"Do not be afraid of food": interview with allergist-immunologist Olga Zhogoleva

2024 Author: Malcolm Clapton | [email protected]. Last modified: 2023-12-17 03:44

About food allergies, immunity and the myths associated with them.

Olga Zhogoleva - allergist-immunologist, candidate of medical sciences, founder of the Everyday Clinic. On her blog, she talks about immunity and how to live without allergies.

Lifehacker talked to Olga and found out if the immune system can actually weaken and whether it will be possible to strengthen it with the help of hardening, healthy foods and vitamins. We also found out why food allergies occur, what should be done to avoid it, and which myths from this area are the most harmful.

About immunology

Why did you decide to become a doctor? And why an immunologist?

My decision was dictated by family traditions, because many members of my family are doctors for several generations. From early childhood it was clear to everyone that I had no other option - they were not even considered. And I have no regrets, because I like the business that I do.

But for a long time I could not decide on the choice of specialization. In the 1-2nd years, I wanted to become an obstetrician-gynecologist. Then a surgeon, from which my grandfather the surgeon dissuaded me. And closer to the end of the university, I wanted to work as a department employee, after which I remained at the department of normal physiology, entered graduate school and spent three wonderful years there, working on a dissertation.

Then I realized that I still want to practice medicine. And since my scientific work was devoted to allergology and immunology, I chose this specialization.

How does your specialization stand out from other medical areas?

I would not say that allergology and immunology have a feature that distinguishes it favorably from other specialties. Each of them has something of its own.

The peculiarity of my specialization is that most of the work happens in the head. In fact, you need to conduct a whole investigation, compare the facts and build logical chains in order to correctly diagnose - to determine what a person is allergic to and whether he has an immunodeficiency.

A physician's work in this area is largely an analysis of the patient's history.

And research is of secondary importance: rather, it only provides a little help, but is not the basis for decision-making. You can't just get tested for all allergens and be treated depending on the results.

What about evidence-based medicine in immunology?

Probably, this question was raised due to the fact that there is an attempt to divide medicine into evidence-based and non-evidence.

In fact, there is only one medicine - evidence-based medicine. It cannot be different. It's just that in the past, a reference to the authoritative opinion of a professor was considered a good argument, and now - to high-quality scientific research. And Russia is in a state of transition to the second approach.

From this point of view, allergology and immunology are no different from other specialties. We rely on scientific evidence to make a destination.

In an interview, neurologist Nikita Zhukov said that in hospitals, entire floors can be allocated for useless physiotherapy. Is there something similar in allergology and immunology?

This is due to the fact that the transformation of medicine from the outdated post-Soviet to the modern one is taking place right now. And everything is progressing slowly.

Allergology still has the same thing. In the laboratory, the patient can be offered research methods that are completely unnecessary in his case. For example, mast cell degranulation is not used in world practice. And with allergies, you do not need to do food immunoglobulin G tests.

But such appointments are inevitable in the modern medical realities of our country. And so far in our specialty there is a place for the saying "How many doctors - so many opinions."

My colleagues and I in our clinic are struggling with this - we try to give equally well-grounded and modern medical recommendations.

In what cases do you need to immediately go to an immunologist, bypassing a therapist?

Not in any. Diagnosis of Immunodeficiency Immunodeficiency is a condition in which the ability of the immune system to fight infectious diseases and cancer is reduced or completely absent. - this is the doctor's business. If people, based on their well-being, will make this diagnosis for themselves, then they can waste their time by visiting an immunologist.

There are criteria that are the basis for suspecting immunodeficiency. For example, six or more bacterial and purulent infections in one year, recurrent meningitis and sepsis, two or more pneumonia in one year. Or prolonged use of antibiotics, which do not help, although they are selected correctly. Another sign may be a situation where a fungal infection has caused pneumonia. If all is well with the immune system, this should not be the case.

And these criteria for self-diagnosis are not very suitable. They should be noted by the patient and therapist during the dialogue. The first one tells something about himself, and the second analyzes and says: “Here and there the bells are not very good with regard to the immune system. Let's consult with an immunologist."

Because in the mind of an ordinary person, "frequent illnesses" is a very vague term. And if he previously had ARVI once a year, and then fell ill three times, then he may consider that he has an immunodeficiency. But this is not the case.

What is immunity and where is it located?

This is a great question that can take hours to answer. The immune system consists of a complex network of organs, cells and substances they produce. It ensures the consistency of our protein composition - protects against enemy proteins. Or decides that we do not need to be protected if the protein is not dangerous.

