Around the world, children are far more likely than ever before to develop food allergies. In fact, the frequency of food allergy in kids has increased significantly over the past 30 years.
And living with food allergies can be very stressful for families.
“Food allergies are fairly common, impacting six to eight percent of young children, and even reaching ten percent in some recent studies in certain countries,” says Dr Stuart Carr, chief medical officer at Snö Asthma & Allergy Centre.
“Although the risk for having a life-threatening or fatal allergic reaction to a food is incredibly low, parents of food-allergic children report a great deal of anxiety around this diagnosis, given the unpredictable nature of food reactions, and the difficulty successfully avoiding accidental exposures, especially with staple food allergens such as milk or eggs, or commonly-used foods such as peanut or sesame,” he explains.
Reassuringly, most allergic food reactions are mild and resolve fairly quickly, but the fear of a more severe reaction (anaphylaxis) is hard to escape from.
“For years, our approach to food allergy has been to confirm the diagnosis, strictly avoid the food allergen, and be prepared to treat a reaction, hoping the child may outgrow the allergy over time. While generally successful, with rare exceptions, this approach provides little comfort or satisfaction to many families,” Carr says.
Fortunately, a lot of progress has been made over the past couple of decades, and this offers a lot of hope for food allergy sufferers and their families.
“First, we know that many children will outgrow food allergies over time, especially younger children with allergies to milk, egg, or wheat, all of which have an excellent prognosis. Studies have shown that around 80 percent of children will develop tolerance to these foods over time, and we are now much more eager to perform supervised oral food challenges in clinic to try to get these foods back into the diet at early ages,” Carr says.
Carr also explains that it is now known that more than half of children with milk or egg allergies will tolerate these in baked goods, such as cakes and muffins and cookies, and that eating such extensively heated egg or milk may actually help them develop tolerance to unaltered egg and milk more quickly.
But Carr cautions that although only 20 percent of children will outgrow allergies to peanuts, tree nuts, or sesame, that’s still one out of every five.
“That means we are also a lot more eager to offer oral food challenges in these patients as well, assuming they have favorable test results and no recent reactions.”
Newer evidence also suggests that parents should rethink the way they view potential allergens when their children are babies.
“We have also made great strides in learning how to prevent food allergies over the past five to ten years, that early regular exposure to foods like peanut and egg are protective, especially in infants with eczema or a strong family history,” Carr says.
“Incorporating peanut into the diet of a high risk infant between four and 11 months of age decreases the risk of developing a peanut allergy by as much as 85 percent, an astronomical impact from just eating!”
Despite these promising developments, there are still a lot of kids with ongoing food allergies, and all the fear and uncertainty that understandably accompany that diagnosis, and oral immunotherapy (OIT) may be starting to fill that gap.
“There has been a lot of research and anticipation around OIT for the past 15 years, but now we finally feel confident that this can be used more widely to help protect our food-allergic patients from anaphylaxis,” Carr says.
OIT involves giving a very small amount of a food allergen such as peanut to a child with a confirmed allergy in clinic, and then continuing to take that same amount at home every day before returning to clinic for a dose increase after a couple of weeks.
Once a pre-determined target maintenance dose is reached, the child continues to take that daily for some period of time, protecting them against anaphylaxis, and in some cases, allowing them to develop tolerance and normalise their diet.
Carr adds though that: “While this sounds very exciting, it is important to understand that while most children receiving OIT can be “desensitised” (protected against bad reactions from accidental exposures), most do not achieve true “tolerance” (being able to eat a completely normal diet).”
“This also comes at a price, as some patients receiving OIT will have anaphylaxis during a dose increase in clinic (much less often at home). It also requires a serious commitment to long-term daily dosing, frequent clinic visits for updosing, and minimizing vigorous activities for a couple of hours after taking the daily dose at home (activities increase the risk for reacting).”
But it seems that OIT does not seem to work very well in adults, whose allergies may simply be too entrenched, rather it works best in very young children, especially for foods like peanut.
“I have been involved in a study back in Canada with nearly 500 peanut-allergic preschool children undergoing OIT, and preliminary results of over 130 who have finished a full year of maintenance dosing shows that 98 percent are protected against accidental exposures, and 75 to 80 percent are fully tolerant (remember, only 20 percent outgrow it on their own).”
“Additionally, the risk for severe allergic reactions with OIT in this age group seems a lot lower than in older children or teenagers, making it both safer and more effective,” Carr adds.
As a result of studies like this, both the Canadian Society of Allergy and Clinical Immunology and the European Academy of Allergy and Clinical and Immunology have endorsed the use of OIT for appropriately-selected children.
And this break-through way of treatment is being carried out at Abu Dhabi’s Snö Asthma & Allergy.
“We are excited to have begun offering this valuable service for children here in the UAE for the first time,” Carr concludes.
www.snoasthmaandallergy.com (02 493 6789).
