Dr. Chitra Dinakar: A thought leader in the field of food allergy

“I have increasingly been seeing children with food allergies in my clinic and in my social circles, with many of them having severe, life-threatening allergies to multiple foods,” says Dr. Chitra Dinakar is Professor of Pediatrics at the University of Missouri-Kansas City and Director, FARE Center of Excellence at Children's Mercy, Division of Allergy/Immunology at Children’s Mercy Hospital. According to her, what she saw in her patients had a direct similarity with recent data that food allergy is considered to be the second wave of the allergy epidemic with up to 8% of children having food allergies in the USA.

Dr. Dinakar was deeply concerned that “a significant percentage of them were of Asian Indian origin, and whose parents and grandparents had no history or knowledge of food allergies. Moreover, some of them had allergies to foods that were not commonly reported in the USA population (e.g. urud dal), and hence were finding it challenging to get appropriately diagnosed and treated.”

These concerns and studies prompted Dr. Dinakar, who had completed her fellowship in Allergy/Immunology at the Cleveland Clinic Foundation, Ohio, and has been at Children’s Mercy since then, to review the scarce literature published on this topic and her search revealed the possibility that Asians have higher odds of food allergy compared with white children, but significantly lower odds of formal diagnosis.

Dr. Dinakar who began her new career in January 2017 as the Gies Endowed Faculty Scholar and Clinical Professor in Food Allergy, Asthma and Immunology Research at the Sean N Parker Center, Stanford University, found that immigrant populations tended to develop the diseases of the society they migrated to. Australian-born Asians had higher odds of developing atopic disease when compared to Asian-born immigrants, and foreign-born children had an initially lower prevalence of atopic disease, which increased after residing in US for more than10 years.

“I also discovered that there is a significant knowledge gap regarding food allergy trends in the Asian Indian population in the US,” Dr. Dinakar says. According to her, Asian Indians have an ethnically unique diet and may have ‘unusual’ or ‘different’ food allergies than the "Top 8" (milk, egg, wheat, soy, peanut, tree nuts, fish, shellfish). And there are standardized tests to diagnose these food allergies or recommendations regarding cross-reactive patterns and foods that are a must-avoid. To her surprise, the young Indian allergist also found that Asian Indians as a demographic population is typically left out of most large-scale studies since they do not meet the National Institutes of Health inclusion criteria for "minority " or "medically underserved" groups. “I therefore believe it is critically important to recognize, diagnose, and treat these unique allergies in this understudied population to optimize nutrition and growth,” says Dr. Dinakar.


Dr. Dinakar chaired the Joint Task Force Practice Parameter Workgroup on Yellow Zone Management of Asthma Exacerbations. She has served on review panels for grant funding programs such as the National Institutes of Health, and has been a member of the UMKC Pediatric Institutional Review Board. She has been involved in more than 50 investigator-initiated, NIH-sponsored, and industry-sponsored clinical trials, and has over 45 peer-reviewed publications, and 2 book chapters. She is an invited speaker at national and international allergy conferences, and mentors junior faculty, A/I fellows, residents and medical trainees.

Loving children comes naturally to this young physician of Indian origin. The opportunity to help care for the health and well-being of the future citizens of India, comprising over one thirds of its population, was compelling and irresistible, inspired her to take up this noble Medical profession. On graduating as the valedictorian from high-school, she was fortunate to be selected to join one of the premier medical institutions in India, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). Admission at JIPMER is through a nationally competitive entrance examination, and all admitted students receive a generous tuition scholarship from the government of India, which made the decision easy for her.

Dr. Dinakar has been passionately interested in studying food allergy trends among Asian Indians for several years. She began with a pilot survey launched in Kansas City that showed there was a variety of food allergies reported in Asian Indians. She then extended her study to capture a larger cohort throughout the USA in the form of a multi center collaboration with Dr. Ruchi Gupta, an accomplished pediatrician and food allergy/asthma researcher, from Northwestern University. IRB approval was obtained at the two collaborating institutions, Children’s Mercy Hospital in Kansas City and Ann & Robert H. Lurie Children’s Hospital of Chicago.

The aims of the Asian Indian Food Allergy Survey were to 1) understand generational differences in food allergy in the Asian Indian population living in the USA 2) determine the top food allergens in this specific population, 3) and to better understand the interplay between genetics and the environment in the development of atopic illness. We hope to capture child and parent demographics (including birth country and state, age of migration), history and nature of food allergy diagnosis (including symptoms, age of onset, and testing), and the presence of other atopic illnesses. The key inclusion criteria include being of Asian Indian heritage living in the USA and having a child with food allergy.

At the end of the study, Dr. Dinakar and her team reported the preliminary results of the study at an invited oral presentation at the International Food Allergy Symposium, ACAAI Annual Meeting, San Antonio, TX in Nov 2015. Among the 114 Asian Indian children with food allergies approximately two-thirds of the allergies were reported to be diagnosed by a physician. Over two-thirds of them were diagnosed by blood or skin allergy tests, and approximately one-third were revealed through a supervised oral food challenge. Tree nut was the most common food allergy in this population and was reported in six out of every 10 children. This finding was unexpected since it is not the most common food allergy in the general population of the U.S.A.

Dr. Dinakar notes that, some of other food allergies noted were to chickpea flour, capsicum (variant of green pepper), and to Indian lentils. Despite the small sample size, a large variety of food allergens that are typically not seen in the general population was reported, including foods such as avocado, banana, beef, bulgur wheat, coconut, corn, eggplant, food dye, garlic, ginger, green peas, jalapeño peppers, kiwi, melon, rice and tomato. Additionally, one in ten parents self-reported that they had a food allergy.

“While the study is still on-going, the preliminary findings are important as they reveal that individuals of Indian descent living in the US tend to be allergic to foods that are frequently not thought of as common food allergens,” Dr. Dinakar, whose expertise includes pediatric asthma, food allergic disorders, atopic and immunological disorders, and health care quality and outcomes, and the Principal Investigator at the Children's Mercy Food Allergy Center, one of the 22 members of the Food Allergy Research and Education (FARE) Clinical Trials Network and Centers of Excellence, says. “I will follow up on this study by evaluating allergic diseases in the Indian subcontinent and determine reasons for the exponential spike.”

Dr. Dinakar, who serves on the Editorial boards of four reputed Allergy/Immunology journals (AllergyWatch (Associate Editor); Annals of Allergy, Asthma & Immunology; Allergy and Asthma Proceedings; Current Treatment Options in Allergy), and serves as the USA Regional Editor of the World Allergy Organization Web Editorial Board, invites all families of Indian origin to participate in the collection of this critically important information at the link below.
In order to participate in the survey, please visit: https://www.surveymonkey.com/s/SouthAsianFoodAllergySurvey

“The data we capture will enable us to start gaining an understanding of why Asian Indian families in the USA are increasingly developing severe allergic diseases such as food allergies, asthma and environmental allergies. It will also help us develop appropriate treatment and prevention strategies for this unique population, one that is typically not well-represented in routine research studies.”

The ongoing survey is part of a study being conducted by researchers at Children’s Mercy Hospital in Kansas City, MO and Ann & Robert H. Lurie Children's Hospital of Chicago in Chicago, IL. The principal researcher for this study is Chitra Dinakar, MD. Children’s Mercy on Broadway.

As of today, about 350 individuals have responded to the surve, while the team would like to have a group of 1000 or more from different regions of this country to participate in the survey, so that it would adequately reflect the food allergy status of the Asian Indian population living in the USA.