Food Allergy Treatment Definitions

Peanut Allergy

As I reported last week, we've been presented with the exciting opportunity to participate in a sublingual immunotherapy program for peanut allergy. As I've begun discussing this opportunity with others, I'm finding a good deal of confusion, both within the food allergy community and beyond, about potential food allergy treatments. The two most promising possible treatments available today are sublingual immunotherapy and oral immunotherapy. Here are a few important definitions when we talk about "food allergy treatments":

Immunotherapy is the process of giving small doses of what a person is allergic to in order to increase tolerance and build immunity to reduce the likelihood of an allergic reaction

In sublingual immunotherapy (also known as SLIT) the allergic person will hold the food extract under the tongue for a short period of time (our allergist's protocol is two minutes) and then swallow it. The dose will be gradually increased over time. Our process will be one office visit every two weeks and daily doses at home at the same level between those office visits. The entire process will take place over 7 months. Following SLIT, patients may participate in a food challenge, or may be recommended for an oral immunotherapy program.

In oral immunotherapy (OIT), an allergic individual swallows a small amount of the food they are allergic to. Treatment begins with a diluted form of the food and is gradually increased during office visits and at home

There are pros and cons to any type of treatment program. I encourage anyone considering SLIT or OIT to do your own research and make the best decision you can for your family. Some will go with a wait and see approach and not take any action right now. Others will decide to move ahead in these still unchartered areas. Here are a few articles and links to get you started if you are considering either method:

Oral Immunotherapy Not Ready for Prime Time, by Dr. Hugh Sampson. In the comments that follow the article, many parents of children who have successfully gone through OIT speak out.

Is Sublingual or Oral Immunotherapy better for Treatment of Food Allergy, published in February 2012 by the American Academy of Allergy, Asthma and Immunology (AAAAI), concluded that neither are optimal. That said, at the March 2012 AAAI annual meeting, presenters offered new research about SLIT and OIT that showed promise and results for both.

It is obvious that things are moving quickly in this area. If you are considering SLIT or OIT, I encourage you to talk to your doctor, read the research and talk to other parents who have been through this. As we move through the SLIT program, I'll keep you apprised of our progress.  If you are interested in talking to someone who has been through OIT, shoot me an email (food allergyassistant@gmail.com) or leave a comment and I can get you in touch with someone.

Food Allergy Treatment Options

For over a decade we've been told strict avoidance is the only "treatment" for food allergy. Finally we are hearing about, and starting to actually see, some real treatments for food allergies. A new e-book co-authored by Michele Hanson and Dr. Wesley Burks, "The Future of Food Allegy Therapeutics," discusses current treatments, as well as what's coming down the pipeline. There are many promising advances for food allergy treatment:

• immunotherapy as a method of desensitization
• adding anti-IgE monoclonal antibodies to immunotherapy
• antigen-fixed leukocytes
• vaccines containing modified recombinant food proteins coadministered with heat-killed Escherichia coli 
• Chinese herbal formulation,
•  anti-IgE mAbs 
• Trichuris suis ova therapy- (translation: eggs of the pig whipworm)

I've provided news links about each of these treatments as a point of reference. Talk to your allergist about these, or other possible treatments, for food allergies. I'm confident we will be hearing more about treating food allergies, rather than avoiding foods, in the coming years.

Time to Re-Check Food Allergies?

This NY Times article, Have a Food Allergy? It's Time to Re-Check, caught my attention recently. Having lived through this with my child for the past 10 years, my concerns about the accuracy of skin and blood tests continues to rise. A year and a half ago, based on blood test results, we were told to add more "foods to avoid to the list.  This was going in the wrong direction!

I've shared our experiences with adding baked milk and baked egg into the diet. This continues to be successful. We are now wondering about other foods we've been told to avoid and so, after consultation with our allergist, we are trying some of the "allergenic" foods in a safe environment.

Safe, as in at home, with epinephrine on-hand.

We tried sesame seeds- no reaction. 
We tried almonds- no reaction.
We tried  McDonalds® french fries (contain milk in the U.S.)- no reaction.

So, not allergic to sesame seeds, almonds or french fries from McDonald's. Now we know.
While I continue to feel greatful for the advances being made in food allergy, I still feel like the medical community is relying on "avoid the allergen" based on blood tests, and not giving us the information we need to make good decisions for ourselves and our children. It is not okay to live for a decade without dairy, eggs, nuts and many other foods. These food groups provide important nutrients and proteins and I want more from our doctors than "stay away from it".

So we continue. We've made a list of things to try. It's scary and exciting, but we need to figure this out. As always, your allergist is still the best source of information when it comes to food allergies.

I am not advocating this method for anyone else. We just needed to find something that works for us now. Already this method has reduced worry, fear, anxiety, and improved quality of life for our family.

I'll keep you posted.