It also destroys our own modified cells, that is, it protects against cancer. The immune system is diffusely distributed throughout our body, and there is not a single point on the map of our body where it is not.

And immunity is resistance to something. For example, we can say that a person has immunity against influenza or chickenpox. In fact, this is a specific and non-specific protection against a specific scourge, a pathogen. And it is represented by substances and cells that are found throughout the body.

How to understand that the immune system is weakened?

Above, I listed the criteria for immunodeficiency. The rest of the immune system works very well, even if it has periods of decreased activity of some departments, which globally in no way affect our vitality and health. For example, after a viral infection, post-viral asthenia, increased fatigue, fatigue, and a slightly higher susceptibility to infections may occur for some time.

Sometimes we can take something else for a decrease in the activity of the immune system. For example, vitamin D and iron deficiency. Or, if a person is allergic to dust, the mucous membranes of the respiratory tract become more susceptible to microbes, because they are in a state of inflammation due to contact with allergens. But this has nothing to do with immunodeficiency.

These changes in the functioning of the immune system do not require us to directly affect it. It is completely self-regulating and self-healing.

Immunity does not need to be stimulated and "raised from the knees."

To maintain the normal operation of this system, you just need to not interfere with it: give up bad habits, get enough sleep, play sports, lead a physically active lifestyle, and eat well. In general, carry out boring recommendations that no one likes. But this is exactly what really helps the immune system.

Is it possible to increase the temporarily reduced immunity with the help of some products?

There is no nutrition for boosting immunity. It is a myth. For the immune system to function properly, you just need to eat a balanced diet.

For example, at least half of the diet should be plant foods (vegetables and fruits). Protein should be at least a quarter of the daily diet, complex carbohydrates with a predominance of whole grains in sufficient quantities are also needed. You need to eat fish 1-2 times a week.

These are components of the normal, balanced diet of a person, which is recommended by nutritionists. But these recommendations are in no way directly related to immunology. They are versatile. It's just a way to get enough nutrients from food.

What vitamins should be taken for prophylaxis, besides vitamin D?

Vitamin D is the only vitamin that makes sense to take for prevention, because we do not receive it from food. In Russia, its year-round reception is recommended for children of any age. And we get all the other vitamins from food in sufficient quantities if we eat in a balanced way.

Is there any benefit from hardening - dousing with cold water or wiping with snow?

Hardening is not dousing with cold water and rubbing with snow, but adaptation to different temperatures. If you go barefoot at home, then this is also it.

If a person lives in greenhouse conditions, wraps himself in warm clothes and it is always hot at home and the windows are closed, then his body loses its ability to adapt to low temperatures. And then even the use of cold drinks or ice cream can lead to the fact that the cooled mucous membranes will become less resistant to the microbes that live on their surfaces.

If a person is adapted to different temperatures and does not get sick immediately after being in a cool room, then this means that his skin, mucous membranes, respiratory, nervous and immune systems are working correctly.

So, those who lived in greenhouse conditions in childhood need to go through the hardening procedure. And it doesn't have to be drastic measures like snow wiping. It is enough to do outdoor sports, ice sports or swimming. These are options for adapting to cold temperatures without harm to the body.

Because if an unprepared person immediately plunges into the hole, this can lead to unpleasant consequences from the nervous and cardiovascular systems.

And if conditions in childhood are generally sterile, then this leads to a decrease in immunity?

Yes, when it comes to the abuse of antiseptics and antibiotics. When the space around a person is unnecessarily sterile, the immune system has no opportunity to exercise. Such a person's immunity may be more vulnerable.

People who live in cities are more prone to allergic diseases. Because the immune system must have molecular diversity for normal development. And in the city, people are less in contact with microbes, less often they are in the fresh air and come into contact with plants, soil, animals.

What myths in immunology do you dislike the most?

Most of all, I do not like the myth that immunity has "fallen down" and needs to be urgently saved and raised. And also the myth of the pernicious and almost fatal effect on the body of the Epstein-Barr virus.

It is a herpesvirus, but not the one on the lips. It does not cause herpes, but mononucleosis - a sore throat with a high fever and enlarged lymph nodes. This virus occurs in 90% of people, and for the majority it poses no danger.

But we have the laboratory ability to look for antibodies to it, and, naturally, they are found in nine out of ten people. Then they try to explain the disease to which it has nothing to do with this virus.

In my practice, I have met patients with the Epstein-Barr virus who, themselves or together with doctors, tried to explain everything to them - from arthritis to conjunctivitis. But the truth is that it is one of the many viruses that, in the form of a carrier, can persist in our country for life.

