Don’t let food allergies get between you and what you love.

Food allergies affect more and more patients every year. In fact, the percentage of people with peanut allergies more than doubled from 1997 to 2008. Food allergies cause more worry for patients and their families than perhaps
any of the other allergy diagnoses – and Cincinnati is no different.
It’s no wonder. Imagine if any other child’s peanut butter sandwich could cause a potentially fatal allergic reaction to your child. No one wants to worry about their child experiencing anaphylaxis from a simple school lunch.

While we can’t cure food allergies yet, we can determine the correct foods, discuss avoidance, and give our patients support and resources (FAAN, ACAAI, AAAAI, or AllergyEats if you’re eating out). We can also educate patients on proper food allergy management for severe reactions, including how to use their Epinephrine.

Food Allergy Treatment in Cincinnati

The first step in food allergy treatment is to diagnose the foods to which the patient is allergic. Food challenges are particularly important since if someone has a convincing history but negative IgE blood tests, they still have a 20% chance of reacting to the food. If you think you are allergic to something, don’t let anyone tell you that you aren’t just based on a blood test; a blood test simply isn’t accurate enough.

Once we determine someone’s food allergy, we then can discuss common foods with hidden ingredients, as well as substitutes for the offending food. We will teach appropriate management of severe reactions including the proper use of epinephrine (adrenalin). For children, we can tailor the education to the age of the child.

Potential Cures for Food Allergies

We will have a cure for food allergies in the future. It’s hard to know how soon a cure will be available, but we get closer to it every day.

1. Oral Desensitization
The first hope we have is oral desensitization. Studies are being done primarily at Mount Sinai and Duke (now North Carolina with Wesley Burks taking over as the Chair of Pediatrics) to determine the safest approach to this method.
While they are still having too many adverse reactions, some allergists, including Dr. Wasserman, are not waiting for the studies to be finished and have started providing oral desensitization to their patients.

We may start offering this in the future, but at this point, it doesn’t seem ready to be done safely. Even Dr. Wasserman has had 40 Grade 4 (respiratory or cardiovascular failure) reactions during his treatments.

2. Modified Peanut Proteins
Researchers at Mount Sinai are also working on modifying peanut proteins to potentially make them safe to use in allergy injections. They hope to keep the proteins responsible for creating tolerance while removing the proteins that cause immediate reactions. This is still early, but at least one wealthy donor thinks this may produce results.

3. Intralymphatic Immunotherapy
Based on his research, Gabriela Senti from Zurich, Switzerland described intralymphatic immunotherapy for environmental allergens. By injecting the allergens directly into the lymph nodes, the allergens were presented directly to the immune cells, and possibly bypassed the circulating allergic antibodies. By using this method, they were able to use lower doses and to reduce the duration of injections from 3-5 years down to just 3 injections over 4 weeks.

Currently, doses required for traditional immunotherapy are too high to be safely used for food allergies. While intralymphatic immunotherapy has only been performed for environmental allergens (dust mites and cat dander), it is possible that the lower doses and fewer injections could make immunotherapy safe and effective for food allergens as well.

4. Allergy Vaccines
Researchers at the at the Institut du Thorax (CNRS/Inserm/University of Nantes) in France have developed an asthma “vaccine” for mice.

Traditional immunotherapy isn’t really a vaccine. It’s better to call it desensitization or immunotherapy. By giving repeated doses of the proteins you are allergic to, we trick your immune system into not overreacting to the allergen. A traditional vaccine works by revving up your immune system so the next time you see a virus or bacteria you can respond more quickly and powerfully, thereby preventing an infection.

In this Dust Mite Vaccine study, researchers used a nanovector and a dust mite protein to trick the body into producing dust mite proteins on its own. This production produced a low level of dust mite protein in the body which effectively worked like immunotherapy, but without all the shots. It’s called a vaccine because it is a one-time injection, even though immunologically, it works much more like immunotherapy. Like the intralymphatic immunotherapy above, it may be possible to use this method for food allergies since lower levels of proteins may be needed.

5. Regulatory T-Cell Tolerance
Another study at the AAAI meeting was presented by Dr. Paul Bryce, PhD from Northwestern. In their research, they attached peanut protein to the regulatory T-cells (a type of white blood cell) of mice and turned off the anaphylactic reaction to peanuts. This has been replicated with egg protein in egg-allergic mice.

Interestingly, this method originated as a treatment for Multiple Sclerosis (MS), where it is beginning human trials. If the procedure works in humans, it could have far reaching effects in allergy and autoimmunity – food allergies, allergic rhinitis, asthma, MS, Parkinson’s, diabetes, lupus, and many others.

From an allergy standpoint, it could not only cure food allergies, but also revolutionize treatment for environmental allergies. Instead of going in monthly for allergy shots, you could go to an allergist once and have your blood drawn. Your regulatory T-cells would be mixed with allergen proteins and injected back into your body. One visit, all your allergies possibly cured.

If you’re interested, you can find more research details and the abstract for the publication in the Journal of Immunology.

6. Peanut Patch Treatments
Dr. Amal Assa’ad at Cincinnati Children’s Hospital is looking at the safety and effectiveness of the investigational medication Viaskin Peanut for treating peanut allergy in children and adults. This would be an exciting treatment possibility. Patients would wear a patch on their arm at all times, giving them a small amount of peanut protein through the skin. We’ll keep you updated when we here the results of this study.

7. Mast Cell Receptor Blocker
Fred Finkelman at Cincinnati Children’s, received a grant from FARE to develop a monoclonal mast-cell receptor blocker which could potentially block all allergic reactions. For more details, here’s a conversation with Dr. Finkelman.

Conclusion
While each of these possibilities will face hurdles before they are ready for clinical use in humans, one of these methods is going to work. As these studies develop and new information comes out, we’ll try to keep you informed. In the meantime, make sure to talk to your children, friends and families about the importance of food allergies in Cincinnati, the need for avoidance at all times, and the proper use of epinephrine in case of an emergency.

For more information on your food allergies, please talk to your doctor or come see us. Our experienced, friendly staff, superior quality of care and four locations in Cincinnati and Indiana will make your visits pleasant and convenient.