Battling Misconceptions: Deep Dive into Food Allergies
Kara Wada, MD: Welcome back everyone to this episode of the Becoming Immune Confident podcast. I am Dr. Kara Wada, board certified allergy, immunology, and lifestyle medicine physician and autoimmune patient. And you are in for a treat today. I am so thrilled to welcome one of my longterm mentors, someone I consider a really great friend and colleague, Dr David Stukus. He is an incredible force in leadership within the allergy immunology community. His official credentials are Professor of Clinical Pediatrics and Director of the Food Allergy Treatment Center. And he, along with me, is an Associate Program Director of our Allergy Immunology fellowship program.
He practices at Nationwide Children's Hospital and teaches at the Ohio State Wexner University College of Medicine. He's also very involved in leadership within multiple professional organizations within our field. And he has spent the last decade combating misinformation and really myth busting through social media.
He is active on Instagram and on X as @allergykidsdoc. Welcome Dr. Stukus and we'd love to hear a little bit more about how did you end up doing what you're doing?
Dr. David Stukus' Journey into Allergy and Immunology
David R. Stukus, MD: Yeah, well, first of all, it's nice to see you. Thank you so much for inviting me. This is fun. So yeah yeah, it's I first got involved. So I'm an academic person through and through like yourself, I love research. I love trying to ask questions, answer questions. I like questioning the world we live in and why do we do the things that we do.
And, oh, I don't know, 10, 15 years ago I started asking myself why am I seeing all of these patients that have these questions that they're referring physicians asked for a consultation on well established myths. Why do they keep coming through our door and where, what are the origins of this and what can we do about it?
And we did some research in that area and we found that these are pervasive. We're talking, this was a long time ago, so, it was, don't give Influenza vaccine to people with egg allergy. Things are still combating, penicillin. Fun stuff and then my brother in law actually it was this was what 2013 he said, " Dave you should take all the research and work you're doing In the academic side and you should like go on Twitter" and I'll never forget.
I looked at him, I said, "What the heck is Twitter?" And then I realized like, "Oh with social media this is a platform you can reach a large audience" And I started, you know using it as a medical professional. So that's been the last geez 11 years of my life. Now mostly on Instagram these days for obvious reasons.
But yeah, it's been great. It's been interacting with the public. It's been trying to get, put good evidence based information out into the world, combat misinformation. You tend to upset a lot of people when you take away their long held myths and misconceptions, but that's okay. And yeah, that's my journey.
Social Media's Role in Medicine
Kara Wada, MD: And you were able to use that, I think for anyone who's listening, that's maybe, colleagues or I know, I think we have a few medical trainees who listen, but you were able to leverage that work and all the effort you were putting in to help you in your day job through promotion too, which I, as one of your mentees, have found really inspiring and really cool to take a non traditional path to promotion, which you know, for the longest time was in this very narrow box.
David R. Stukus, MD: Yeah, that wasn't even my thought. That was our Vice Dean of Medical Affairs. This was, oh my, years ago when I went up for my first promotion to associate. I told my story. I said, "Oh, here's all the work I'm doing and with research and clinical work and all the professional organizations. And I do this on social media."
And he perked up and he said, "wait a minute. He's like, "Tell me your story again, but lead with the social media stuff". He's like, "that's really interesting". And then we had a conversation about how can I use the traditional metrics for promotion and apply that to the work on social media in regards to here's the impact I'm having, the reach I'm having.
And lo and behold, it got me promoted not only once, but twice. And then I've tried to lead the way and we've actually changed our promotion and tenure, guidelines to incorporate social media metrics for those like us who are using it as part of the profession.
Kara Wada, MD: It's really cool and as I am preparing my packet to go up for the first time finally. I am sure I will be messaging for a few tips.
David R. Stukus, MD: Absolutely,
Discovering the Field of Allergy
Kara Wada, MD: I am curious, and I feel like you've told me this story at some point along the way, but how did you discover the field of allergy?
