WW 07: Going with your gut

Abi Barnes on tackling allergies with exposure therapy, micro-dosing, and the gut microbiome

Hello & welcome to the next edition of Wellwatching, an exploration of the evolving business and culture of wellness by me, Alex Grieves. If you’re new, have a read through previous interviews here. 

It was such a pleasure to talk to my dear friend Abi Barnes for this week’s interview. Abi is a US-based licensed attorney, author, and the co-founder of Allergy Amulet - the fastest food allergen and ingredient detection device on the market. In 2019, she was named to Business Insider’s Top 100 Coolest People in Food & Drink. Her work has been published in several well-known periodicals and journals, including Forbes and The Atlantic, and her research has been featured in The Economist. She holds advanced degrees from Vermont Law School and Yale University. Abi is committed to making the world a safer place for the food allergy community, and using business as a force for good.

I got to know Abi when we spent a summer together studying Mandarin Chinese at Middlebury College Language School, and later a semester studying abroad in Hangzhou, China. It was in China where I witnessed the difficulty that Abi’s allergies posed first-hand, where the concept was neither mainstream nor well-understood. Despite being equipped with the right vocabulary, the message - that eating tree nuts could cost Abi her life - was often lost in translation.

This memory made me curious to talk to her about the specific culture surrounding allergies in the US, and how she and other innovators are tackling these issues today.

We talked about the move away from avoidance culture (read: no more Bubble Boy), the hidden dangers of the plant-based movement, micro-dosing, and the gut as the new epicentre of the allergy conversation. Have a read below.

Tell me a bit about yourself: what do you do?

I co-founded Allergy Amulet with the hopes of improving the quality of life for those managing food allergies—and potentially save lives. The Amulet is the world’s smallest and fastest food allergen and ingredient consumer detection device, allowing users to test their foods and within seconds determine whether or not their food allergen is present. 

How did you get started in this field?

As you know, I have severe food allergies and have managed them since I was a young kid. I felt like there was so little innovation in the space to better manage them. Almost everyone I know with allergies has experienced the worst-case scenario: someone at a restaurant says your dish is safe, and you learn the hard way that it’s not. With Allergy Amulet, I wanted to give people more control over these scenarios, and provide them with a tool that could help keep them safe and bring them peace of mind. I also think back to our days in China, and this really would have come in handy. 

First things first: just how big an issue are allergies in the US?

We’re currently focused on detecting the ‘Top Nine’ allergens:  fish, shellfish, wheat, soy, peanuts, tree nuts, milk, eggs, and sesame. In the US, 85 million people avoid these foods, and 32 million Americans have a food allergy. To put this in perspective, in the US, diabetes affects 27-33 million; asthma 25 million; and Alzheimer’s 6 million. In short, allergies are a huge issue, and a growing one: in the past few decades, there’s been a marked rise in the number of people with food allergies. 

Whoa. What’s behind this growth?

There are a number of theories about why so many people are developing allergies.. One of the leading theories is that changes in our food system are affecting our gut microbiome. The introduction of pesticides has resulted in a food monoculture and a loss of crop diversity, which isn’t good for our health. Another is the hygiene hypothesis—the idea that we’re the “Purell generation,” and we’re not exposed to enough bacteria. Reliance on antibiotics may also be to blame. We’re increasingly aware that antibiotics kill both good and bad bacteria, which can damage the gut and the way it digests food. It’s likely some combination of these theories, but they all contribute to poor gut health. Our team has written a few articles on this in more detail (see here and here).

What is the connection between gut health and food allergies? 

As many of us will have observed, there's been a recent surge of interest in the gut microbiome and how its balance or disruption can have profound effects on our health and wellbeing. In the context of allergies, new research from Yale University, which Allergy Amulet recently wrote about, suggests that environmental triggers may be disrupting the gut microbiome. Ultimately, this disruption decreases our body’s ability to regulate our immune system, and makes us more sensitive to potential allergens. It’s still early days, but this cutting-edge study is helping to explore and define this connection.

How have Americans’ attitudes towards allergies changed over the years?

