In the United States, approximately 5-8% of all children have a food allergy. Any one of the parents of these children will tell you that they cannot wait for a cure. Food allergy reactions can occur after ingestion of just a trace amount of food. Symptoms occur very rapidly and can be life threatening for many. Parents of children with food allergy need to remain constantly vigilant, communicate with all caregivers and school personnel, and must always remain prepared in case of accidental ingestion. Needless to say, living with a food allergy can be challenging, particularly when young children are involved. Several studies have demonstrated frequent bullying of food allergic children and lower quality of life for parents.
Currently, the only proven method for food allergy treatment is complete and strict avoidance of the offending food allergen. It’s easy to understand why so many parents desire another option. There are several promising areas of research into ways to desensitize, or even cure, food allergies. Mainstream media reports of these research studies often use attention grabbing headlines or over-representation of the study findings, which leads to false hope.
One area that has received the most research and press involves oral immunotherapy (OIT). OIT is not a cure for food allergy. It is a procedure that introduces very small, and gradually increasing, amounts of known food allergen to someone who is allergic to that food. There is typically a medically supervised build up phase, followed by a daily at home maintenance phase. As long as that person continues to eat a small amount of that food every day, indefinitely, they will theoretically remain desensitized. This does not allow them to incorporate large amounts of that food into their diet, but the risk of severe reaction with accidental ingestion is hopefully decreased.
Due to an incomplete understanding of risks and benefits, OIT is not currently approved by the Food and Drug Administration. That has not prevented some medical professionals, some of whom are not allergists, from offering OIT to their patients. There is ongoing debate, often very passionate, between physicians currently offering OIT for food allergies and others who feel it is still experimental. It is easy to see why this can be frustrating and confusing to families.
One of the main reasons for debate is that OIT is associated with allergic reactions in a large percentage (studies range from 40-90%) of people who undergo the procedure. Reactions are not limited to being mild, and can progress to life threatening anaphylactic reactions. To complicate matters, reactions have been reported at all stages of protocol, in some cases, after someone has been on daily dosing for weeks or months without any problems. In addition, long term side effects like the creation of new food allergy associated conditions, such as eosinophilic esophagitis, are starting to be recognized in a subset of patients who undergo OIT.
It’s easy to find many stories of success and improved quality of life after undergoing OIT. Many parents may want to rush to sign up their child for this procedure given the promise it holds. However, many of the world’s most experienced food allergy experts recommend caution at this time given the current state of understanding. I firmly believe that we will have several treatment options for food allergies in the near future…just not yet. I look forward to the day when I can tell new patients with food allergies about the ‘old days’, when avoidance was our only option.
David Stukus, MD, is an associate professor of pediatrics in the Section of Allergy and Immunology at Nationwide Children’s Hospital. Dr. Dave, as his patients call him, is passionate about increasing awareness for allergies and asthma.
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