David R. Stukus, MD: So I wanted to be a cardiologist. That's when I applied to pediatrics. I liked the plumbing. It made sense to me of like, if there's a hole here, a hole there, narrowing, constriction, then you know, how does that change things? And I did my cardiology rotation early in internship. I think it was August. And I realized that reading telemetry at two o'clock in the morning was not something I loved. And then we started admitting all of these children with asthma that autumn. So, intern years as a resident, I said, "why are all these kids getting admitted?" Then, asthma is so common, but like we should be able to keep them out of the hospital.
And then I realized like, "whoa, asthma is not just one condition, right?" So now it's well established of, there's asthmas and multiple different phenotypes and endotypes and specific individualized, whatever. So asthma is what I fell in love with. And I said, "Okay, well, I can be a pulmonologist."
I don't love managing ventilators and the mechanical aspect of the lungs. I said, or I can become an allergist. And our friends and mentors, Becky Scherzer gave a, she rattled off the compliment cascade during an impromptu teaching session. And I said, I want to be able to do that. And then I realized even just like six, seven years ago.
So my first love with asthma. And then I realized with food allergy, that's where we are now with where we were with asthma 15 years ago, as we're just on the cusp of understanding individualized phenotypes, endotypes, individualized approach to management and things like that. So I love it. We as allergists immunologists are trained to think about the human body very differently than many of our colleagues.
We're always thinking about the Immune system and how that interacts with all the pathophysiology and yeah, it's like the old Russell Crowe movie of A Beautiful Mind. We're moving around leukins and cytokines and..
Kara Wada, MD: That's a really good analogy. That's probably a better visual. I've tended to lean toward using the analogy of a symphony lately and needing all of, the woodwinds and the brass and everything like working the percussion and in a nice harmony, but I think that visual of that whiteboard is probably, or the chalkboard is pretty accurate when it comes to.
The complexity once you get under the surface layer it gets messy pretty quickly.
Understanding Food Allergy
Kara Wada, MD: Maybe let's start out with kind of simple things for those who haven't been listening to some of our old allergies, what is food allergy and how is it different from an allergist perspective compared to what you're hearing from your patients and families?
David R. Stukus, MD: This is always a great starting point and one that just very few people understand, I found and what I love doing is clarifying this when people, so everybody who comes to me, all I do is focus on food allergy. They all think that they or their child have food allergy and I tell them up front, I say, "I'm really glad you're here. We're going to spend time together today to really clarify what the diagnosis is because that changes everything." And when it comes to a food allergy, that means the body's immune system forms a response against a food. This is most often in the form of this immediate hypersensitivity caused by an antibody known as immunoglobulin E or IgE.
And you can't fool the immune system, right? So that's why I love allergies just like you. It's cause and effect. You're either allergic or you're not. So if you're allergic to a food, every single time you eat that food, regardless of what form, you really should have this reproducible reaction to it. And it's obvious.
It's big red itchy hives on the skin, swelling, you can have vomiting, you can have difficulty breathing or anaphylaxis. So if you're eating a food and you're not experiencing those symptoms, you're probably not allergic to that food. Whereas if you are eating that food or you're feeding your child that food and you're noticing, "Wow, they don't feel well every time they eat this" we can piece it together and try to figure that out.
So, it really is an immune response. We use the clinical history. As the most important indicator whether allergy may be present. So for everybody listening right now, or watching, if you're eating something and your body's not telling you it doesn't belong, you're probably not allergic to that food despite what all the marketing will tell you online.
Kara Wada, MD:
The Complexity of Food Allergy
Kara Wada, MD: Something that we have not talked as much about on the podcast to this point are some of the other immunologic things that can happen when we ingest food. They're not as common as true food allergy, but they're more commonly talked about than they were when we were going through medical school, but things like EOE or FPIES.
David R. Stukus, MD: Yeah, so we clarify what, are you allergic or not? So are symptoms reproduced? Is it that immediate type of allergy? Cause that's a very different management style. That is, even small amounts can make some people feel very sick. We need to have epinephrine auto injectors. We need to make sure we know what to avoid, how to avoid it, all that fun stuff.
