Dr. Inderpal Randhawa remembers acutely the children in the ER suffering from severe allergic reactions triggered by even the smallest exposure to certain foods.
A nibble of a peanut or a sip of milk could prove fatal within minutes for some patients.
Those episodes compelled Randhawa, a pulmonary ICU transplant immunologist, into a 20-year journey studying and quieting food allergies. The founder of the Food Allergy Institute in Long Beach has used that knowledge to expand into San Diego County, opening a clinic in 2021 in Vista, and another more recently in Fremont.
“Don’t think of us as a doctor’s office, we are a major system,” he said. The institute has 240 employees spread across 125,000 square feet of space.
Food allergies affect 35 million people in the U.S., including 8-10 million children, Randhawa said.
Peanuts, milk, eggs, tree nuts, soy, wheat, fish, shellfish and seeds are the most common foods that can trigger mild to severe reactions, from hives to difficulty breathing.
The institute treats food allergies in people from age 6 months to 30 years using its data-driven Tolerance Induction Program. During the treatment, blood is drawn, tested for 400 different allergens “and within a matter of microseconds, we give them a snapshot of all the things they’re anaphylactic to,” the 49-year-old doctor said.
The program, called TIP, relies on analytics, artificial learning and immunology, with patients prescribed fruit-flavored gummies and tarts that contain tiny amounts of pharmaceutical-grade proteins from the foods that trigger reactions in them.
“When they’re done with this program, they can eat foods like a completely non-allergic person,” he said. “If they’re anaphylactic to peanuts, they will actually be able to consume 60 to 75 peanuts in one setting, when previously, one one-hundredth of a peanut would have put them in the hospital.”
Since its inception, the institute has treated about 22,000 people worldwide. In the future, he plans to expand the program to individuals up to 50 years old. His treatment goal is clear. “I want every patient to achieve remission.”
Randhawa recently shared his insights on treating food allergies and his vision for the future in the following exchange, which has been edited for clarity and length.
Q: Are food allergies on the rise?
A: Certainly, in the last 10 to 30 years, there’s been a percentage level increase — 1%, 1.5% — in the general population across all developed countries in the world, and then even developing countries are starting to see an uptick. So, there’s a clear set of factors. Whether it’s genetic, environmental or potentially related to the foods, there’s a constellation of factors here that are making this disease increase in prevalence.
We’re doing a handful of studies right now, trying to answer some of those questions geographically, as we do have patients from all around the country and all around the world. We collect a lot of historical data. We’re compiling that research over the next nine to 12 months and will be publishing it.
Q: Could research funding cuts to the National Institutes of Health affect your work in any way?
A: Actually, no. I knew we would never get funding because there isn’t enough funding available. We do have a nonprofit arm. And so, through our nonprofit/philanthropic efforts and our operational budgets, we always fund our research internally.
Q: How did you become such an expert in food allergies?
A: I became a plant biologist. I began sequencing plant proteins down to DNA, RNA, protein, etc., and I saw the relationships that exist. Ultimately, that led me down the path of studying evolutionary proteins and how the immune system reacts to proteins. What I noticed at that stage is that we could diagnose these patients properly if we used large-scale data from actual patients.
Q: So, you use AI?
A: Absolutely! We’ve been doing this for a long time, and way before ChatGPT showed up. What I’ve been very consistent with and frankly very strict about is data security. All of our patients come in and sign informed consent. We identify all of their data, and then it goes into our systems to train and make our systems better, but the system doesn’t know who that person is.
I’m a firm believer in that and I do believe it’s the model others should use.
To this day, no other system can accurately diagnose patients with food anaphylaxis. Our system achieves an accuracy rate of 95 to 96%. We publish that work in the top journals, and that’s one of the key components of how we start our treatment process.
Q: Are you expanding into the Bay Area to meet increasing demand?
A: Absolutely. We have hundreds of active patients who already fly here from the Bay Area, so giving them a local home is going to be great. We want to provide access to this program for the millions of people in California who would gain significant benefits from achieving remission.
We also have a couple of thousand patients who come here from around the world. I just saw a new patient come into our system yesterday who is coming here from Chile, and that’s a familiar story. Every month, we have 10 to 12 patients coming here from other countries.
Q: How do they hear about your program?
A: As far as what we do here in the U.S., we started a marketing department two years ago. We are trying to educate people about what we do, working with local physicians and healthcare providers. We encourage them to look at our publications, research, and, most importantly, the patients who have come here and now can freely consume these foods without restriction.
Building that network of referring doctors has been a good step forward here in California, and we’re actually doing this now across the U.S.
Q: Does insurance cover any of this?
A: It depends on what kind of insurance you have, but if you have a typical commercial insurance, it will cover roughly half of the program costs. The cost out of pocket is $850 to $900 per month during active treatment of which 40 to 50% is covered by most commercial insurance. Most people are in our program for two years. Once you’re in remission, the cost drops off precipitously.
Q: Has anyone under your care ever ended up in the hospital?
A: No, and I’m super proud of that.
Q: Are there plans to expand the Food Allergy Institute outside of California?
A: It is time, but that will require a couple of things. We have to continue to build the referral network and get out to the specific areas where we actually have a large number of patients. Dallas, Chicago, the Northeast, Florida.
As far as an international expansion, I definitely see that happening in the next two to three years.
Q: You say the goal is remission. Why not call it a cure?
A: Ideally, we would want patients to be in remission for some time, such that if they stopped consuming all of these foods they can eat, the disease would never come back. We are seeing that evidence in our patients who are about 6 or 7 years in remission; it seems like it’s gone. We’re going to study and confirm that.
But if we can get to that point where even two-thirds of our patients can reach a very deep state of remission, where they never have to carry an EpiPen again, and there’s no evidence of the disease state coming back, we will certainly use ‘cure’ at that time.
Dr. Inderpal Randhawa Profile
Age: 49
Education: Earned his medical degree from Northwestern University’s Feinberg School of Medicine in 2001.
After completing a combined internal medicine and pediatrics residency at Loma Linda University in 2004, he trained in allergy and immunology at the David Geffen School of Medicine at UCLA and adult and pediatric pulmonology at the UC Irvine School of Medicine in 2009. He holds a bachelor of science degree in biochemistry from USC, where he graduated Magna Cume Laude in 1997. He also completed research projects at Stanford University and the National Institute of Health, focusing on transplant immunology.
Qualifications: Holds five board certifications in allergy, transplant immunology, pulmonology, pediatrics and internal medicine.
His other job: Medical director of the Children’s Pulmonary Institute at the Miller Children’s and Women’s Hospital on the campus of Long Beach Memorial Medical Center, where he has led that division for over a decade. Under his leadership, the institute achieved a national ranking of No. 40 in pediatric pulmonology and lung surgery by U.S. News and World Report for 2023-24. He also developed over a dozen specialty centers helping children with respiratory disorders.
Allergies: “I have no direct relationship to food anaphylaxis, my family doesn’t have any, my kids don’t have any,” said the Long Beach father of three, including 11-year-old twin boys and a 17-year-old daughter.
