Future in management of food allergies – recent achievements

digital illustration antibodiesFood allergies are very common in children (6-8%) and sometimes they can even be life-threatening. Also, the quality of life of young patients and their families is severely affected. Currently, therapy of allergy is limited to avoidance of allergens and “rescue” pharmacological treatment. More and more doctors believe that the future is in active approach to the problem. Anticipatory testing, early introduction of potential food allergens, and active tolerance induction are the basis of the new model of treatment.


Allergy is a pathological response of tissues to the effects of substances foreign to the body. It is based on the production of specific IgE antibodies which after binding to the antigen (allergen) cause the release of inflammatory mediators, what induces the symptoms. The most common factors that cause food allergies in children are cow’s milk, eggs, nuts, soy and seafood. Some of the allergies cease with age, while others remain for a lifetime.

Children who are allergic to one type of food have a predisposition to a greater number of food allergies. Therefore, the occurrence of hypersensitivity to one foodstuff should be an indication for further diagnostic tests. If such an approach is not adapted in medicine, another allergen will be detected in the event of a child’s unexpected response to the exposure. Anticipatory testing would prevent the above situation and would reduce patient’s and parents’ fear of foods which are really safe. The diagnostic process would include: gathering accurate history with a focus on allergy, skin tests, specific IgE testing, and oral provocation tests in case of doubt.

Former beliefs that the best way to avoid allergies is to mitigate contact with the allergen in the neonatal and infancy period proved wrong. Recent studies (Katz et al., Koplin et al., Du Toit et al.) have shown that the early introduction of food in children significantly reduced risk of allergy development. For example, Katz et al. in the cohort study, conducted on more than 13,000 newborns, demonstrated that administration of cow’s milk in the first 2 weeks of life significantly reduced the incidence of sensitization in comparison to infants who came into contact with the allergen at the age of 4-6 months.

Traditionally, when a child develops an allergy doctor recommends avoiding food. However, recently there are new strategies that allow for acceleration of tolerance to the allergen. Active induction of tolerance currently focuses on three areas. The first is the use of probiotics in infants and lactating mothers. The second area is the heat treatment of dairy products served to the patients. The last focuses on oral immunotherapy. It involves adding a small amount of allergen to a diet, what leads to desensitization (increase of the threshold of responsiveness to allergen). All of these methods lead to a faster onset of tolerance in young patients.

In the future, proactive approach to the problem of food allergies will improve the quality of life of many patients and it will block developing hypersensitivity among many other people. Scientists hope that in the next few years this new procedure will be adopted by allergologists worldwide.

Written by: Katarzyna Godzisz, Michał Godzisz, Krzysztof Grzechnik

Source:
1. Katherine Anagnostou, Adam Fox. Recent advances in the management of food allergy. Clin. Pract. (2014) 11(6), 639–647
2. Pereira B, Venter C, Grundy J, Clayton CB, Arshad SH, Dean T. Prevalence of sensitization to food allergens, reported adverse reaction to foods, food avoidance, and food hypersensitivity among teenagers. J. Allergy Clin. Immunol. 116(4), 884–892 (2005).
3. Sicherer SH, Sampson HA. Food allergy. J. Allergy Clin. Immunol. 125, S116–25 (2010).
4. Katz Y, Rajuan N, Goldberg MR et al. Early exposure to cow’s milk protein is protective against IgE-mediated cow’s milk protein allergy. J. Allergy Clin. Immunol. 126(1), 77–82. e1 (2010).
5. Koplin JJ, Osborne NJ, Wake M et al. Can early introduction of egg prevent egg allergy in infants? A population-based study. J. Allergy Clin. Immunol. 126(4), 807–813 (2010).
6. Rautava S, Kainonen E, Salminen S, Isolauri E. Maternal probiotic supplementation during pregnancy and breastfeeding reduces the risk of eczema in the infant. J. Allergy Clin. Immunol. 130(6), 1355–1360 (2012).
7. Leonard SA, Sampson HA, Sicherer SH et al. Dietary baked egg accelerates resolution of egg allergy in children. J. Allergy Clin. Immunol. 130(2), 473–480.e1 (2012).
8. Kim JS, Nowak-Wegrzyn A, Sicherer SH, Noone S, Moshier EL, Sampson HA. Dietary baked milk accelerates the resolution of cow’s milk allergy in children. J. Allergy Clin. Immunol. 128(1), 125–131.e2 (2011).
9. Anagnostou K Islam S1, King Y et al. Assessing the efficacy of oral immunotherapy for the desensitisation of peanut allergy in children (STOP II): a Phase 2 randomised controlled trial. Lancet 383(9925), 1297–1304 (2014)


Would you like to know more? Watch on MEDtube.net: Allergic Fungal Rhinosinusitis – FESS

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