Management of all food allergies comes down to one word: avoidance. This is a lot harder than it sounds. As a parent who prides myself on my planning, I have accidentally exposed my son to his allergens on multiple occasions. A single slip up not reading a package or trusting someone else is all it takes.
So like all parents, I am desperate for a cure. After significant research into all the possible routes, I can tell you that there are no perfect ways today to cure food allergies. Anyone guaranteeing a cure or promising no chance of a reaction along the way is lying to you.
However, we do know that the immune system can be re-trained to stop reacting, or to react less severely to food allergies.
Outgrowing an Allergy
Many children will outgrow their allergies without any sort of intervention.
Children are more likely to outgrow their allergies by themselves if they:
- Have fewer food allergies
- Have a milk or egg allergy
- Can tolerate treated versions (i.e baked) of their allergies
- Do not have eczema or asthma
- Have lower IgE levels
Read more about outgrowing allergies here
Oral Immunotherapy (OIT)
Pollen allergies have been treated successfully for a long time with allergy shots and sublingual immunotherapy (SLIT), where they put small amounts of the allergen under people’s tongues.
Back in the 1980’s scientists began to look into using this treatment for food allergies. Unfortunately, a patient died after receiving the wrong dose, and all research was shut down.
In the last 10 years, a LOT of research has gone into Oral Immunotherapy (OIT) for food allergies, and the results have been getting better and better.
Oral immunotherapy means regularly eating small amounts of an allergen. Typically, the amount of allergen eaten each day starts incredibly small (so small you can’t see it) and increases until it is a full serving every day.
The goal of OIT is to desensitize a person to an allergen. This means that you can be exposed up to a certain amount without having a reaction. However, if you are exposed to more than that amount, you can still have a reaction -- though it should be more mild.
Doctors are working on improving OIT so that eventually people can fully tolerate their allergens. Tolerance means you could eat any amount, as often or as infrequently as you want, and nothing would happen.
Wouldn’t that be magical?
More research is also being done on SLIT and transdermal (through the skin) treatments for food allergy.
What Does Immunotherapy Look Like?
OIT starts with an in-office appointment to figure out the starting dose. This is done by beginning with a tiny amount like 1 milligram of protein, and doubling it every 30 minutes until you reach a good starting dose for that allergen.
Then, a person eats the starting dose for some number of days, say 2 weeks, at home.
Periodically (i.e. every two weeks) the dose is increased by a small amount, for example, 5-10 milligrams. Most up-dosing, as it’s called, happens in a doctor’s office. Then a patient continues maintenance dosing at home until the next up-dosing visit.
The goal is to up-dose your way up to a full dose (say, 2,000 milligrams) over a period of months. A patient will often have to continue eating that top dose for years to maintain the desensitization.
Does Immunotherapy Work?
Immunotherapy does work. Depending on the food, people do become desensitized to their allergies. This can alleviate so much anxiety and worry over an accidental reaction, even if a patient doesn’t fully tolerate the food.
What Are the Risks of Immunotherapy?
A large number of people stop therapy because eating their allergens in increasing amounts, and sticking to the protocol, is logistically difficult and causes a lot of anxiety.
About 10% of people have an allergic reaction to the food on their journey. An increased dose one day will be too much for their bodies and they end up needing treatment. Most commonly, people will develop stomach pain or some mild, but annoying-enough symptom that they want to stop therapy.
The Future of Immunotherapy
We can look to the kids who naturally outgrow their allergies to try to understand what can help retrain the immune system. There are a few concepts that are gaining more and more acceptance:
It’s clear that people with less reactive immune systems, meaning they have fewer, less severe allergies, and no eczema or asthma, are more likely to outgrow allergies. Doctors are trying to understand how to calm the immune system down.
One drug, called Xolair (Omalizumab), targets and shuts down IgE antibodies. It is given by injection in the doctor’s office. This drug is being studied to see if taking it can improve OIT outcomes. It is also being studied to see if it can prevent food allergies and asthma.
Another drug, dupilumab, interrupts one piece of the allergic chain reaction. This drug is given by injection into the skin every two weeks at home. It has already been proven as an effective treatment for asthma.
A lot of universities and companies across the country are trying to understand why allergic disease rates exploded and if we can reverse it. Many are researching probiotics, environmental changes, and even fecal transplants to see if we can get our immune systems to stand down.
The data from milk and egg allergies shows that regularly eating baked versions of the foods increases the odds of outgrowing the food allergy. This is a form of immunotherapy. Some doctors are looking to see if eating other legumes can help someone begin to tolerate peanuts, or if eating stone fruit can help desensitize tree nut allergies.
Like every food allergy parent, I use up every birthday, shooting star, and fountain wish on the dream that my son one day won’t have to deal with food allergies. Thankfully there are hundreds of doctors working around the country to make this a reality.