Food Allergies: Have We Finally Found a Way to Treat Them?
Nov 28, 2018
Food allergies affect 1 in 13 U.S. children, causing immediate onset allergic reactions every time someone eats the food. Peanut, milk, egg, wheat, soy, tree nuts and seafood are the most common food allergies.
Reactions range from mild (itching or hives) to severe (anaphylaxis) and in rare instances, death. There is no ‘safe’ amount someone with food allergies can ingest and caution must accompany every meal or snack. As you can imagine, this is stressful for parents and caregivers of children with food allergies and impacts quality of life, including playdates, school attendance, and dining at restaurants.
Current treatment entails education and avoidance measures. Families must learn to communicate with food handlers and school personnel, read labels on packaged products and understand risks with various types of exposures. While families can learn how to successfully manage food allergies and try to avoid exposure, accidental ingestion is common. The number one concern voiced by parents of food allergic children is that their child may be unknowingly exposed and have a severe reaction.
Researchers have been investigating ways to treat or possibly cure food allergies. We now have a way to potentially prevent peanut allergy from developing. Unfortunately, due to the complicated multifactorial nature of food allergies, a cure is not likely anytime soon. However, breakthroughs surrounding desensitization have been promising. Recently, media outlets have reported two products likely to receive FDA approval in the near future for people with peanut allergy: oral immunotherapy (OIT) and a patch worn on the skin.
As with all medical information, it’s important to read past the headlines. Here is some important information to consider:
Variations Exist. Peanut is the most studied food allergen as it is less likely to resolve on its own and it is associated with the most severe reactions.
Peanut OIT involves gradually increasing amounts of peanut then eating a pre-specified amount every day.
Peanut patch immunotherapy involves wearing a patch with a small amount of peanut protein on the skin every day.
Clinical use of oral immunotherapy. A small group of practicing allergists have been using oral immunotherapy for many foods to treat their patients. They need to follow a strict regimen and monitor patients very closely. This is not currently recognized as standard of care or supported by guidelines.
This is Not a Cure. This method can potentially desensitize someone and increase their threshold for a severe reaction from accidental ingestion of a very small amount of allergen to a larger amount.
Do Not Try This on Your Own! Experience from research studies and allergists in practice shows that most children receiving oral immunotherapy will have an allergic reaction at some point. Most are mild (hives, upset stomach) but anaphylaxis and need for epinephrine can occur. This should only be done under close supervision from a trained allergist.
Strict Schedule. The daily dosing and potential side effects are not tolerated or desired by everyone. There are limitations on exercise, caution during illness and practical challenges with compliance in children and adolescents.
Shared Decision Making. As food allergen immunotherapy becomes more mainstream, it will be extremely important for BOTH families and allergists to understand what is entailed.
This will not be a treatment for everyone. The child’s age, possibility of outgrowing their allergy, type of food, prior reactions, current skin prick/blood IgE test results, desire to consume, reasons for pursuing therapy, and goals of therapy are just a few variables that MUST be considered for each and every family.
Allergists must be prepared to treat reactions in their office, offer support 24/7 for families who have questions or reactions, and be versed in the nuances of treatment.
It is impossible to capture all of the important points surrounding this exciting potential treatment option for children with food allergies in one article. Hopefully this post presents a few pertinent details that families can consider and then direct questions to their personal allergist.
For more posts about allergies and asthma from Dr. Stukus, click here.
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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