There has been a big shift from a culture of avoidance to one of exposure. Previously, pediatricians and allergists advised avoiding certain foods with your baby, which ironically almost guaranteed allergies for some. Fast-forward to today, and we’ve realised that our bodies actually need to be introduced to potential allergens to more effectively prevent, or at least mitigate, adverse responses. This is partly thanks to the LEAP study, a groundbreaking piece of research that showed how early infant introduction to allergens can prevent food allergies down the road. There is also oral immunotherapy, which helps desensitise individuals to their food allergen. Essentially, a patient engages in microdosing sessions—initially with allergists, and later as part of a long-term exposure plan—to increase one’s tolerance to allergens. While you would still avoid these allergens, the purpose of oral immunotherapy is to prevent the more severe reactions, like anaphylaxis, when inadvertent exposure occurs. 

How is the allergy industry evolving to better address these challenges? 

In the past 5-10 years, as allergies have become a more prevalent issue, the number of food allergy startups and the amount of investment into food allergy innovation has exploded. It’s been a long time coming. Recently, Before Brands, a company that leverages the LEAP study method, raised over $50 million to introduce allergens to babies. This company helped put allergy innovation on the Silicon Valley map. Similarly, the first FDA-approved drug, Palforzia – essentially peanut powder in pill form – was recently approved for children.  

These innovations started the domino effect for other startups to approach allergy prevention and management in new ways. On the infant prevention side, companies like SpoonfulOne (Before Brands), LittleMixins, and ReadySetFood have different methods for introducing allergens into babies’ diets. 

On the post-reaction side innovative epinephrine solutions are helping us go beyond the Epi-Pen, which is exciting. We’re seeing nasal sprays and smaller more durable options like Windgap Medical, as less invasive methods of delivery. And then companies like Pareto are working on ‘curing’ food allergies altogether from within the gut microbiome.

However, there’s been virtually no innovation on the management front. This is where the Amulet comes in.

What do you think is wrong with the way America currently approaches allergies and food safety?

Despite increasing awareness, there is still a lack of understanding of the distinction between a mild food intolerance and a full-blown food allergy. Every three minutes someone is rushed to the emergency room because of a food allergy, but the severity of the problem isn’t well-known or appreciated.

With the increasing prevalence of gluten- and dairy-free foods and diets due to personal preference rather than an intolerance or allergy, some people don’t appreciate the severity of the latter. All the more reason for better education on allergies, how allergic reactions present in the body, and effective ways to prevent and mitigate adverse outcomes. 

Restaurants and fast-food chains are definitely getting better about ensuring that their customers have the information they need to make informed decisions. The UK is in many ways  ahead of the US, which can partly be attributed to several recent high profiled deaths, like the Pret a Manger incident a few years ago. After that, Allergy Amulet had a lot of interest from London restaurants and chains. They’re starting to pay more attention, and consumers are demanding it.

Where do you see future evolution in this space?

Greater scrutiny around food manufacturers’ supply chain and cross-contamination has fueled the rise of “clean labels”—jargon-free labels with foods people recognise and all ingredients identified. They’re really the ground zero of a bigger shift: if people understand that the gut can be disrupted by processed food or chemicals that exacerbate allergies or other food problems, they’re likely to pay much closer attention to these labels. 

The plant-based movement has also created unintended consequences for allergy sufferers. In vegan and vegetarian circles, nuts are seen as nutritional heroes, and nut- and soy-based milks are everywhere. But as a vegetarian allergic to nuts, this trend is my worst nightmare. Vegan and vegetarian restaurants can be very dangerous for me if I’m not careful. It points to the need to make allergy management increasingly sophisticated and mainstream. Given that allergies are an invisible disability, we need to make kitchens safer and more accommodating for the food allergic.

What's been your biggest wellbeing breakthrough over the last year?

As a start-up CEO, it’s easy to get stuck on the hamster wheel of multi-tasking. I’ve been working on being more mindful, and paying greater attention to my breath.  

What does ‘wellbeing’ mean to you?

Not too tight, not too loose. 

What’s the next challenge that you’d love to take on?

Our team is working on expanding Allergy Amulet’s detection capabilities beyond allergies, including food toxins, contaminants, and biomolecules. We've already started detecting molecules beyond food allergies (we haven’t made that data public yet, so watch this space!). We want to help people as well as food manufacturers with improved food safety. It’s a growing need, and we’re really excited about how our technology could address this issue.

You can find out more about Abi and Allergy Amulet here.