Interesting press release from the 2012 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI):
March 5, 2012 - Follow up story on CNN.com: Experimental treatment may help food allergies
One step closer to treatment for food allergy
ORLANDO – Currently, there is no cure for food allergy and no medication to prevent reactions. The only way to avoid a reaction is strictly avoiding the trigger food. This can be tricky because you have to carefully read food labels and ask about ingredients when eating food prepared by another person.
Yet, thanks to research from the 2012 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI), more clues are falling into place regarding the prospects for safe treatments for food allergy.
Two potential treatments are sublingual immunotherapy and oral immunotherapy. The goal of immunotherapy is to build up your immune system. Your body responds to gradually increasing doses of the allergen by developing immunity or tolerance to it. The difference between sublingual and oral immunotherapy is that the allergen is held under the tongue with sublingual, where the allergen is simply swallowed with oral immunotherapy.
New research from the 2012 AAAAI Annual Meeting found that children with severe milk allergy who received a longer schedule of sublingual immunotherapy and then moved to oral immunotherapy had less respiratory reactions along with less frequent use of certain medications.
“While the overall result of the study, which was recently published in The Journal of Allergy and Clinical Immunology, found that oral was far more effective than sublingual immunotherapy, it was also clear that oral was associated with more significant allergic reactions to the treatment,” said senior study author Robert A. Wood, MD, FAAAAI, director of Allergy & Immunology at Johns Hopkins Children’s Center.
In their previous research, sublingual was compared to oral immunotherapy after a short period of increasing sublingual doses. To add another piece to the puzzle, the same researchers from Johns Hopkins and Duke University decided to see if a longer period on sublingual and then oral immunotherapy would improve the safety of the treatment.
Thirty children with cow’s milk allergy were randomly placed into two groups that received either a short or longer sublingual schedule followed by oral immunotherapy. Eight sublingual subjects
moved over to oral immunotherapy. After comparing reactions across the doses, the study authors concluded that the longer sublingual schedule before moving to oral immunotherapy appeared to improve safety although it did not eliminate all symptoms. Symptoms occurred with approximately 25% of 2,251 doses.
While the overall rates of reaction between the two groups were similar, the longer sublingual immunotherapy group followed by oral immunotherapy had fewer lower and upper respiratory reactions and used antihistamines and inhaled beta-agonists less frequently.
“We continue to search for the best approach for the treatment of food allergy. This study shows that for at least some children, especially those with more frequent or severe reactions to oral immunotherapy, beginning treatment with sublingual might be beneficial,” emphasized Dr. Wood.
The AAAAI represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has nearly 6,500 members in the United States, Canada and 60 other countries. The AAAAI’s Find an Allergist/Immunologist service is a trusted resource to help you find a specialist close to home.
Editorial notes:
• This study was presented during the 2012 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) on March 2-6 in Orlando. However, it does not necessarily ref read more..
Tuesday, 13 March 2012
Prolonged Exposure To Sublingual Immunotherapy-Allergic Reactions-Food Allergies
Wednesday, 7 March 2012
Sublingual Immunotherapy-Allergic Reactions-Allergic Asthma-Food Allergies-Peanut Allergy
This summary was compiled from the tweets posted by @MatthewBowdish, an allergist/immunologist, who attended the 2012 Western Society of Allergy, Asthma and Immunology (WSAAI) meeting. The tweets were labeled #WSAAI. The text was edited and modified by me.
Dr. Scott Sicherer discussed Future Treatments of Food Allergy:
Current management of food allergy includes avoidance only if proven food allergen, nutritionist counseling, growth monitoring, and EpiPen for anaphylaxis.
Anti-IgE (omalizumab) treatment can raise thresholds for food allergic reactions in most patients. However, 25% of patients do not respond.
Chinese medicine formula FAHF-2
Traditional Chinese medicine formula FAHF-2 stops peanut-induced anaphylaxis in mice, and human trials are currently underway at Mount Sinai medical center.
Immunotherapy for peanut: previous injection IT worked but there were a lot of reactions. Now efforts are directed toward oral or sublingual immunotherapy. Allergists are also looking at rectal administration of attenuated peanut allergen.
Oral immunotherapy for food allergy reduces basophil activation but it doesn't promote tolerance (it is more like desensitization).
Reactions to the maintenance dosing of food oral IT were associated with exercise, viral illness and menstruation.
Patients on SLIT for peanut could take more peanut than oral IT with associated immunologic changes concurrent with desensitization. In general, SLIT was not as good as OIT.
OIT is not a cure for food allergy, but quite possibly a treatment.
Epicutaneous Immunotherapy (EPIT), using skin to promote tolerance, showed increased peanut cumulative dose from 1.8 ml to 26 ml. However, EPIT is based on a limited number of subjects.
70% of children who are allergic to egg or milk can tolerate extensively heated forms of the protein (e.g. cookies, cake).
Prevention of food allergy and atopy through diet
With prevention of food allergy through diet, one must look at sensitization, inflammation and allergic disease. There a difference in preventing allergic disease or delaying disease.
Breast feeding is good for everyone, especially when given exclusively for 4-6 months.
Having fish in maternal diet was protective against development of eczema (probably mediated through synthesis of PGE2).
Delaying introduction of solids is unlikely to be helpful in prevention of atopy. On the contrary, earlier introduction of solid food is now thought to be more protective. Late introduction of wheat, egg, milk, etc. were all assoc with increased risk of atopy. Allergists are awaiting Learning About Early Intro ("LEAN") study results for more evidence-based answers.
There is no evidence for restricting maternal diet while breast feeding. Soy formula selection doesn't protect against atopic disease.
There are some additional benefit for use of extensively hydrolyzed formula vs. partial one, but the number needed to treat (NNT) is high.
Risk factors for peanut allergy include soy consumption as infant, eczema, and use of topical ointments with peanut oil.
More peanut in environment (especially “messy” snacks like peanut butter) can cause more peanut allergy but ingestion of peanut is less likely to be associated with peanut allergy (i.e., early oral intake is good, but skin exposure is bad).
Sibling risk of peanut allergy is about 7%. Should we test siblings before introducing peanut?
8 foods cause 90% of food allergies (click to enlarge the image). The likelihood of a negative oral food challenge is shown in relation to the respective values of skin prick test (SPT) and serum IgE (sIgE):
The jury is still out on the use of probiotics for treatment of atopy but they may be helpful in prevention (but there is no good evidence). It is well established that there are more bacterial cells in your body than the total number of your own cells.
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