panels for grant funding programs such as the National Institutes of Health, and has been a member of the UMKC Pediatric Institutional Review Board. She has been involved in more than 50 investigator-initiated, NIH-sponsored, and industry-sponsored clinical trials, and has over 60 peer-reviewed publications, and 2 book chapters. She is an invited speaker at national and international allergy conferences, and mentors junior faculty, A/I fellows, residents and medical trainees.
Loving children comes naturally to this physician of Indian origin. The opportunity to help care for the health and well-being of the future citizens of India, comprising over one thirds of its population, was compelling and irresistible, inspired her to take up this noble Medical profession. On graduating as the valedictorian from high-school, she was fortunate to be selected to join one of the premier medical institutions in India, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). Admission at JIPMER is through a nationally competitive entrance examination, and all admitted students receive a generous tuition scholarship from the government of India, which made the decision easy for her.
Dr. Dinakar has been passionately interested in studying food allergy trends among Asian Indians for several years. She began with a pilot survey launched in Kansas City that showed there was a variety of food allergies reported in Asian Indians. She then extended her study to capture a larger cohort throughout the USA in the form of a multi-center collaboration with Dr. Ruchi Gupta, an accomplished pediatrician and food allergy/asthma researcher, from Northwestern University. IRB approval was obtained at the two collaborating institutions, Children’s Mercy Hospital in Kansas City and Ann & Robert H. Lurie Children’s Hospital of Chicago.
The aims of the ongoing Asian Indian Food Allergy Survey are to 1) understand generational differences in food allergy in the Asian Indian population living in the USA 2) determine the top food allergens in this specific population, 3) and to better understand the interplay between genetics and the environment in the development of atopic illness. The goals are to capture child and parent demographics (including birth country and state, age of migration), history and nature of food allergy diagnosis (including symptoms, age of onset, and testing), and the presence of other atopic illnesses. The key inclusion criteria include being of Asian Indian heritage living in the USA and having a child with food allergy.
Dr. Dinakar and her team reported the preliminary results of the survey at an invited oral presentation at the International Food Allergy Symposium, ACAAI Annual Meeting, San Antonio, TX in Nov 2015. Among the 114 Asian Indian children with food allergies approximately two-thirds of the allergies were reported to be diagnosed by a physician. Over two-thirds of them were diagnosed by blood or skin allergy tests, and approximately one-third were revealed through a supervised oral food challenge. Tree nut was the most common food allergy in this population and was reported in six out of every 10 children. This finding was unexpected since it is not the most common food allergy in the general population of the U.S.A.
Dr. Dinakar notes that, some of other food allergies noted were to chickpea flour, capsicum (variant of green pepper), and to Indian lentils. Despite the small sample size, a large variety of food allergens that are typically not seen in the general population was reported, including foods such as avocado, banana, beef, bulgur wheat, coconut, corn, eggplant, food dye, garlic, ginger, green peas, jalapeño peppers, kiwi, melon, rice and tomato. Additionally, one in ten parents self-reported that they had a food allergy.
“While the study is still on-going, the preliminary findings are important as they reveal that individuals of Indian descent living in the US tend to be allergic to foods that are frequently not thought of as common food allergens,” Dr. Dinakar, whose expertise includes pediatric asthma, food allergic disorders, atopic and immunological disorders, and health care quality and outcomes, says. “I will follow up on this study by evaluating allergic diseases in the Indian subcontinent and determine reasons for the exponential spike.”
Dr. Dinakar, who serves on the Editorial boards of four reputed Allergy/Immunology journals (AllergyWatch (Associate Editor); Annals of Allergy, Asthma & Immunology; Allergy and Asthma Proceedings; Current Treatment Options in Allergy),and serves as the USA Regional Editor of the World Allergy Organization Web Editorial Board, invites all families of Indian origin to participate in the collection of this critically important information at the link below: https://www.surveymonkey.com/s/SouthAsianFoodAllergySurvey
“The data we capture will enable us to start gaining an understanding of why Asian Indian families in the USA are increasingly developing severe allergic diseases such as food allergies, asthma and environmental allergies. It will also help us develop appropriate treatment and prevention strategies for this unique population, one that is typically not well-represented in routine research studies.”
As of today, about 350 individuals have responded to the survey, while the team would like to have a group of 1000 or more from different regions of this country to participate in the survey, so that it would adequately reflect the food allergy status of the Asian Indian population living in the USA.
Dr. Dinakar has served in leadership capacities at national Allergy/Immunology organizations. She is a member of the Board of Directors of the American Board of Allergy and Immunology (ABAI) and recently got elected to the Board of Directors of the American Academy of Allergy, Asthma and Immunology (AAAAI). She was on the Board of Regents of the American College of Allergy, Asthma and Immunology (ACAAI). She also serves on the Executive Committee of the Section of Allergy/Immunology in the American Academy of Pediatrics (AAP-SOAI) and is an elected member of the prestigious American Pediatric Societies (APS). She is a former President of the Greater Kansas City Allergy Society and a former Board member of the Shawnee Mission Education Foundation. She is a board member of the Food Equality Initiative and the Food Allergy Support Group of Greater Kansas City.
