Managing food allergy in childhood
This study reviews the newest developments on experimental therapies for the treatment of food allergy. Epitope studies and microarray technology promise to improve the accuracy of diagnostic testing and may allow the prediction of reaction severity and the likelihood of allergy resolution. The regular ingestion of small amounts of food in oral immunotherapy (OIT) has been shown to dramatically increase reaction thresholds. However, a subset of patients have developed significant gastrointestinal symptoms requiring discontinuation of the treatment. A similar treatment given sublingually has appeared safer than OIT, but has also shown a less robust effect. Ingestion of extensively heated foods seems to accelerate the natural resolution of milk and egg allergy. The injectable anti-IgE therapy omalizumab has been shown to benefit in conjunction with OIT and preliminary data has suggested that it may also be effective as monotherapy. The Chinese herbal formula FAHF-2 has been shown to suppress anaphylaxis from single and multiple food allergies in mice, and early human studies have shown that it is well tolerated. Improved testing should allow more accurate diagnosis of food allergy. For these patients, treatments are on the horizon, but further studies are needed to determine long-term safety and efficacy.
- "About safety, allergic reactions occurred in the majority of patients treated. They are primarily mild reactions, severe in about 4%; however, no threatening-life events nor death has been reported . Frequency and severity of side effects seem reduced in protocols involving more gradual dose increases . "
[Show abstract] [Hide abstract] ABSTRACT: Home based oral immunotherapy (OIT) for food allergy has often been used for young children in Japan, the majority of whom are believed to outgrow the allergy by the school age, therefore the true efficacy of the therapy has been controversial. The aim of this study was to evaluate the efficacy and safety of a newly developed slow- type home-based oral immunotherapy (OIT) regimen in children with hen's egg (HE) allergy, who had low likelihood of outgrowing the allergy, with treatment involving only elimination diet. We retrospectively reviewed the medical records of 43 children with egg allergy (30 males; median age 6) who fulfilled Burks et al.'s criteria of being unlikely to outgrow the allergy. Thirty children who agreed to start OIT were assigned to the treatment group, and 13 who did not want to participate immediately were assigned to the untreated group; the patients underwent an elimination diet for 1 year, during which they were monitored. The OIT regimen involved the intake of the maximum tolerated dose 2 to 3 times a week at home, with initial dose introduction followed by dose build-ups with medical supervision. We statistically evaluated the rate of children who changed their threshold up to 32 g of egg - defined as, oral tolerance induction- in both the groups for 1 year and in the OIT group for 2 years, as well as the rate of children who fulfilled Savage et al.'s criteria of clinical tolerance after reaching the abovementioned remission stage. The rate of children who achieved oral tolerance induction to 32 g of egg after 1 year in the OIT group (9/30) was significantly higher than that in the untreated group (0/13). The total rate within the OIT group was significantly increased from 9/30 at 1 year to 17/30 at two years without any severe adverse reaction; of the above 17 children, we followed 14 children, and noted that 11 of these were able to obtain clinical tolerance. The home-based OIT with an intermittent loading protocol was very safe and effective in children with a low likelihood of outgrowing egg allergy.0Comments 6Citations
- "However, the underlying mechanism explaining the relationship between asthma and difficulties in OIT is unclear. Most previous standardized protocols involve multiple dose increasing phase at an initial day or several days, termed as a rush escalation phase, which is either performed in an outpatient clinic or in a hospital, followed by a more gradual weekly to biweekly dose escalation period at home [1,12,24252627. Although this approach greatly contributes to desensitization and potential permanent tolerance for patients with food allergies, adverse events occur mainly during the rush escalation phase. "
[Show abstract] [Hide abstract] ABSTRACT: Up to 30% of patients with food allergies have clinical reactivity to more than one food allergen. Although there is currently no cure, oral immunotherapy (OIT) is under investigation. Pilot data have shown that omalizumab may hasten the ability to tolerate over 4 g of food allergen protein. To evaluate the safety and dose tolerability of a Phase 1 Single Site OIT protocol using omalizumab to allow for a faster and safe desensitization to multiple foods simultaneously. Participants with multiple food allergies received OIT for up to 5 allergens simultaneously with omalizumab (rush mOIT). Omalizumab was administered for 8 weeks prior to and 8 weeks following the initiation of a rush mOIT schedule. Home reactions were recorded with diaries. Twenty-five (25) participants were enrolled in the protocol (median age 7 years). For each included food, participants had failed an initial double-blind placebo-controlled food challenge at a protein dose of 100 mg or less. After pre-treatment with omalizumab, 19 participants tolerated all 6 steps of the initial escalation day (up to 1250 mg of combined food proteins), requiring minimal or no rescue therapy. The remaining 6 were started on their highest tolerated dose as their initial daily home doses. Participants reported 401 reactions per 7,530 home doses (5.3%) with a median of 3.2 reactions per 100 doses. Ninety-four percent (94%) of reactions were mild. There was one severe reaction. Participants reached their maintenance dose of 4,000 mg protein per allergen at a median of 18 weeks. These phase 1 data demonstrate that rush OIT to multiple foods with 16 weeks of treatment with omalizumab could allow for a fast desensitization in subjects with multiple food allergies. Phase 2 randomized controlled trials are needed to better define safety and efficacy parameters of multi OIT experimental treatments with and without omalizumab.0Comments 38Citations
- "Several prior studies have shown some success in using these approaches for single specific food allergens such as milk89101112131415, egg [13,14,161718, peanut192021222324, and hazelnut . These current types of experimental treatments need to be tested for optimization in safety, efficacy, and length of time262728293031323334. Safety is of critical importance at all phases of any protocol (initial dose escalation day, dose escalation, and maintenance phases) and allergic reactions while on OIT remain an important feature in long-term follow-up studies and in determining the overall success of food allergen immunotherapy . "