However, there are people who have more delayed onset types of allergies and they're not as straightforward. There's interesting examples like you mentioned, so eosinophilic esophagitis, we get inflammation in the esophagus, which is often tied to diet in some way. We don't have good testing that indicates exactly what food's causing it.
You don't have immediate symptoms, but oftentimes if you remove certain foods from the diet like milk, people often feel better. We have food protein induced enterocolitis syndrome, which is profuse vomiting three hours after eating a food, which typically has an onset in infancy. Again, no good diagnostic tests available, so you have to diagnose this based upon the history.
Have a high index of suspicion. There's unique situations like Alpha Gal Syndrome, where people are bitten by a Lone Star tick, and they become sensitized to a carbohydrate that's found in mammalian red meat. And then, down the road they can develop delayed onset allergic reactions. So it's the classic hives or anaphylaxis, but it's three to six hours after eating meat.
So, yes, so there are very unique presentations and then we, I think we also have to discuss, it's not a true allergy, but like celiac disease, right? So 1 percent of the population, yeah, this is food related, if you're eating gluten, it's causing your body to form an autoimmune response against itself, you avoid gluten, you repair yourself and you're fine.
So it's not a technically a food allergy, but that absolutely is a great example of food causing major problems inside the body..
Kara Wada, MD: I think what you brushed upon with each of those is we always go back to the history which is the lived experience of that, you know of your patient and that really centers then how we proceed in regards to testing or other and testing maybe labs or skin testing, but it also may be a trial away from a particular food like is in the case of EOE.
David R. Stukus, MD: Yeah. And I tell every single family the same thing. Like, " I believe you and I hear you. I just want to figure out, is this allergy or maybe an intolerance", which is more digestive issues. And I couldn't agree more of," All right, well, we've clarified, you're not allergic to this. We don't need to strictly avoid it, but I hear you that you feel that this is making you or your child sick. So why don't we come up with a plan where let's take it out of the diet for about two weeks, not for two months, but two weeks. Let's very carefully assess what are the symptoms you're worried about."
They should completely resolve in that period of time. If they don't resolve after eliminating that food, it's probably not the food. Or if they do resolve, let's eat the food again and see if they come back again. Because there are very powerful placebo, nocebo effects, especially when it comes to dietary manipulations.
Kara Wada, MD: Yeah, and why two weeks? Why not two months? Like what is the risk there?
David R. Stukus, MD: Well, the risk would be a lot of these symptoms are more coincidental as opposed to causal and our human minds, this goes for you and I as well, we're fallible when it comes to like memory and assessing things, so we often, we have a lot of cognitive biases that impact the way we view the world.
And if you're going for months and months you get this interesting sort of this anecdote effect, right? We see this all the time. I'm sure you talk about this with the other guests. So if I go two months and I think that gluten is causing me, I don't know, me to feel tired or something like that.
And during those two months, I avoid gluten but I feel better. I'm probably neglecting other factors such as maybe I'm exercising more, maybe the weather has changed, maybe I had a viral illness that was impacting me, maybe my sleep hygiene has changed, maybe I cut back on my caffeine, maybe I cut back on my alcohol, whatever it may be, but my mind is going to attribute it, it must be the gluten and it can't be the other factors.
Kara Wada, MD: The other thing in that specific situation I always think about are you, if in certain instances if you take gluten out if you're not replacing it with gluten free equivalents of those foods maybe you're not eating as much of the simple carbohydrates and you're just feeling better because you're not on that rollercoaster of blood sugar or what have you which can be the case for some folks.
David R. Stukus, MD: Right, there's so many ways food can affect us, it's not because you're allergic. But like glycemic index, if you're eating a lot of carbs, your glucose is going to spike. You're going to crash. You're going to feel pretty terrible. If that's a staple of your diet. So maybe just avoidance of those foods in general is impacting your care. It gets very complicated, very quickly.
