Stemming the Food Allergy Tsunami

By Stephen J Smart, MD, President of Allergy & Asthma of Illinois

Growing Problem. Ask any mom and they will likely tell you that food allergies have seemed to explode since they were kids. This is borne out by data, including a 3-fold rise in peanut allergy over 10 years. Office visits for food allergy have also tripled for some specialty practices. It can be frightening if your child has food allergy. Treatment in the past has been limited to confirming true food sensitivity, education on avoidance and an action plan including Epipen for accidental reactions.

Good news. Coincident with the rise in food allergy, there has also been growing research leading to improved diagnosis, prevention and treatment of food allergy, especially for peanuts.

Diagnosis. While skin tests (in an allergist’s office) are the gold standard for respiratory allergy (allergic nasal/sinus disease and asthma), neither blood tests nor skin tests are perfect for foods. Interpretation is not straightforward, as there are different cut-off points for different foods. Moreover, there are common “false-positives” and these individuals may be misdiagnosed and find themselves unnecessarily avoiding a number of foods. Proper diagnosis often requires a food allergy specialist to interpret testing in light of the patient’s history. Sometimes a physician-supervised open food challenge (OFC) is needed to affirm or refute true allergy. Difficult diets and the attendant anxiety over potential reactions can be very stressful for families. Unnecessary avoidance only amplifies the problem. Studies have even shown that the quality of life with food allergy can be worse than diabetes.

Prevention. In 2015, we also learned that peanut allergy can be prevented by introducing peanut protein into a baby’s diet at an early age. In a landmark study where high-risk children were defined as having eczema and/or egg allergy, early feeding of peanut decreased the risk of becoming allergic by 70-85%. Such children are evaluated as young as 6 months of age.

Treatment. This is the big news. About 2 months ago, the FDA approved the first oral immunotherapy (OIT) for peanuts, called Palforzia. Peanut allergy leads to both the real risk of anaphylaxis (a severe allergic reaction) and the daily fear and anxiety of possible reactions. This impairs quality of life through compulsive avoidance, label reading, restaurant fears, etc. While peanut OIT does not cure peanut allergy, it does desensitize to the extent that small accidental exposures can be well-tolerated. Treatment involves putting a tiny bit of peanut powder into food every day in an amount that is slowly increased over time. OIT is not for everyone; there are manageable allergic side effects during dose-building but the process requires a dedicated patient and family.

Conclusion. Food allergy is a growing problem, but new approaches are making it more treatable. This begins with advanced diagnostics, followed by patient and family education, action plans and now, oral immunotherapy such as Palforzia.

For more information or to book an appointment, contact Allergy & Asthma of Illinois, located at 6615 N. Big Hollow Rd, Peoria. Drs Smart and Ewbank specialize in all aspects of allergic disease and asthma. Their Food Allergy Center has extensive experience in OFCs and peanut OIT with Palforzia is coming soon. Call 309-691-5200 or visit us online at www.peoriaallergy.com for more information on whether this treatment is right for your child.

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