October 24, 2018 | Black & Kletz Allergy
Approximately 15 million Americans are affected by some form of food allergy and nearly 6 million of those are children under 18 years of age. Many epidemiological studies indicate that the prevalence (i.e., the proportion of individuals in a population having the condition) of food allergy is increasing over the past 2 decades. Genetic and possibly environmental factors predispose individuals to the development of many allergic disorders including food sensitivity.
Though a large number of foods can cause allergic reactions, in the United States, milk, egg, and peanut are the 3 most common allergenic foods. Current management strategies require strict avoidance of these foods. Despite the intent of strict avoidance, accidental ingestion of allergenic foods can and does happen. This may result in a severe reaction which may require the use of a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick). An individual who is susceptible to severe food allergies may result in considerable anxiety which may impact the quality of life of that individual as well as their families.
Several clinical trials are now looking at various treatment options in an attempt to reduce the risk of severe reactions with accidental exposures. These involve different types of gradually increasing exposures to foods at regular intervals under controlled conditions.
- Desensitization: An increase in reaction threshold to a food allergen while receiving active treatment.
- Sustained unresponsiveness: A lack of a reaction to a food allergen after active therapy has been discontinued after a period of time. It requires some level of continued allergen exposure.
- Remission: A temporary state of non-responsiveness off therapy.
- Oral tolerance: A complete lack of clinical reactivity to an ingested food allergen. It does not depend on continued food allergen exposure.
Several types of immunotherapy, including oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT), are under active investigation for the treatment of food allergy.
- Oral Immunotherapy: This form of immunotherapy requires the daily ingestion of an allergen powder (e.g., peanut protein along with lipids and carbohydrates) that is mixed with another food and ingested. OIT involves treating patients with escalating doses of the offending food, with the hope of slowly inducing desensitization to that food. Adverse reactions of this therapy may include systemic reactions, gastrointestinal symptoms, and/or skin manifestations. Some trials have demonstrated that the use of anti-IgE (i.e., Xolair (omalizumab) with OIT will allow updosing to proceed more quickly and with fewer allergic side effects. Other studies are also investigating whether adding adjuvants such as probiotics to peanut can increase the efficacy of the therapy.
- Sublingual Immunotherapy: This therapy requires the application of an allergen extract in the sublingual space (held under the tongue for 2-3 minutes and then swallowed) on a daily basis over the time of treatment. SLIT is well tolerated with minimal side effects that are typically limited to oropharyngeal itching or tingling.
- Epicutaneous Immunotherapy: This approach involves the application of a small allergen patch to the back or upper arm. The patches are changed at 24-hour intervals over years of therapy. EPIT is generally well tolerated. Typically, only mild skin irritation is noted at the patch site for the majority of patients.
In comparing the different types of immunotherapy for food allergy, OIT has the greatest amount of clinical desensitization, followed by SLIT and then EPIT. Allergic side effects to the different treatments are in the same order with OIT having the most allergic side effects.
Despite the 3 types of desensitization methods that are utilized for food allergies, there are still gaps in our knowledge and unanswered questions to be answered:
- The optimal dose, frequency, and duration of OIT are unknown.
- Is maintenance therapy or food ingestion required to maintain remission? If so, at what dose and what frequency?
- Is a combination or sequence of either OIT, SLIT, and/or EPIT better than one treatment alone?
Though these treatment options are not yet approved by the FDA, the future looks promising for the treatment of food allergies as research continues to answer some of previous unanswered questions.
The board certified allergists at Black & Kletz Allergy have been diagnosing food allergies in both adults and children for over 5 decades. As of yet, there are no FDA-approved methods to treat food allergies, although several methods are being researched at this time. As of now, the gold standard approach to treat food allergies is to strictly avoid the offending food. It is very important to identify the specific food that one is allergic to in order to avoid it in the future. Black & Kletz Allergy has 3 office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The allergy specialists are able to test for most foods and can be done by either blood tests or allergy skin tests. We offer onsite parking at each one of our locations and both the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. If you feel you may have a food allergy and/or a food intolerance, please call us today to schedule an appointment. Alternatively, you may click Request an Appointment and we will respond within 24 hours by the next business day. The allergy doctors at Black & Kletz Allergy are eager to help you find out if you are allergic to foods and to identify which ones. This will allow you live in less fear by avoiding the offending food as well as have a detailed plan on what to do if you would accidentally ingest the given food.