Kara Wada, MD: It does. Yeah. And one of the things I've been thinking about recently, so I read this book in the last couple of months, it is called Eve. And it was essentially I think the subtitle is the 200 million year history of how the female body helped evolution, something to that effect. But one of the things that it had me thinking about is how even before humans were human, how we had to really think about our food as a potential source for symptoms to survive.
Like, you're like, "Oh, bears like, oh Bob the bear he went and ate those berries and he got really sick", Or like last time I went to that bush like I didn't feel good like so I think there is probably something pretty hardwired into our you know, kind of survival mode brain that has us always wanting to associate our physical symptoms with what we ate that probably helped us end up here today. The reality is, our prefrontal cortex now can think about all the other potentials too.
David R. Stukus, MD: Absolutely. Most of us eat every day. And most of us eat throughout the day. So it is a major part of our lives. Our social engagements are focused around eating. We just got through the holiday season and it's all food all the time. It is just, it's natural for us to think that foods are impacting our health. And sometimes they are. Sometimes they're not. When it gets really problematic, and this is something you deal with on a regular basis, is when you start attributing, like, these magical properties, and you start thinking, "Oh my gosh, I slipped up. You know what? I missed my superfoods last week, or I ate something that's filled with toxins", or whatever, and then you get the anxiety and the guilt, and that's a whole other thing, but
Kara Wada, MD: Yeah.
Future of Food Allergy Treatment
Kara Wada, MD: I'd love to switch gears a little bit because one of your real focuses this last few years is impacting the landscape of treatment for food allergies. So I'd love for you to share a little bit about like where we are in, maybe where we're headed. Or maybe, in your crystal ball.
David R. Stukus, MD: Absolutely, yeah, so we're going to focus mostly on these IgE immediate onset hypersensitivity reactions. So we've known for, what, 120 years that we can desensitize anybody to anything, right? We've been giving allergy shots or allergen immunotherapy for over 100 years for people with inhalant allergies.
We can desensitize people when they have drug allergy. Well, the same principles apply when it comes to a food allergy. The problem is, so what this entails is basically giving the immune system very small amounts of what you're allergic to. We can't give it by injection because that actually causes a lot of problems when it comes to foods, at least as of this point.
But we can have people eat very small amounts of what they're allergic to. Now, for anybody listening, if they're paying attention, you'd say, "wait a minute, you're gonna have somebody who's allergic eat what they're allergic to? Isn't that gonna have them cause a reaction?" Yeah, it absolutely could.
So this has to be highly supervised. There are all kinds of different safe, safety things that we put in place to make sure that people can succeed. And even then, adverse reactions occur in almost everybody because this is a years long, if not lifelong, therapy. But what it entails is basically eating very small amounts of what you're allergic to, increasing the dose gradually every couple of weeks, going to see your allergist, doing the updosing in the office to make sure you tolerate it until you reach this maintenance dose.
And then you continue to eat that every single day. So this is every single day at home. There's no exercise for two hours afterwards. You have to adjust doses if you have an acute illness. We want to avoid hot showers right after a dose. You have to monitor for an allergic reaction. We have to absolutely control all the other underlying conditions like asthma and environmental allergies and eczema.
But what this can reliably do for most people over time is once you reach maintenance, it resets the immune system. You're still allergic to that food, meaning if you stop treatment, you revert back to being allergic. But you would, while you're receiving the therapy, you would need to eat a higher amount to cause an allergic reaction than you'd have to eat at the beginning of therapy.
So, it gives you that bite proof protection most people want. What's the trade off? This is a daily part of your life. You have to monitor for allergic reactions. Allergic reactions will occur. Some people do not tolerate the treatment and they develop chronic conditions like eosinophilic esophagitis that we mentioned, chronic abdominal pain.
They have anaphylaxis, needing epinephrine. So, this is a long conversation. When I meet families and we talk about this is oral immunotherapy. This is an hour long conversation. We actually do entry food challenges where we spend three to four hours with them. We try to figure out their threshold to very small amounts, which affects their protocol that they're going to get.