And it poses a real danger only for people with immunodeficiency and sickle-cell anemia. In the first case, the immune system may not have enough power to cope with it, and in the second, the risk of lymphoma increases. But most people do not have these diseases and are safe despite exposure to this virus.

Can herpes simplex indicate a temporary decrease in immunity?

The appearance of herpes suggests that something has happened to the barrier functions of the mucous membrane. Either a person has a temporary failure of the immune system due to a previous viral infection.

A person is a carrier of herpes. And in such cases it can become aggravated. But that doesn't mean anything bad about the immune system. On the contrary, it works well, since it does not allow herpes to go beyond the rashes on the upper lip and wings of the nose.

If there were problems with immunity, then everything would develop horribly. The virus would cause generalized infection, sepsis, damage to various organs and the nervous system.

About allergology

What is food allergy?

Like any other allergy, it is caused by the immune system not correctly recognizing the proteins in food. She believes that they are dangerous, and begins to fight with them.

The knowledge of frequent allergies to dairy products has turned milk in the minds of some people into a poisonous and harmful product. But the essence of allergies lies in the fact that the product itself does not pose any danger if your immune system works without errors.

Just milk, as well as eggs, wheat, fish, nuts, soy, peanuts and seafood are the most common allergens. And if a person has symptoms of food allergies, then we will think about products from this category first.

I also keep repeating that allergy is a very logical disease. And if you do not see the logic in your state, then most likely you are dealing with something else.

Why does food allergy occur?

For a person to develop an allergy to something, they must have a certain set of genes that make their immune system prone to it.

But at the same time, a person is not programmed for a specific allergy from birth.

His body is simply capable of making these mistakes - incorrectly recognizing proteins. And then each allergy sufferer begins an individual scenario that determines which proteins his immune system will not make friends with.

And we still do not fully know why one person was allergic to milk, another to an egg, and a third to fish. Most likely, the conditions under which the acquaintance with these products took place play a role.

Is there an exact list of foods to which you may be allergic?

For a substance to become allergenic, it must meet certain requirements. The first is to have a certain structure. For the immune system, in her opinion, it is substances of protein origin that are dangerous. For example, sugar is a carbohydrate, which means it cannot cause allergies.

And allergies to drugs and metals work in a different way. For example, in order for a substance from a drug to become allergenic, it needs to stick to our protein, and only then can the resulting structure become a potential irritant for the immune system.

The second requirement: the substance must have certain dimensions. Not all protein from food meets these criteria. They must be large enough to be noticed by the immune system. And even if they pass along this parameter, then she may still not react to them, because, perhaps, the structure of protein fragments also matters.

So far, this information is only accumulating. But, for example, knowing that not all proteins are capable of causing allergies due to their size, we can say that some substances do not contain allergens. For example, in beets (not sugar, but ordinary), no proteins were found that could cause an allergic reaction. Or mushrooms - raw ones still contain some proteins that can cause allergies, but cooked ones do not contain them.

There are also foods that, if they cause allergies, are not by themselves, but due to another allergy. For example, an allergy to grass pollen can lead to allergies to squash and pumpkin. But the latter by themselves are rarely capable of causing allergies.

So we still don't know exactly which proteins can cause allergies, and we don't have an exhaustive list of them. The structure of many allergenic proteins has already been deciphered, but research in this direction is still ongoing.

Can you be allergic to a certain product if you eat a lot of it?

If a person has eaten something too much and he develops a rash, then usually we are talking about pseudo-allergies. The fact is that some food components have a direct irritating effect on the skin and mucous membranes.

They mimic an allergic reaction due to the fact that by themselves they cause some kind of vascular reaction in the skin. Or because they induce histamine from mast cells in our skin. The release of this substance also occurs with allergies, so such confusion can arise.

But the difference from allergies is that the immune system is not involved in these reactions. They are not dangerous, and in most cases a person has a tolerable portion of the product that he can consume without negative consequences.

Can allergies occur from time to time?

This can only be with cross-allergies. For example, a person with a birch allergy may have a form of apple allergy in which some varieties will cause a reaction and others will not. Or a person may not tolerate an apple with a peel, and without it everything will be fine. There are also cases when the body tolerates a fresh apple well, and a reaction occurs to a lying one, because it has managed to accumulate proteins that are capable of causing it.

Only in such situations is the instability of symptoms possible. In all other cases, the product always causes allergies under all circumstances. It's the same with drugs - a reaction to the drug will occur every time you meet with it.

How to prevent the occurrence of allergies?

