Can Allergen-Free Food Subscriptions Help Families? | Interview with Christopher Warren, PhD

The food-as-medicine intervention, offering $155 monthly benefits for allergen-free groceries, benefited food-insecure families with 

 children. However, despite the observed benefit, the intervention failed to reach statistical significance.

The intervention, assessed in a small pilot study, provided a monthly subscription to allergen-free foods through the Food Equality Initiative’s online marketplace where parents could select foods. A different variation of the intervention with identical outcomes was studied in clinics affiliated with Lurie Children’s Hospital of Chicago, University of Kansas, Baylor/Texas Children’s Hospital, Stanford University, and Northwestern University, which provided a monthly subscription to allergen-free foods through the Food Equality Initiative’s online marketplace where parents could select foods.

The intervention lasted anywhere from 6 to 9 months, depending on the center. Families qualified for the intervention if they struggled to feed their families during the COVID-19 pandemic and had a child with a food allergy. Participants completed surveys at baseline and the 6-month follow-up.

Investigators hoped this program could improve allergy management outcomes, recognizing the psychological and social burden of allergies.

“It’s challenging to navigate daily life [with a severe food allergy], even if you have tons of resources… just because food is everywhere, and it's not always clear where your allergen might lurk,” Christopher Warren, PhD, told HCPLive at the 

2025 American Academy of Allergy, Asthma, & Immunotherapy (AAAAI) annual meeting 

in San Diego. “If you are on a very tight budget and don't often have access to all the latest and greatest supports, you can imagine how that would be even more challenging.”

The sample included 89% of non-White participants, and children had a median age of 8.1 years. The most common food allergies were peanut (n = 12), milk (n = 10), egg (n = 10), and shellfish (n = 10).

This pilot study observed high rates of dropout, with 66 participants initially enrolled and only 26 who retained through the uncontrolled study period which ended in October 2024.

“It wasn't easy to recruit participants into this study, surprisingly enough,” Warren said, “and it wasn't easy to retain participants to this study, even when you might imagine it would be very attractive to be presented with the option of, ‘Here, get $155 worth of free food every week, get a CSA basket of fresh food… shipped to your door. All you need to do is fill out some surveys.’ But it was challenging to successfully communicate that really was the expectation and that that was the nature of the study.”

Food allergy-related healthcare utilization (0.7 to 0.2) and missed school or workdays (0.8 to 0.5) declined over the 6-month intervention. Additionally, caregivers reported a greater composite food security (2.4 to 2.7) and more confidence in their ability to prepare allergy-free meals. The analysis also reported fewer food-related socio-behavioral limitations on the Food Allergy Independent Measure (3.2 to 2.6).

However, despite this, the intervention did not reach statistical significance, which Warren said could have been influenced by the dropout rate.

“Challenges we hadn't anticipated [was] digital literacy with the ordering platform—the idea of checking out a virtual shopping cart was not…something that that many of these families had any prior experience with and that led to more barriers to participation,” he said.

Warren, C, Bilaver, L, Davis, C. Implementation and Impacts of a Multi-site, Online Food-as-Medicine Intervention for Pediatric Food Allergy Patients at Risk of Food Insecurity. Presented at AAAAI 2025 in San Diego from February 28 – March 3.

A food-as-medicine intervention aimed at food-insecure families with allergic children provided $155 monthly benefits for allergen-free groceries. Despite observed benefits, such as reduced healthcare utilization and improved food security, the intervention did not achieve statistical significance, potentially due to high dropout rates. Conducted across multiple sites, the study faced challenges in participant recruitment and retention, partly due to digital literacy barriers. The intervention showed promise in reducing food allergy-related socio-behavioral limitations and increasing caregiver confidence in preparing allergy-free meals, but further research is needed to confirm its efficacy.

HCPLive spoke with Warren at AAAAI 2025 about a pilot study showing allergen-free food subscriptions reduced healthcare use but lacked significance.

Allergen-Free Food Subscriptions May Aid Families Manage Allergies, with Christopher Warren, PhD

Christopher Warren, PhD

Prashant D. Tailor, MD, is a retina fellow at the Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA.