But what this really does is it onboards each family because each family is a little bit different. Some are highly anxious some are a little too gung ho some just have lots of questions so this is what we do. There's other approaches being investigated, which I would love to start doing soon.
This is similar to what you've been doing with inhalant allergens, would be sublingual immunotherapy. So when we take small amounts and put drops of the liquid food under the tongue, let it absorb through the mouth, the early research is very favorable, especially for peanut and young children.
Less risk of severe side effects. And you can achieve desensitization. There's a company that produces a patch that you wear on the skin for peanuts. So, epicutaneous immunotherapy, where you desensitize through the immune cells in the skin, it can increase the threshold you need to eat. That's not currently available, but there's ongoing research studies.
Our center's one of them to try to get it approved. And then, just two days ago, the anti IgE biologic, known as omalizumab, which we've used for over 20 years for allergic asthma, Rhinosinusitis. That is going to get a fast track from the FDA. Here's the cool thing with Omalizumab. So this is an injection you get once a month.
Essentially it's going to be years long therapy. We have to figure that out down the road. Omalizumab doesn't care what you're allergic to. It blocks the IgE that's involved in the allergic response. This is ideal for people with multiple food allergies or those who have underlying comorbid allergic conditions.
It does not involve eating the food, so you don't have a risk of an allergic reaction, but it gives you that increased threshold protection that most people want. So, what I tell families now, this is so exciting, the conversation we're having now is going to change six months from now. It's going to change a year from now.
There are options galore. What I would caution is, anybody who says that they have a well founded cure for food allergy, that has not been proven. I have not seen any evidence that demonstrates that any of these can reliably cure food allergy in individuals over time. Now, some people will be cured by OIT, oral immunotherapy but we need to figure that out individualized. So yeah, lots on the pack, but there's the five minute spiel for what's a very exciting moment in the treatment of food allergy.
Kara Wada, MD: I will be curious to see in the next five to ten years, one of the programs we're soon to be launching for aero allergens at Ohio State is Intralymphatic Immunotherapy. And so that I'll be curious to see if anyone takes on investigating that. It's outside of my kind of area that I'm as more interested in and going to not planning on taking it on.
But I think that will, I'll be curious and just seeing that there does appear to be less risk for anaphylaxis. So I'll be watching, waiting, listening, seeing if that were to pan out or not.
David R. Stukus, MD: Oh, I couldn't agree more. They've restarted the vaccine trials as well. There's groups also looking at this mRNA technology that was put in place for the COVID vaccine. There's so much stuff coming down the pike. So it's wonderful. Stay tuned. Yeah, there's gonna be many options.
And to be honest with you, what I think what we're gonna be doing more than anything is we're gonna be altering disease progression. So, five years ago we diagnosed a baby with peanut allergy. After they experience a reaction, it's okay, let's avoid it. Let's talk about risks. And it doesn't have to be as restrictive as maybe it was one's believed, but we need to avoid giving them peanut to eat 'cause it could cause a reaction. We'll repeat testing or 20 percent outgrowth. Now it's very likely going to be, "Oh, well, they have a peanut allergy. Let's put them on oral immunotherapy because they're going to probably tolerate it much better when they're younger or in the near future, it's on the patch or something like that."
And we can actually modify their disease, change their life. This is all changing very rapidly.
Kara Wada, MD: And that concept as a whole isn't totally new. With my experience as a mom, so my middle child, Josie, had a reaction to egg a scrambled egg when she was about nine months old. And the great news for us at that point in time was she was tolerating egg in a baked good, which is a little bit different that egg protein, if it is like an extensively baked like a cupcake or a muffin changes just enough where some kids will tolerate it. And so there's some thought that by continuing to keep that in her diet, that perhaps that sped up her outgrowing her food allergy. And then being able to eat eggs in one of those food challenges that you described with our other colleague. And she's not a huge fan of eggs, but she can eat them okay, which is a huge relief.