If it were very simple, then, probably, we would not have such a prevalence of allergies. So far, we are just getting closer to understanding. But we already know something. This does not give a 100% guarantee that there will be no allergies. It's just that the chances will be lower.

The likelihood of allergies increases if there is a deficiency of vitamin D, secondhand smoke, poor microflora due to the urban lifestyle and lack of contact with animals, abuse of antiseptics and antibiotics, and a poor diet.

Accordingly, the opposite state of affairs reduces these risks.

It is also not good when a child is introduced to foods that contain potential allergens at a later age. For example, children who start eating fish before one year have a lower risk of allergies than those who first tried it when they were five years old.

What myths about allergies do you think are the most harmful?

First myth: allergy to red. It is believed that the color of the product indicates its allergenicity. But this is not the case. Red and white fish cause allergies with the same frequency.

Second myth: a breastfeeding woman should not eat foods that could potentially cause allergies. That is, not when the allergy already exists, but so that it does not exist. This is a very harmful myth because it leads to overly strict and unnecessary restrictive diets.

Third myth: atopic dermatitis is 100% allergic. And all his treatment comes down to finding the allergen and stop using it. But this is also not the case. This is a dermatological disease that, due to the genetic structure of the skin, can be aggravated by external influences on it.

And people with atopic dermatitis have an increased tendency to allergies. But she accompanies only about 30% of children with this disease. And the older a person is, the less likely it is that his atopic dermatitis is associated with allergies. As a result, this myth leads to unnecessary diets and insufficient local therapy.

The fourth myth: steroid drugs in allergology are extremely harmful and dangerous. They supposedly drive the disease inside, are addictive, affect height, weight, hair growth and sexual function. This myth is due to the fact that there are pill steroid drugs that are really capable of affecting the body as a whole with their prolonged use.

But it is wrong to distribute their possible side effects to local remedies - hormonal creams, sprays, inhalation drugs. They are specially designed so as not to cause negative reactions that may arise from tablets. As a result, this leads to unnecessary costs and avoidance of the correct therapy for allergic diseases.

Fifth myth: there are non-allergenic cats and dogs. Indeed, there are animals on which the reaction occurs less often. The molecules are found in varying concentrations in the fur, dandruff and saliva of the animal. And a person may have a threshold of sensitivity to such molecules.

Accordingly, a situation is possible where a particular person may not have an allergic reaction to a particular animal. But at the same time, one cannot say that there are ideal breeds that can be gotten by people with allergies. This can be traumatic for a person - symptoms will nevertheless arise, and for an animal - it will have to be given.

What things do allergy sufferers need to know in order to live happily ever after?

He needs to know that today modern medicine can control his disease and enable him to live a full life.

When it comes to food allergies, diet doesn't last forever.

And even an allergy to fish and nuts can eventually disappear in an adult. And it often goes away to other allergens in childhood.

There is also highly effective allergen-specific therapy that can reduce symptoms and even completely go into remission. And modern antiallergic drugs are well studied in terms of safety and effectiveness. You can not be afraid to take them for a long time, if there is evidence.

What advice can you give to the readers of Lifehacker as an allergist-immunologist?

The first tip is not to be afraid of food. If you do not have allergies, you should not expect it to appear suddenly at any time in your life for anything. This fear has no scientific basis. Food allergies in most cases start in childhood when they get to know food.

The second tip is more about parents of young children. Remember that protective tactics - when we do not give food, do not allow contact with animals, do not let them out into the street and do not go out of town - works to the detriment of

Variety of exposure to food and the environment during childhood is one way to prevent allergies. This makes our immune system healthier and helps it function properly.

Life hacking from Olga Zhogoleva

Books

I would like to recommend work on nutrition - this is a very important topic in the field of allergology. There are wonderful books by nutritionist Elena Motova "My best friend is the stomach" and "Food for joy". I also recommend the book "Soup First, Dessert Then" by nutritionist Maria Kardakova. All these works promote a healthy attitude to their diet, fight myths and allow a person to adequately evaluate products and not be afraid of food where it is not necessary to do so.

Blogs

I adore the Telegram channels “Wet Mantu” by medical journalist Daria Sargsyan and “Notes of a Pediatrician” by pediatrician Sergei Butriy. I also recommend subscribing to the YouTube channel of the doctor and scientific journalist Alexei Vodovozov.

Films

Once upon a time I really liked the TV series "House". At that time, I was studying at a medical university and tried to simultaneously solve riddles and find out - after all, lupus or not lupus. But now it has lost its relevance a little, especially in the era of new ethics. Therefore, I can recommend the series "The Good Doctor" about a doctor with autism and savant syndrome who became a surgeon.