AI Ophthalmologic Interdisciplinary Communication with Dr. Prashant Tailor, MD

Advancements in AI technology have led to bridges being built between specialists in countless industries. By quickly and efficiently translating technical jargon, large language models (LLMs) can efficiently decode even the most scientific writing for transfer between different medical fields. Recently, an LLM was tested by having it transcribe notes from several 

, Prashant D. Tailor, MD, a retina fellow at the Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, explained the potential applications for and impediments to the widespread use of AI summaries to transcribe ophthalmology notes.

"These new protocols could be applied to any niche field, especially subspecialty medicine, in the retina clinics or the glaucoma clinics or the cornea subspecialty clinics...you're diving down not just into ophthalmology, you're diving down into a niche field," Tailor told 

The results of Tailor’s study showed a significant level of acceptance, with attending physicians reporting significantly higher overall satisfaction (82.8% vs 72.7). Additionally, while errors were noted in 26% of PLSs, the vast majority took less than 1 minute to correct. Most of these errors occurred in the planning section of the summary. The majority (83.9%) of all errors were considered low risk.

However, attending physicians did report longer correction times and greater perceived burden (26.9% vs 2.5%) than with trainees. Tailor and colleagues noted that, with a 15% overread error rate, the influence of both AI and human error are compounded. The team therefore sees multilayered human oversight as the next method of filtering out the LLM’s mistakes.

“Patients look and refer to [our notes] asking ‘what do I need to look at or know about?’ And if there’s a summary that’s wrong, or an AI generated thing is incorrect, that can cause a lot of confusion,” Tailor told 

. “I think it needs to be vetted by multiple steps.”

Overall, however, the results of the study showed that LLM-generated summaries were associated with greater satisfaction and comprehension among non-ophthalmology clinicians and professionals, while simultaneously reducing time burden for ophthalmologists. PLSs, the team therefore indicates, have the potential to bridge additional disciplines outside of ophthalmology alone.

“I think the team based approach in healthcare is the most important thing about taking care of patients, especially as they get more complex. I think AI is just a supplement there, a tool," Tailor told 

 "If we can help communicate better in different ways so everyone’s on the same page, then we can better take care of our patients, too.”

Tailor PD, D’Souza HS, Castillejo Becerra CM, et al. Evaluation of AI Summaries on Interdisciplinary Understanding of Ophthalmology Notes. 

 Published online April 03, 2025. doi:10.1001/jamaophthalmol.2025.0351

Tailor discusses the future of AI in ophthalmology and beyond, and some of the challenges it may bring.

AI Use in Ophthalmic Interdisciplinary Communication, with Prashant Tailor, MD

Dr. Prashant Tailor, MD

The panel concludes by discussing the long-term outcomes for patients treated for hypercortisolism.

Long-Term Outcomes for Patients Treated for Hypercortisolism

The panel concludes by discussing the long-term outcomes for patients treated for hypercortisolism, emphasizing the need for further studies and data, and sharing their final thoughts on the disease and its future management.

Honey East, MD

Joseph, do you have any final thoughts about, or takeaways from, this discussion?

Education is important for everybody. Many health care providers, including myself, always had this feeling about FMT [fecal microbiota transplant]. Is it dangerous? Will patients wind up getting sick? Where does the stool come from? Is it a mix of donors or a single donor? How much will it cost? And the whole idea of a colonoscopy with bowel prep and propofol, which I mentioned before, seems like a lot. We need to change the way we think about the natural course of 

 infection [CDI]. Hopefully, people will and explore all treatment options that are available at this point.

As far as education with the practitioners, it is about educating the patients as well. If they happen to be frequent fliers for, let’s say, as you mentioned, UTIs [urinary tract infections]. Or they go to their physician, and they say, “I have a cold,” and they’re given an antibiotic. You have to explain to patients as you’re seeing them come into your practice that it’s not important to get an antibiotic every time you go to your physician’s office. And to educate them and not to try to doctor-shop and get an antibiotic if they don’t get the right answer from their primary care physician [PCP] or whomever. It’s important not only for practitioners, but for patients or potential patients for 

 Certainly, we’re going to continue to need patient education, and I appreciate that comment. Andrew?

