CUIMC's Food Allergy Program: A Center of Excellence
Program is a member of the FARE Clinical Network
For children with life-threatening allergies to ubiquitous foods like milk, peanuts, tree nuts, eggs, or wheat, every unfamiliar food in which these might be hidden triggers fear and anxiety. Currently, one in 12 children is allergic to one or more food allergy.
To meet the growing demand for advanced treatments, CUIMC’s Food Allergy Program is building its research portfolio and offering multidisciplinary specialized care. The program is one of several Centers of Excellence designated by Food Allergy Research & Education (FARE) that are dedicated to advancing research, raising awareness, and supporting patients and their families. CUIMC’s membership in the organization, “provides us the support to be able to both do clinical trials and provide the highest level of care for our patients,” says Joyce Yu, MD, Associate Director of the Food Allergy Center and Director of the Food Allergy Clinic.
Dr. Yu notes that the incidence of all types of allergies has increased, including asthma, allergic rhinitis, and eczema, in addition to food allergies. Many allergists point to the hygiene hypothesis—the idea that allergies are spiking because children are exposed to fewer microbes than in the past—as an explanation. But food allergies may also be due a shift from our ancestors’ mainly unprocessed, plant-based diet to one that includes a range of processed foods, genetically modified organisms (GMOs), and artificial sweeteners. Other possible explanations include a link to climate change, pollutants that could be altering the expression of our genes, and more sedentary lifestyles, Dr. Yu explains.
The four food allergies that appear earliest in life are reactions to milk, egg, soy, and wheat. And while infants and young children tend to outgrow these allergies, “We are starting to see a little more persistence of some of these allergies, and it's unclear why,” Dr. Yu says. Allergies to peanuts, tree nuts, fish, and shellfish often emerge later and are more persistent, she adds. These four also seem to be more frequently reported to be associated with severe reactions. “But any of these allergens can cause a severe reaction.”
Current standard care includes diets designed to avoid the foods that cause a reaction, emergency action plans that spell out what to do if a child eats an allergen, self-injectable epinephrine, other medications dispensed in emergency departments, and then repeated evaluations to determine whether a child has naturally outgrown his or her allergy.
A number of studies are evaluating the effectiveness of different forms of immunotherapy, which expose patients to escalating amounts of the food they are allergic to in the hope that this constant exposure will lessen their reactivity to that food. Epicutaneous immunotherapy (EPIT) requires the patient to apply a patch containing a food allergen daily. Other trials combine oral immunotherapy (OIT) with a biological therapy such as omalizumab (Xolair®), an asthma medication that binds to IgE, the antibody that can cause an allergic reaction, thereby further reducing the risk for a reaction.
Doctors know that OIT can very effectively “desensitize” people to the allergen so that they no longer experience a reaction, but they have to continue to consume the problem food daily.
So far OIT seems to be a very effective approach, but the long-term outcome is still unknown. More studies to assess its effect on the immune system are being conducted. In the meantime, says Dr. Yu, “We will have to continue to measure immunologic markers patients’ IgE, do skin tests, and do food challenges to see whether they are still reactive to the food.”