Food allergy has always been challenging to diagnose and manage. Currently there are no official ways of treating a food allergy. The workup starts with identifying the foods in question with a careful review of the history. This can then followed by skin or lab testing. Once the diagnosis is confirmed, we make dietary recommendations. This usually involves strict avoidance of the trigger foods. Often, we will prescribe an epinephrine auto-injector to treat any future severe allergic reactions.
Thanks to an increasing amount of research, we have a growing number of tools that help us prevent and treat some of the more common food allergies.
Preventing food allergies:
Thanks to the results of the Learning Early about Peanut Allergy (LEAP) study from 2015, we now have the tools to help us reduce the chances of a child developing peanut allergy. With a review of the infant’s history, the allergist can identify which child under the age of 1 is considered high risk for developing this allergy. If appropriate, a protocol can then be implemented at home, that allows us to introduce peanut safely into their diets. This protocol can reduce the chances of developing peanut allergy by as much as 80%!
There is ongoing research looking into other foods too, including egg and milk.
Treating an existing food allergy:
Treating food allergy is even more exciting because of the positive impact that it can have on a child’s and caretaker’s lives. These options can significantly reduce the chances of a systemic allergic reaction with the food in question. This of course reduces the burden of dealing with food restrictions and worrying about possible future reactions.
Oral immunotherapy (OIT) allows us to desensitize food allergic patients by introducing the food in question orally over time. The food is ingested in very small amounts initially. This is then slowly increased over the span of a few months, until a daily maintenance dose is achieved. There are many different ways of performing these protocols, and they have different goals. They can be designed to simply reduce the chances of an allergic reaction with an accidental exposure, while still actively avoiding the food. Other protocols allow for introducing the food liberally in a diet. Currently OIT is being used to treat food allergies like peanut, some tree nuts, wheat, egg, milk, among others. We have been following and implementing some of these experimental protocols. We should have an FDA-approved product that can be prescribed for treating peanut allergy this way, in the near future (www.aimmune.com).
Epicutaneous immunotherapy (EPIT)
Also known as patch desensitization, this tool allows us to desensitize an allergic person to their trigger food through the skin. A patch containing the food allergen in question is placed daily on the skin. This exposure desensitizes the immune system and thus reduces the chances of an allergic reaction from an accidental exposure to the trigger food. Because this is very safe compared to OIT, there is a significant amount of research looking into these options, including from DBV Technologies: https://www.dbv-technologies.com/viaskin-platform/.
Other experimental options
The good news is that there are many other experimental options in development including sublingual immunotherapy and vaccines that can treat and help prevent food allergy. Thanks to this research, soon the question will not be whether we can treat or prevent food allergy, but which option are we going to try first. Give us a call if you want to ask about these today.