Food Allergy Prevention, Treatment, and Management in 2020

The last five years have been a whirlwind for food allergies. The first treatment for food allergies was approved by the FDA, five studies consistently proved that food allergies can be prevented, and legislatures passed laws increasing access to medication for food allergies. 

The amount of new changes can almost make us forget some of the biggest events.

Food Allergy Prevention:

The LEAP study published in 2015 gets all the attention for definitively proving that early exposure is better than avoidance when it comes to peanuts. This study was so conclusive it led to worldwide changes in pediatric guidelines in 2017. In the United States, the American Academy of Pediatrics began recommending early introduction following the results of the LEAP Study.

Equally important, and often overlooked, are the EAT, PETIT, and CHILD studies. 

In 2016, the EAT study found that it was possible to prevent babies from developing allergies to multiple foods beyond peanuts, but only if they were consistently exposed to the allergenic protein. The EAT study is also credited with proving that early introduction would not reduce breastfeeding rates, and that early introduction could actually work for the average family. 

After years of confusing findings on the early introduction of eggs, the PETIT study proved that almost all egg allergies could be prevented if babies start with hard boiled eggs. The PETIT study found that raw and cooked eggs could still lead to an allergic reaction.

Perhaps the most exciting research finding of the last few years has been the results of the CHILD study. The LEAP study was often criticized for focusing on “high risk” infants. Few babies are considered high risk, yet almost 5% can end up developing a peanut allergy. The CHILD study examined early allergen introduction in “low risk” children and showed the same 80% reduction in peanut allergy. 

Combining the results of these three studies, we can be sure that every baby should be fed allergens early and often. 

Food Allergy Treatment (Immunotherapy)

Emerging forms of food allergy treatment involve exposing a person with a food allergy to increased doses of the allergenic food. The first goal is to increase the amount of food that a person can tolerate without reacting, reducing the risk of life-threatening allergic reactions (desensitization). The dream goal is to erase the food allergy entirely (tolerance). 

There are three kinds of treatments that have been approved by the FDA or are getting closer to FDA approval:

  1. OIT (oral immunotherapy), where a person eats the allergen
  2. SLIT (sublingual immunotherapy), where droplets of the allergen are placed under the tongue
  3. EPIT (epicutaneous immunotherapy), where a patch with the allergen is put on the skin

In 2019, Palforzia was approved by the FDA as an OIT option for those with peanut allergies. Unfortunately, it is not without risk — 10% to 20% of those who start Palforzia stop it due to allergic reactions and other issues before getting to desensitization. However, for those with severe allergies, the sense of control it can bring may be invaluable. 

Today, only around 200 allergists in the US provide their patients with oral immunotherapy, meaning it can be hard to access. 

SLIT is widely considered to be safer than OIT because it uses significantly smaller doses. It has been used for decades for the treatment of many environmental allergies. There are nearly a dozen studies in the works, but there are no FDA-approved SLIT treatments for food allergies yet. 

Lastly, DBV Technologies has been making big strides with its Viaskin patch for the treatment of peanut allergy with EPIT. A randomized, placebo-controlled study with 74 peanut allergic patients showed good safety with the patch, and only skin reactions. At 52 weeks, however, only modest results were seen. The best outcomes were in younger children aged 4–11 years old. 

While significant progress has been made, and there is promise in treatments for food allergies, doctors are now trying to understand if there are certain patients (severity of allergy, age, etc.) who respond better to different types of treatments. 

Legal Protections for Food Allergies

For those with existing food allergies, the world has changed dramatically. Food allergy sufferers, their friends, and their families have worked tirelessly to make food allergies understood. And because of everyone’s hard work, there are many more protections for those with food allergies. 

Food allergies are recognized as a disability requiring accommodation under the Americans with Disabilities Act. On May 31, 2019, the U.S. Court of Appeals decided that it may be necessary and reasonable for an individual who has a disability due to a medically diagnosed diet – such as a gluten intolerance or food allergies – to bring their own food to a restaurant. This was a big win for people who have severe allergies, and were otherwise barred from restaurants. 

The last few years have also seen several state laws passed to help ensure the safety of food allergy sufferers. 

New York requires day care staff to be educated and trained in recognizing anaphylaxis and in the proper administration of epinephrine. Illinois requires health insurance to provide coverage for epinephrine auto-injectors for persons 18 years of age and under. Michigan requires epinephrine auto-injectors in schools for use on any student suffering an allergic reaction and requires staff training. 

And many more laws are in the works across dozens of states. 

All in all, things are looking up for the future of food allergy prevention and those with existing allergies.