Food Allergy Treatment: "Failure is Not an Option!"

peanut-allergy

Today’s New York Times Magazine (March 10, 2013) has a lead story on the work of Dr. Kari Nadeau at Stanford and her ground-breaking research on food allergy. I had the pleasure to hear Dr. Nadeau lecture at the American Academy of Allergy, Asthma and Immunology meeting in Orlando in 2012. I met with her after the lecture and got the sense she was determined to treat children with food allergies and give them hope. Until now, the party line in medicine for food allergies is avoidance. This is obvious, and you don’t need a doctor to tell you that. But now, there is clear evidence that children can be desensitized to food either by oral or sublingual allergy immunotherapy.

The concept of desensitization or now more commonly referred to as immunotherapy is to give small amounts of the allergen to a patient and slowly build up their immune tolerance. I do this commonly for patients allergic to environmental allergens, such as animals (pets mainly), pollen, dust and mold. The results are usually very gratifying: patients can visit relatives with cats and dogs, and in many cases even live with a pet they couldn’t tolerate being around before. Also, many patients, children and adults suffer terribly when the tree or grass pollen counts are high. Again, immunotherapy can make a tremendous difference.

Immunotherapy to foods has been a different story: doctors and researchers had several stumbling blocks to advance this area of medicine. One, it has been difficult to conduct research trials in healthy children aside from their food allergies and expose them to risk in being food challenged or treated with the allergen they are allergic to. Second, is money (always, an issue.) Not many pharmaceutical companies are interested in desensitization or immunotherapy treatments due to the fact that they are not patentable, that profits will not benefit their company. Dr. Nadeau mentioned that she went without a salary for 3 years while doing these studies because funding for the research was minimal compared to typical drug company-sponsored research.

The two types of food allergy immunotherapy being closely looked at: oral and sublingual.

What’s the difference?

Oral immunotherapy to foods, such as peanut, involve giving a child miniscule doses of peanut in a flour base mixed with apple sauce. Every two weeks, the dose is increased until over 6 months the child is getting the equivalent to about 8 peanuts. So for example, the child at the end of the program is asked to eat 8 peanuts a day to maintain immune protection from the allergy.

Oral immunotherapy seems to work very well, the down side is that during the protocol the children do get reactions similar to peanut allergy at times–and at the end adherence to having to eat that food daily can be an obstacle in children and adolescents especially. The sublingual protocol in my opinion is preferable. This involves a solution of peanut diluted also to a low level and given in drop form under the tongue (sublingual). As I mentioned, I have done this for years with environmental allergens and found it safe and effective.

The research studies also have found the sublingual approach to peanut allergy to be safer than oral therapy but slightly less effective. The goal with sublingual immunotherapy is not for the child to ultimately eat the food, but rather be protected from accidental exposure to the food allergen. One of the children mentioned in the article (the author’s son) stated,” I’m tired of being Epipenned”– meaning, he was tired of using the self-injectable adrenaline whenever he had a food allergy reaction.

Families call my office and ask if I treat peanut or other food allergies–I regretfully say, “Not yet.” I think the sublingual can be done in private practice settings, not just research facilities. But it is difficult when prominent researchers voice their disapproval of doing this treatment in private practice. But that’s why I love Kari Nadeau’s saying:” Failure is not an option!” This inspires me to get ready to take the next step.

Dr. Dean Mitchell
Mitchell Medical Group, NYC & Long Island

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