Dr. Dinakar, who has been awarded with numerous awards was the recipient of the “Distinguished Fellow Award, American College of Allergy, Asthma and Immunology in 2016.
“I was honored to receive the “Distinguished Fellow Award” from the American College of Allergy, Asthma and Immunology (ACAAI), a professional organization of more than 6900 allergists/immunologists from across the world, at their annual meeting in November, 2016. According to the ACAAI website, this award is presented to “a Fellow who has made significant contributions to allergy, asthma or immunology in the United States or Canada and/or has an outstanding reputation as a clinician/teacher, dedication to ACAAI activities, scholarly achievement and leadership qualities”. In the words of Dr. Bryan Martin, the President of the ACAAI, “Dr. Dinakar is incredibly active in the College and has been instrumental in the quality of College educational endeavors. She supports the practicing allergist as a Director of the ABAI, and the College representative on the Council of Pediatrics Subspecialties. She is a wonderful mentor and tireless worker for the allergy community.”
Last year, she was thrilled to receive “The Woman in Allergy Award” by the American College of Allergy, Asthma and Immunology (ACAAI). The annual award “honors an individual who has advanced the role of women in medicine or made a significant contribution to the specialty”. In the words of the 2016 ACAAI President Dr. James Sublett, “Dr. Dinakar is one of those “go-to individuals” who is always willing, when asked, to step up and take a leadership role. Whether it’s leading the development of a Practice Parameter, or chairing a College committee, we know the job will be done well and on time.”
Some of the awards Dr. Dinakar was bestowed with include, “Excellence in Service” (for Distinguished Editorial Service), Missouri State Medical Association (2016), “Woman in Allergy Award” by the American College of Allergy, Asthma and Immunology (2015), “Acellus Teacher of the Year” award by the International Academy of Science (2015), the “Award of Excellence” by the American Association of Allergists & Immunologists of Indian Origin (AAAII, 2009), “Golden Apple Mercy Mentor Award” by Children’s Mercy Hospital, and an honorary “Kentucky Colonel” awarded by the Governor of Kentucky. She is listed on the Consumer Research Council’s ‘Guide to America’s Top Pediatricians’; Best Doctors in America; Kansas City Magazine’s ‘SuperDocs’ and ‘435 Magazine’ Best Doctors.
“It is energizing to me to know that colleagues I admire and respect believe in my passions,” says Dr. Dinkar with a sense of pride and accomplishment. “At the same time, it is humbling to realize that this honor was possible only because of the unstinting mentorship and encouragement of path-breaking leaders and supportive colleagues. I have found that almost every person I encounter has a story to tell, and their personal battles and victories inspire and motivate me. To me, therefore, the awards are a reflection of the collective “goodness” of the amazing people I have been fortunate to interact with in my life.”
Having had the benefit of experiencing healthcare delivery in two nations, both In India and the US, at near-opposite ends of the spectrum, Dr. Dinakar is well aware of the breakthroughs and limitations in healthcare globally. “I am passionate about minimizing health care disparities and moving healthcare quality forward in every which way I can, one baby step at a time. Having been blessed with receiving top-notch training in both India and the USA, I am passionate about advancing cutting-edge research knowledge in both these countries, and using the expertise and understanding gained to improve global health.” She hopes that her new assignment at Stanford University “will enable me to accomplish my goals.”
Being a pediatrician, and a mother of two young college boys- the older a sophomore at Stanford, and the younger a Freshman at UC Berkeley, Dr. Dinakar is an unabashed and ardent believer in the power and ability of the future global citizens to take mankind forward.
Dr. Dinakar also believes that many young Indian Americans are doubly blessed with having the benefit of both “Nature and Nurture.” In other words, the majority of them have inherited priceless genes and drive that brought their incredibly hard-working and motivated parents/grandparents to cross continents in a desire to ensure a robust future for their progeny. According to Dr. Dinakar, “while there are unique generational, cultural, language, social and economic challenges in growing up as the children of immigrants in the USA, the opportunities presented to them are limitless. After all, this is “the land where dreams come true!”
Addressing the young Indian Americans, Dr. Dinakar says, “You are extraordinarily gifted and loved beyond measure. Feel empowered to unlock your phenomenal potential and translate your dreams into reality.”
Dr. Dinakar finds time and passion to be actively involved in every aspect of her family life. “I believe that my family is a microcosm of the world around me, and how I interact with my family defines and shapes how I interact with the world. I believe that each one of the members of my family tree (vertically and horizontally) is exceptional and extraordinary, and am deeply grateful for the countless ways in which they have enriched and fostered my growth, either directly or by example.”
“I am a kinetic person and enjoy putting my fast muscle fibers and mitochondria to work,” describes Dr. Dinakar of herself. A classically trained Bharathnatyam dancer, she learned ballroom dancing after coming to the USA. She revels in all kinds of dance movements, including Bollywood. A competitive track athlete in school/college, she says, “nostalgic memories motivate me to represent my hospital in the annual Kansas City-wide Corporate Challenge events, where I typically medal in the 100m and 400m sprints, and Long Jump events.” She was the captain of the basketball team in medical school and “I play 2 on 2 basketball with my boys in the driveway, when the weather permits. My boys are talented musicians and I enjoy listening to them. I also love reading good books and watching movies, though I wish there were 36 hours in a day!”