David R. Stukus, MD: Yeah, absolutely. Or there's just the concepts of there are people out there that have mild food allergy, which sounds like heresy to say, but those phenotypes exist, meaning no matter how much they eat, they're just going to have, a mild reaction. We can, if we can identify those individuals, we can manage them very differently.
And likewise, if there are those who are exquisitely sensitive and they have severe reactions to very small amounts, we need to identify them and then put them on a therapy that can protect them.
Kara Wada, MD: Yeah it really, I think that analogy from the beginning of seeing food allergy in this paradigm that is more akin to how we were seeing asthma as I was going through my training and this real shift in thinking, " Oh, when I went through medical school, asthma was two conditions."
And the reality is it's more like a dozen ballpark. And this is where I talk a little bit on here about flavors of inflammation. There are subtle differences in how the immune system is working under the hood that create then these differences in how folks respond to therapies.
David R. Stukus, MD: And here's what blows a lot of people's minds. Cause it's really hard to conceptualize is that's not a static process, right? It's dynamic. It's constant. Changing over time, and it's, we're learning this with food allergy, is the severity of a reaction. We used to be taught food allergy reactions can get worse every time you eat the food.
Well, that's not actually true. Most people probably have the same sort of type of reaction. But the severity can be influenced by external and internal co factors. So, are you exercising at the time of ingestion? How much did you eat? Are you fighting off a viral infection? Are there other causes of inflammation inside the body?
Are you taking non steroidal NSAID medications? For women, are you on your menstrual cycle? Is there psychosocial stress involved? All kinds of factors like that. So that's what's blowing everybody's minds right now of like, wow, this is a dynamic process.
Kara Wada, MD: Yeah. And becomes even more pertinent when you're considering OIT, as you mentioned, because you're having to factor those things in on an every single day basis and doing the mental math too, to some degree.
David R. Stukus, MD: Yeah, no, absolutely. And then this is where, this dives into you and I spend a lot of time on social media. So when you're trying to communicate this to the general public, or especially on social media, these support groups and echo chambers, people naturally compare themselves or their children to others.
You can't do that anymore when it comes to food allergy. No two people are the same, I promise you. There, everybody has a very individualized risk tolerance of their food response to therapy. So I think it's helpful to hear from stories from others, but be very cautious at comparing you or yourself or your child to anybody else is because it just ain't it, it ain't the same anymore, which is good. I think it's great.
Kara Wada, MD: Yeah, and one thing I've noticed in some of these support groups too is you will see the two extremes. So you will see those that are maybe the more mild that are successful, that are cured, that are like the poster A plus children. And then you'll see the folks that are maybe having a more severe disease course. And there is this element of competition that comes up, like within these circles too, which is it's just, it's so not helpful. Yeah.
Communicating Medical Information on Social Media
David R. Stukus, MD: I couldn't agree more and then I'm thinking of myself actually, of course, as we all do, but so I'm, here's what I struggle with and I've struggled with this for years. If I were to post something on social media about a very rare condition that affects, say, one in a million people within a day, I guarantee you I will have hate mail in the comments.
How dare you say this is rare, this is me, you're describing me, this is impacting my life. Well yeah, there are people out there that have that, but what I'm trying to suggest is that for the 999, 999 out of a million that don't have it, they don't need to worry about that. You'll always find the rarest of the rare, and of course, especially when you get into the people, the algorithms and who they follow and things like that.
So I guess what I'm struggling with is, how can I address this in a way that's empathetic to those who actually have that rare condition whereas I'm also trying to reassure those who do not, and that, that's a constant struggle, or you just accept it is what it is and that's how social media is these days.
If you figure it out, please let me know.
Kara Wada, MD: That's so true. One of the reasons I do the podcast is because I tried Twitter for all of like five minutes, and I'm just not a short winded person. I think the reality is that diseases that are unified by too much inflammation, which is what we talk about here, they require nuance.
And when we talk about the brain body connection, it requires nuance, and you can't really do nuance right in however, what is it, however many characters? Is it 240?