I am cautiously optimistic now, at this point, as to where we’re headed with CDI treatment, as we have the first FDA-approved FMT product at this point right now with seemingly more on the way. We’ve got the first one through the door, and it’s going to be a matter of seeing where things go from here. As you mentioned earlier, maybe hopefully in the next 10 years we’ll have narrowed it down to which key microorganisms are essential for restoring the microbiota. And if we see these improvements, then hopefully the treatments will continue to become more effective into the future as well.

Appreciate that. I have to say that I’ve considered myself in the past a drug pusher, if you will, in the good sense of the term. But I am excited the fact that there is now an FDA-approved fecal microbiota replacement and that’s a nice, good step forward with assurance that it’s screened and safe, for the most part. And that’s a major step for managing patients with recurrent 

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Experts provide practice pearls for educating patients on and using FMTs for the management of CDI.

Key Takeaways on FMTs in the Treatment of CDI

Joseph Reilly, BS, PharmD, BCGP

Celiac disease is a gluten-sensitive enteropathy, with a global pooled prevalence of 1.4%, which is increasing. Injury to the small bowel results in loss of absorptive surface area that translates into malabsorption of fat-soluble vitamins, iron, folic acid, and vitamin B12, which result in gastrointestinal and systemic symptoms. Here, we will review the updated recommendations of the American College of Gastroenterology (ACG) guidelines on the evaluation and management of celiac disease.

Patients with symptoms and signs of malabsorption, including chronic diarrhea with steatorrhea, weight loss, abdominal pain, and bloating, should be considered for celiac disease testing. The new guidelines suggest that those with a first-degree family member with confirmed diagnosed of celiac disease should also be considered for testing, regardless of whether they have symptoms. Screening in the general population is not recommended.

A combination of positive celiac serologies and small-bowel biopsies showing villous abnormalities are required to make the diagnosis of celiac disease. The sensitivity and specificity of tissue transglutaminase IgA (TTG-IgA) for untreated celiac disease is 95%, making it the serologic testing of choice. Because the prevalence of IgA deficiency in patients with celiac disease is as high as 2 - 3%, it is advisable to measure total IgA levels at the beginning of testing. If the levels of IgA are insufficient, an IgG-based test like deamidated gliadin peptide IgG or TTG-IgG would be the preferred serologic testing. For diagnosis, it is important to confirm that patients are incorporating gluten in their diet, as antibody-based testing is grounded on the intake of gluten.

For patients with positive serologies, EGD with duodenal biopsies is required to confirm the diagnosis.Those with a high clinical probability of celiac disease (>5%) and negative serology should undergo upper endoscopy with duodenal biopsies due to the possibility of seronegative celiac disease and for evaluation of other enteropathies. Obtaining 1 or 2 biopsies from the duodenal bulb and at least 4 biopsies from the post-bulbar duodenum is important for an adequate diagnosis as celiac disease can be patchy. The diagnosis is confirmed based on the presence of villous blunting, intraepithelial lymphocytosis, and crypt hyperplasia per the Marsh or simplified Corazza classification. Intraepithelial lymphocytosis (≥25/100 epithelial cells) alone is not specific for celiac disease, hence alternative diagnoses should be considered.

In cases of serology and histology discordance, testing for high-risk HLA haplotypes of celiac disease is helpful to clarify the diagnosis. If HLA-DQ2 and HLA-DQ8 are negative, the diagnosis of celiac disease can be safely ruled out. HLA-DQ2 and HLA-DQ8 also play a role when patients have already started a gluten-free diet on presentation. In those who are positive, a gluten challenge can be pursued.

