The Future of Food Allergies

Food allergies can be scary. This hit home for our family in a big way last summer, when my 10-year-old son, Jacob, experienced a sudden allergic reaction to cashews. One day, he could eat anything he wanted; the next, we were rushing him to the emergency room with vomiting, full-body hives and a funny feeling in his throat.

True food allergies should not be confused with food sensitivities. As opposed to sensitivities, which usually come on gradually and aren’t life-threatening, allergies cause an immediate immune response to specific food proteins. These responses can affect circulation, breathing, the skin and the digestive tract; they range from hives and vomiting, as in Jacob’s case, to a severe reaction called anaphylaxis, which can quickly shut down body systems and even cause death. Food allergies are very unpredictable, says our allergist. Nobody knows why they happen or how severe the next reaction might be.

Currently, the only approved treatment for food allergies is strict avoidance of the foods concerned, plus an emergency plan for when to use an EpiPen to inject epinephrine, which halts anaphylaxis. But families like ours are placing new hope in emerging research and treatment trials.

Jacob’s food allergy has changed our lives. We now have EpiPens everywhere, read every food label, ask every restaurant about cross-contamination and constantly debate what Jacob can eat. Worry and food allergies go hand in hand.

Our one comfort is that we aren’t alone.

National spike in allergies reflected locally

The Food Allergy Research & Education (FARE) organization estimates that more than 15 million Americans suffer from food allergies. FARE’s website notes that in 2013, the Centers for Disease Control and Prevention (CDC) reported that food allergies among children increased approximately 50 percent between 1997 and 2011.

Across the Pacific Northwest, allergists are seeing this national trend play out in their own practices. In Western Washington, the Northwest Asthma & Allergy Center (NAAC) began tracking the number of office visits related to food allergies and found that they nearly doubled in five years, from 6,000 in 2008 to more than 11,800 in 2012.

Kids with asthma, environmental allergies (such as plant pollen and dust allergies) or eczema are especially vulnerable. In particular, asthma and skin allergies are spiking in the U.S., according to the American Academy of Asthma, Allergy & Immunology (AAAI) and the CDC. Jacob had all of these risk factors.

New studies and treatment methods

After Jacob’s diagnosis of a tree nut allergy, I gorged myself on Internet fact-finding (much to his embarrassment) and talked to leading allergists and researchers at the Seattle Food Allergy Consortium (SeaFAC). Finding out how many new treatments are under exploration did offer us some hope.

Environmental allergies have been treated successfully with immunotherapy, or allergy shots. Patients gradually become desensitized by having a small amount of allergen injected, with the dose increased slowly over time. However, this tactic does not work for food allergies. In 1996, an accidental death during a clinical trial of food allergy immunotherapy by injection effectively halted the practice.

In ongoing studies, researchers are trying to avoid the potential dangers of injection by using small amounts of the allergen that are either swallowed or held briefly under the tongue. According to Stephen Tilles, M.D., an executive committee member at SeaFAC, these new oral immunotherapies are not risk-free: Some patients have dropped out of studies because of severe reactions, such as hives, vomiting and breathing problems.

But many patients have been desensitized using these experimental practices, Tilles says. As published in The Lancet in January 2014, a new study conducted by Addenbrooke’s Hospital in Cambridge, England, reports that more than 80 percent of participants who previously had dangerous reactions to small amounts of peanuts have now been desensitized enough through oral immunotherapies to safely eat five peanuts at a time.

Desensitized patients can ingest up to one serving of a food, depending on the level they achieved during treatment, relieving them of the fear of accidental exposure as long as they continue to eat a daily maintenance dose. Desensitization is considered the first step toward tolerance. It is still not known if patients will achieve complete food tolerance, meaning the food in question can be eaten freely without worry, even sporadically.

In other treatment news, there’s a drug called Xolair that helps short-circuit allergic reactions. Currently approved for asthma, Xolair is being used experimentally in several desensitization studies to reduce the risk of reaction during allergy treatment.

Then there’s the Viaskin Peanut patch, the latest treatment to offer promise to food allergy sufferers. Generating worldwide excitement, the “peanut patch” was developed to desensitize the immune system through the skin, avoiding the risks of ingestion and allergy shots. The patch recently passed its safety trial, and researchers are now working to verify its effectiveness. Results are due this July.

Seattle’s next steps

After learning about these exciting studies, I was disappointed to find there were few local opportunities to participate. I had created a mental plan to get Jacob desensitized, but most clinical trials are available only at a handful of research hospitals and universities in New York, California and a few other locations.

Luckily, there’s light at the end of the tunnel: SeaFAC aims to attract funding, leading researchers and major new clinical trials to our region, combining the powerhouse capabilities of UW Medicine, Seattle Children’s Hospital & Research Center, Virginia Mason Hospital & Medical Center, Benaroya Research Institute, Northwest Asthma & Allergy Center and Asthma Inc. Thanks to SeaFAC’s efforts, Seattle is hosting its first major food allergy treatment study for the Viaskin Peanut patch. Next the organization plans to open a pilot food challenge clinic at Seattle Children’s, with the ultimate goal of a permanent clinic.

In the meantime, our family continues to help Jacob manage his food allergy by teaching him how to read labels, ask the right questions and learn to say no to foods he’s not sure are safe. We hope that in the future, he’ll be able to eat anything he wants — with no worries for any of us.

Food allergies by the numbers

• 15 million Americans have food allergies.
• 1 in 13 children younger than age 18 has a food allergy (that’s two kids in every classroom).
• The total cost of caring for children with food allergies is nearly $25 billion per year, with a big chunk of that coming directly from families.
• Food allergies result in 300,000 ambulatory care visits and 2,000 hospitalizations each year.
• Up to 100 deaths occur annually from peanut allergies alone.

Sources: Food Allergy Research & Education (FARE), National Institutes of Health (NIH)