May-June 2020 | Health

The detective

A Rockville doctor on food allergies, surprising diagnoses and why some people shouldn’t get a dog

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Photo by liz lynch

A 16-year-old who needs an insulin pump once told Dr. Rachel Schreiber, an allergist/immunologist in Rockville, that his peanut allergy bothered him more than his diabetes. “He was always afraid of something hidden and surprising,” Schreiber says. After she started him on oral immunotherapy (OIT), a process of food desensitization that involves giving patients increasing doses of the food they’re allergic to (starting with miniscule amounts), the boy came to Schreiber’s office every other week for peanut flour, which he also took at home. Nine months after OIT began, he ate three peanut M&M’s.

“He went to the Montgomery County fair and he said, ‘I was stepping on peanut shells and I wasn’t scared,’ ” Schreiber, 48, says. “It’s these little things that you and I do every single day that scare patients with allergies and their families.”

Schreiber started offering OIT three years ago after parents kept asking if there was any option for their food-allergic children besides avoidance. “The idea is that it will give you protection if you have an accidental exposure. It’s not a cure,”Schreiber says. She offers OIT for peanuts, tree nuts, sesame, wheat, milk, eggs and soy. She tells parents that the treatment is intense, so it’s not for everyone. But when patients complete the process, she says, it’s exciting for all involved. “This really has changed our lives,” parents tell her.

Schreiber decided to become a doctor when she was an undergraduate at the University of Maryland, but medicine had made an impact on her years earlier. When Schreiber was 12, her mother was in a car accident and suffered a spinal cord injury. She spent three months in the hospital, went through lots of physical therapy, and is able to walk with leg braces and a cane. “I saw the power of medicine and the power of healing, and how that could really affect not only one person, but when one person is sick, their entire family’s affected,” Schreiber says. After med school at the University of Maryland in Baltimore, she completed her residency in internal medicine and a fellowship in allergy/immunology at the University of Pittsburgh.

She worked for practices in Pittsburgh and Montgomery County, then opened Schreiber Allergy five years ago. She and her husband, Dan, met as 12-year-olds at Charles E. Smith Jewish Day School in Rockville, then lost touch in college and reconnected at a high school reunion. They have two teenage sons. She see patients of all ages (about 60% are pediatric) for asthma and allergies, including environmental allergies, which she treats with allergy shots if other medications don’t work. If Schreiber thinks a patient has outgrown a food allergy, she has them do a “food challenge” at her office. As with OIT, there’s a risk of an allergic reaction, including anaphylaxis. “It’s something that we’re prepared to deal with, but it’s not something we ever want to have to deal with,” she says.

Schreiber often has to do some digging to find the right diagnosis. When a 13-year-old went into anaphylaxis at school, Schreiber learned that the episodes were happening in PE, and figured out that the girl was eating foods with wheat before the class. The diagnosis was wheat-dependent, exercise-induced anaphylaxis. “Sometimes my patients say to me, ‘You’re like a detective,’ ” Schreiber says.