In the case of children, a combination of elevated TTG IgA and a positive endomysial antibody (EMA) in a second blood sample is recommended to confirm the diagnosis. This approach is also reasonable for adult patients foregoing EGD, although the diagnosis would be deemed possible, instead of confirmed. For children younger than 2 years, the guidelines recommend a combination of TTG-IgA and deaminated gluten peptide (DGP)-IgG, as EMA IgA is less accurate in this population.

The only effective therapy for celiac disease is gluten-free diet (GFD). Due to the importance of adherence to a gluten-free diet, consultation with a dietitian is recommended after diagnosis. About 80% of individuals with celiac disease who are on a GFD will have a negative serology after 6 to 12 months. Although clinical improvement and normalization of antibodies suggest adherence to GFD, intestinal mucosal healing should be one of the end-point goals of therapy. As healing can take time, particularly in adults, the guidelines suggest a follow-up endoscopy with biopsy after 2 years of following a GFD. Lack of mucosal healing correlates with lymphoproliferative malignancy, bone disease, and refractory celiac disease. In the case of asymptomatic children following a GFD, follow-up biopsies are not recommended.

Although multiple tools to detect gluten in food have come to the market recently, data is lacking about their impact on clinical outcomes and adherence to GFD. Hence, the guidelines suggest against gluten detection devices.

Although dysbiosis is present in patients with celiac disease, there is not enough data to support the use of probiotics. Although oat consumption is safe in most patients with celiac disease, some might react to the oat protein itself, and there is risk of contamination with wheat. Hence, the guidelines suggest consuming gluten-free oats.

Patients with celiac disease are at higher risk of pneumococcal infections compared with the general population, which is due to functional hyposplenism. Hence, the ACG guidelines recommend vaccination against pneumococcus after diagnosis as part of the preventative care of patients with celiac disease. For adults without previous vaccination, the ACG suggests 1 dose of PCV20 (pneumococcal conjugated vaccine 20) alone or 1 dose of PCV15, followed by 1 dose of PPSV23 (pneumococcal polysaccharide vaccine 23).

Measurement of bone density with dual-energy X-ray absorptiometry should also be considered.

The updated guidelines provide new recommendations about considering testing asymptomatic first-degree relatives of confirmed individuals with celiac disease, correlation between serologic and endoscopic diagnosis in children and adults, the role of mucosal healing, the lack of evidence of tools to detect gluten, and probiotics. It also highlights the importance of preferring gluten-free oats, and of preventative immunization and measurement of bone density. As research evolves in this field that affects an increasing number of individuals, more data will be available to facilitate their diagnosis, adherence to gluten-free diet, and preventative care.

Rubio-Tapia, Alberto MD1; Hill, Ivor D. MD2; Semrad, Carol MD3; Kelly, Ciarán P. MD4; Greer, Katarina B. MD, MS5; Limketkai, Berkeley N. MD, PhD, FACG6; Lebwohl, Benjamin MD, MS7. American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease. The American Journal of Gastroenterology 118(1):p 59-76, January 2023. | DOI: 10.14309/ajg.0000000000002075

An expert reviews the updated recommendations of the American College of Gastroenterology guidelines on the evaluation and management of celiac disease.

Celiac Disease ACG Guidelines Update

Lady Katherine Mejía Pérez, MD

Patient Case No. 2

Patient No. 2 has stage 3 CKD and uncontrolled hypertension. They have a moderate reduction in their estimated glomerular filtration rate, confirming stage 3 CKD. Their hypertension is likely contributing to CKD progression.

Difficult-to-treat hypertension is a condition where blood pressure remains uncontrolled despite the use of three or more antihypertensive medications, including a diuretic. This condition is distinct from resistant hypertension, which is more common and involves blood pressure that is not controlled with three medications but may not include a diuretic. Difficult-to-treat hypertension is less frequent, affecting a smaller subset of patients with high blood pressure. It often requires a more comprehensive approach, including lifestyle modifications and potential secondary causes evaluation, to achieve optimal management.

Panelists discuss how chronic kidney disease (CKD) and uncontrolled hypertension create a damaging cycle, in which hypertension accelerates kidney damage while declining kidney function makes blood pressure harder to control.