David R. Stukus, MD: 280 I think, on,on X.
Kara Wada, MD: I couldn't do it. And so, and even when it comes to these little TikTok videos, like, it just you're always going to miss something.
And so, here we are.
David R. Stukus, MD: I couldn't agree more.
Kara Wada, MD: On that note, we are coming close to, I know we both have things to continue on in our work today.
Connect with Dr. David Stukus
Kara Wada, MD: If folks were interested, like maybe there are some local parents who are in need of an allergist or interested kind of in some of the studies you're enrolling, where where can they find you? How can people follow you on social media? We're going to link to all these in the show notes, but have you share as well.
David R. Stukus, MD: Yeah, well, thank you. So, yeah, so my professional account is @allergykidsdoc. I'm most active on Instagram these days. If you're interested, I'm also the producer and the host of a podcast series for the American Academy of Allergy, Asthma, and Immunology. So, I like podcasting as well.
And that's fun, because I get to have experts such as yourself. I believe you gave a very well received podcast episode on managing allergies over the holidays. Yeah. So yeah, so there's great information there. You can find me all over the internet. And then if you're really looking for a good board certified allergist, both the American College and American Academy of Allergy, Asthma and Immunology have easy tools where you can search for board certified allergist near you.
That board certification does matter. Even certified allergist, you're going to get variations in level of comfort with certain conditions in the care you receive. But I promise you, if you really have concerns about allergies or the immune system we go through specialized training.
We, again, we just think about the body very differently. Anybody can say that they treat allergies, but that doesn't mean they actually have the expertise in order to do so.
Kara Wada, MD: Yeah, we spent a minimum of two years, sometimes three. Before we were even able to sit for that exam. And then we continue to have to show up and show that we are continuing to keep up with our all the, this is a rapidly changing field, and so every few months we have to go through a certain number of articles, answer questions, like, we're continuing to learn.
This is a field that you can't just be done. You have to continue learning, because as we've talked about today, this things are changing at rapid pace, and I still feel like I'm drinking water out of a fire hose years out from training.
David R. Stukus, MD: Yeah, I don't want to keep as much longer. Did I ever tell you I missed these MOC questions that we do that you were talking about? So we do them every six months. We have to go through and show our competency and review articles. So one of the articles that had questions was something that I co authored.
And I was like, "Oh, I'll just answer the questions without looking at the article. Yeah, I missed like two out of three questions. Devil's in the details,
Kara Wada, MD: Whoops! The good news is you don't have to get a hundred percent, but yeah. Oh, that's pretty hilarious. Well, thank you so much for taking time out of your day. This was wonderful, well overdue, and can't wait to talk again soon.
David R. Stukus, MD: Thank you so much. Thank you to your wonderful audience and it's been a pleasure. And yeah, hopefully we can chat again soon.
Kara Wada, MD: Thanks, Dave. Take care.
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You see, leaving a review is like giving us a virtual high five and it helps our podcast to reach even more people who could benefit from the valuable insights, entertainment, and inspiration we strive to provide week after week. So if you're finding value in what you hear, here's what you can do. Open up your podcast app, whether you're on Apple podcasts, Spotify, or any other platform, and give us a glowing five star review we're dedicated to bringing you the best and your feedback helps us fine tune our content to suit your interests and needs.
But, hey, don't stop there. If you have a moment leaving a few kind words in the review section goes a long way too.
Share what you love about the podcast, your favorite episodes, or how it's made a positive impact on your life. Your words, not only brighten our day, but they also encourage others to join our incredible community.
Remember every five star review and every word of encouragement counts, it's like fuel to keep us creating, innovating and striving to make your listening experience even better. So if you're up for it, show us some love by leaving us that virtual high five in the form of a five star review today.
And a huge shout out to all of you who have already taken the time to do so.
Thank you for being a part of our podcast journey and we can't wait to keep bringing you more amazing episodes in the future.
Until next time, keep shining and keep listening and keep on building that confidence in yourself and your immune system health.