Ask the Medical Expert: Food Allergies
Advancements in Food Allergy Treatment
By Carolyn Comer, MD
Board Certified Allergist/Immunologist at Alabama Allergy & Asthma Center
Medical Director of the Food Allergy Treatment Center
Food allergy affects over 12 million Americans and is on the rise. From 1997-2007, the prevalence of reported food allergy increased 18% among children under 18 years of age. Four to six percent of children in the U.S. have food allergy and about one to two percent of adults are affected. The foods most often associated with food reactions are milk, egg, peanut, tree nuts, soy, wheat, fish and shellfish. Food allergy is a medical problem that has lacked treatment options. Now, new advances in food allergy treatment are available.
Symptoms and Diagnosis of Food Allergy
The history of symptoms occurring within minutes up to two hours following ingestion of food is the most important factor in diagnosing food allergy. Symptoms may include hives, swelling, flushing, nasal congestion, runny nose, cough, wheezing, difficulty breathing, difficulty swallowing, nausea, vomiting, abdominal discomfort, weak and/or rapid pulse, sensation of “impending doom”. Symptoms of an allergic reaction to a specific food (e.g. peanut) can range from mild with a skin rash to severe, including anaphylaxis and death. Symptoms can progress rapidly.
The patient’s history and physical examination, along with appropriate allergy tests (skin prick tests and/or blood tests for allergic antibody for the food allergen in question) generally confirm the diagnosis of food allergy. Positive allergy tests without a corresponding history of symptoms upon ingestion of the food may suggest sensitization to the food allergen without an allergic response. An oral food challenge is recommended when other allergy test results indicate either “no allergy” or “low allergy”. An oral food challenge is often instrumental and necessary in directing the appropriate management of a suspected food allergy. Oral food challenges carry low risk when performed in a medical setting under the supervision of a board certified allergist following appropriate safety guidelines.
Why Patients and Families Seek Treatment Today?
The gold standard of treatment has been strict avoidance of the specific food. The patient and family must keep auto-injectable epinephrine available at all times in case of allergic reaction occurring from accidental ingestion. All labels must be read to avoid “made in a facility with…” or “produced on shared equipment with…” There must be clear communication with schools and restaurants regarding the specific food allergy. Exposure to food with cross contact to the food allergen can cause a severe life threatening reaction in a highly sensitive individual.
Anaphylaxis can occur at any time, even in an individual with a prior history of mild reactions to the food allergen. The patient and his/her family are constantly vigilant and prepared to treat a reaction at any time. Daily fear and anxiety are frequently present. In some cases, the food allergic child is kept away from social events and experience isolation. In more extreme cases, food allergic children are bullied or ostracized.
Avoidance as a Treatment Strategy May Be Impractical
Due to the tremendous impact that food allergy has on the day to day quality of life for patients and their families, new advances in treatment have been pursued for decades. Allergen specific immunotherapy for food allergy has been investigated over the past 20 years with the goal of offering the food allergic individual new options for management of their food allergies, in addition to avoidance. Avoidance of specific food for patients, as a primary strategy to stay healthy and active, can be difficult and impractical.
What Advances in Treatment Are Under Development Today?
As a result, new advances in treatment that include using food protein, administered in different ways, are ongoing. Routes of administration of the food protein currently under investigation include oral, sublingual, and epicutaneous (patch), all of which have a greater safety profile over traditional subcutaneous immunotherapy (shots). Oral immunotherapy (OIT) with primary emphasis on peanut, tree nuts, milk, and egg has been shown to be 85-90% effective at invoking a desensitized state in the food allergic individual which is significantly greater than with the other forms of food-specific immunotherapy to date, although clinical trials are still ongoing.
New Advances in Food Allergy Treatment – OIT
The success with new advances in treatment for food allergies in clinical settings across the country, along with parallel development in related clinical trials, has created an opportunity for patients and families who are seeking a solution to their food allergies today.
The goal of food oral immunotherapy (OIT) is to desensitize the food allergic individual so that an accidental ingestion of the food does not cause a reaction. OIT begins with an extremely small amount of the food protein (usually micrograms) and is gradually increased every 1-2 weeks in a medical facility under the direct supervision of a board certified allergist trained in food OIT.
Why Choose a Board Certified Allergist with Specific Training in Food OIT?
Safety for the patient is the primary concern by the board certified allergist, specifically trained in the most current science and clinical management of food allergy. OIT is performed in a dedicated clinic setting for food allergy treatment with “one on one monitoring” of the patient by medical staff trained to recognize and treat early anaphylaxis. The treatment protocol generally takes 21-24 weeks to reach a maintenance dose but can be individualized if needed. Once the maintenance dose is reached, this dose is then continued on a daily basis. The patient undergoing food OIT is desensitized as long as the maintenance dose is continued as prescribed. Often, additional food to which the patient has been desensitized can be safely incorporated into his/her diet along with the daily prescribed dose. Thus, the food allergic individual gains day to day control and freedom from the potential of a severe life threatening reaction.
For Additional Information about OIT
If you are interested in learning more about oral immunotherapy please visit www.oit101.org or Alabama Allergy & Asthma Center at www.alabamaallergy.com/foodallergy/ . If you are a provider and wish to refer a patient for an oral immunotherapy consultation please fax your referral to 205-870-1621, or fill out our online referral form. For all other information about OIT or to schedule a consultation please contact our Food Allergy Treatment Center’s Program Director directly at 205-777-7183.