Manesh R. Patel, MD

Niels Jongs, PhD, is a statistician at the University of Groningen.

Niels Jongs, PhD

Troum discussed the AGILE study and how DECT scanning helped visualize improvements in uncontrolled gout.

Orrin Troum, MD: Accurately Imaging Gout With DECT Scanning

 of pegloticase (Krystexxa; Amgen) may reduce the treatment burden for patients with uncontrolled gout in new research which found 1-hour infusions to be well-tolerated.

Orrin Troum, MD, clinical professor of medicine, Keck School of Medicine, University of Southern California, and director, clinical rheumatology research, Providence St John's Hospital, Santa Monica, California, presented data from the phase 4 AGILE study evaluating shortened infusions at last month’s 

can College of Rheumatology (ACR) Convergence 2024

 spoke with Troum to learn more about gout management and how shortened infusion times can help reduce patients’ treatment burdens. He also discussed autoimmune investigations he is involved in at Providence St John's, including indications such as lupus, Sjogren disease, and psoriatic arthritis.

Troum emphasized the value of dual-energy computed tomography (DECT) scans in managing gout and the importance of expanding the access of use of DECT scans, which are not available for rheumatologists in all areas.

“By DECT scanning, you can get a very clear picture with over 90% accuracy with being specific and sensitive to identifying urate crystals, and that has been a big help to me, because it helps us in targeting patients, specifically with tophaceous gout that we can measure… and by the end of Krystexxa therapy, they don't have anymore. So that's really a very good outcome for me that I've used… Not everybody has access to it, but [it’s been a] very useful tool for me,” Troum said.

Relevant disclosures for Troum include AbbVie/Abbott, Amgen, Bristol-Myers Squibb, Eli Lilly, Genentech, GlaxoSmithKlein, Novartis, Roche, and UCB.

Troum O, Botson J, Fang F, et al. Safety, Tolerability and Efficacy of Pegloticase Administered with a Shorter Infusion Duration in Subjects with Uncontrolled Gout Receiving Methotrexate: Primary Findings of the AGILE Open-label Trial. Presented at: Presented at: ACR Convergence 2024; November 14-19; Washington, DC. Abstract 2012.

Orrin M. Troum, MD

An expert discusses how chronic hand eczema (CHE) is a common condition affecting 1% to 5% of adults and is defined as hand eczema lasting at least 3 months or relapsing at least 2 times per year, distinct from atopic dermatitis.

Prevalence, Presentation, and the CHE Patient Journey

Video content above is prompted by the following: 

a dermatology specialist discussing CHE diagnosis, clinical presentation, and treatment approaches.

: CHE is defined as hand eczema lasting at least 3 months or relapsing at least 2 times per year, with point prevalence of 1% to 5% in adults and lifetime prevalence around 15%.

: While atopic dermatitis can manifest on hands, CHE encompasses broader etiologies and clinical presentations.

: CHE presents significant functional limitations due to its impact on daily activities and occupational performance.

Dr Chovatiya emphasized that CHE is "common, burdensome, [and] highly symptomatic for patients, and something that we're probably missing the boat on in terms of really adding a name to it to get to the next step of treatment."

Raj Chovatiya, MD, PhD

Final Insights

Video content above is prompted by the following:

Are there any final insights you’d like to share regarding LDL-C and Lp(a) screening and management of high-risk cardiovascular patients?

Pediatric lipid screening is crucial for early detection and management of dyslipidemia, which can prevent cardiovascular diseases later in life. Current guidelines recommend universal lipid screening for children between ages 9-11 and 17-21, with selective screening for those with risk factors. However, implementation remains inconsistent due to barriers such as lack of awareness and time constraints in clinical practice. To improve uptake, strategies include integrating screening into routine pediatric visits, utilizing electronic health records for reminders, and educating healthcare providers and families about the importance and benefits of early lipid screening.

Panelists discuss how effective cardiovascular risk management requires comprehensive screening for both LDL-C and Lp(a), along with aggressive treatment strategies for high-risk patients.

Authors