Thomas Casale, MD
Chief Medical Advisor for Operations, Food Allergy Research & Education (FARE)
“We have never been closer to offering effective treatments and the need for those treatments has never been greater.”
We are in the midst of a food allergy epidemic.
In the United States, an estimated 32 million people – 7.5 percent of children and 10 percent of adults – have a serious, potentially life-threatening food allergy. The number of emergency claims for treating anaphylaxis to food increased by 377 percent from 2007 and 2016.
There are no approved treatments for food allergy. Allergists advise patients to avoid problem foods and always carry epinephrine to treat dangerous symptoms.
To prevent reactions, food allergy sufferers must practice strict avoidance, which means they have to think about every bite of food, every day. In a recent survey of food allergy patients and their caregivers, more than half reported mental health concerns related to anxiety.
The good news is that hope is on the horizon. Prospects for food allergy treatment are at various stages of development. Some are undergoing laboratory studies, and small- and large-scale clinical trials, while others have been submitted to the U.S. Food and Drug Administration (FDA) for approval.
Many allergy treatments involve giving patients the food proteins they’re allergic to, starting with tiny amounts and raising the dose over time to increase tolerance. For some, immunotherapy successfully retrains their immune system — they can still tolerate the food they were allergic to even after stopping treatment. Others can still tolerate allergens as long as they eat the food each day after completing oral immunotherapy.
While immunotherapy can be effective, some patients remain sensitive to their allergen, and some leave treatment because being exposed to their allergen causes adverse reactions, including breaking out in hives, swelling, and vomiting, as well as difficulty breathing and dropping of blood pressure.
Methods for food allergen immunotherapies can include eating the problem food, placing dissolved food protein under the tongue, and absorbing food protein from a patch on the skin. Injecting food proteins under the skin caused safety issues in the past, but is once again being studied. Nasal spray food protein vaccines are being studied in mice.
In a different approach, researchers have safety tested a vaccine containing peanut DNA in adults. Two peanut protein immunotherapies have completed clinical trials, and another is being reviewed by the FDA for approval.
Drugs that block allergic reactions
Food allergies cause the immune system to overreact when someone is exposed to a problem food, which leads to a chain of events with the release of mediators that results in allergic symptoms.
Researchers have made remarkable progress recently in developing anti-allergy drugs created from immune proteins called antibodies. These biologic drugs specifically block the chain of events that cause allergy symptoms. Some are already approved to treat other allergic diseases like asthma and eczema, and are now being tested to treat food allergies, both as standalone treatments and in combination with food-allergen immunotherapies.
Researchers learn more about the complex factors that influence food allergies every day. We now know that giving peanut foods to allergy-prone infants can prevent about 70-80 percent of peanut allergy cases, reversing decades of doctors’ advice to parents to avoid allergenic foods. We are beginning to explore how food allergies might be influenced by our microbiome, the microbes that live in and on us, and we are hunting for better ways to diagnose food allergies, since current tests require patients to risk a reaction by eating their problem food.
This is a pivotal moment in food allergy research. We have never been closer to offering effective treatments and the need for those treatments has never been greater. Investing in innovative therapies, diagnostics and prevention will pay dividends in protecting public health.
Thomas Casale, MD, Chief Medical Advisor for Operations, Food Allergy Research & Education (FARE), [email protected]