Food Allergy Treatment Definitions

Peanut Allergy

As I reported last week, we've been presented with the exciting opportunity to participate in a sublingual immunotherapy program for peanut allergy. As I've begun discussing this opportunity with others, I'm finding a good deal of confusion, both within the food allergy community and beyond, about potential food allergy treatments. The two most promising possible treatments available today are sublingual immunotherapy and oral immunotherapy. Here are a few important definitions when we talk about "food allergy treatments":

Immunotherapy is the process of giving small doses of what a person is allergic to in order to increase tolerance and build immunity to reduce the likelihood of an allergic reaction

In sublingual immunotherapy (also known as SLIT) the allergic person will hold the food extract under the tongue for a short period of time (our allergist's protocol is two minutes) and then swallow it. The dose will be gradually increased over time. Our process will be one office visit every two weeks and daily doses at home at the same level between those office visits. The entire process will take place over 7 months. Following SLIT, patients may participate in a food challenge, or may be recommended for an oral immunotherapy program.

In oral immunotherapy (OIT), an allergic individual swallows a small amount of the food they are allergic to. Treatment begins with a diluted form of the food and is gradually increased during office visits and at home

There are pros and cons to any type of treatment program. I encourage anyone considering SLIT or OIT to do your own research and make the best decision you can for your family. Some will go with a wait and see approach and not take any action right now. Others will decide to move ahead in these still unchartered areas. Here are a few articles and links to get you started if you are considering either method:

Oral Immunotherapy Not Ready for Prime Time, by Dr. Hugh Sampson. In the comments that follow the article, many parents of children who have successfully gone through OIT speak out.

Is Sublingual or Oral Immunotherapy better for Treatment of Food Allergy, published in February 2012 by the American Academy of Allergy, Asthma and Immunology (AAAAI), concluded that neither are optimal. That said, at the March 2012 AAAI annual meeting, presenters offered new research about SLIT and OIT that showed promise and results for both.

It is obvious that things are moving quickly in this area. If you are considering SLIT or OIT, I encourage you to talk to your doctor, read the research and talk to other parents who have been through this. As we move through the SLIT program, I'll keep you apprised of our progress.  If you are interested in talking to someone who has been through OIT, shoot me an email (food allergyassistant@gmail.com) or leave a comment and I can get you in touch with someone.

School Bans Packed Lunches Containing Dairy or Eggs

School Lunches

My heart goes out to the community featured in this article at The Record. The piece, titled "Father of Boy with Severe Food Allergies Says He Never Intended to Restrict what Other Children Can Eat", seems to have turned into a huge misunderstanding.

The main characters are a well-meaning dad of a food allergic kindergartener, a seemingly sympathetic, well meaning school board and a bunch of parents caught totally off-guard.

Reportedly, a letter went out a few days before the start of school to all kindergarten parents. It stated that "their children could not bring dairy items or food containing eggs in their lunches because of a kindergarten child who has an anaphylactic reaction to those foods". In addition, these parents were given a list of acceptable items including soy yogurt, vegan margarine, whole grain bread, some lunch meats and brands of cookies. There was also a list of stores where these items could be purchased.

No wonder the dad's upset and feels like this has turned into a spectacle for his child and the other parents are mad. The school board is saying, "no comment".

This is the kind of scenario all food allergy parents fear. Fortunately, it's not typical, and with good communication, can usually be avoided.  We've had a great experience dealing with our school district throughout the years.

My advice is to start the communication the spring before the start of school. Meet with the principal and school nurse and any other school staff that may be helpful. Find out what measures are already in place and how food allergies have been managed in the past. Use this as an information seeking session.  After you've gathered all of the information, determine what your child needs and request a healthcare plan. In the U.S., a 504 Plan makes the most sense. In other countries, including Canada, there are similar plans available under other names. Regardless of the name, you are looking to protect your child in the least restrictive way. The plan needs to clearly state who does what and who is responsible for what. Everyone's rights need to be considered and respected.Try to be open and flexible during the process. Everyone wants what is best for the citizens of the school.

I hope for this little kindergartener's sake, the community mentioned in the article can come together and do what is best for all.

Baby's Eczema and Food Allergy

Egg Allergy and Eczema

What a difference a decade makes. Back in the day, parents of babies with eczema were advised of the food allergy march: itchy, angry skin, leading to food allergies and to asthma. I remember our doctor saying "eczema is linked to egg allergy". As a result, we were advised to told to postpone highly allergenic foods, such as eggs, milk and nuts, for several years.

So we did, and as later skin and blood tests confirmed those food allergies, avoidance, we were told, was key. 

In a recent Journal of Allergy and Clinical Immunology, Australian researchers pointed to a genetic link between allergies and eczema. The study, by Murdoch Childrens Research Institute in Melbourne, found that babies with changes to the filaggrin gene had a higher chance of a positive skin prick test to egg allergy.

Now here's the interesting part, those babies with the changed fillagrin gene and the positive skin test to egg allergy who were then given egg at an early age, had a decreased risk for developing a "ful-blown" egg allergy. Delaying the introduction of egg (which many of us were told to do) actually increased the risk of egg allergy.

It seems that there may be a skin sensitivity to food proteins, but not necessarily a gut sensitivity. Many doctors are now suggesting early introduction of egg, milk and other typical food allergens in order to develop tolerance.

What's a parent to do? Talk to your doctor. Make sure they are up on the latest research- this is new information. If your baby has eczema or you are concerned about food allergy, see an allergist sooner, rather than later.

Peanut Allergy Immunotherapy Has Arrived

Food Allergy Sublingual Therapy

It seems fitting that my 500th Food Allergy Assistant post is one of hope and anticipation.

The letter was addressed "To the parents of...". The return label was from the allergist's office. The envelope was thick and indeed contained the long-awaited announcement.

"Our office has begun peanut sublingual immunotherapy. Do you want to participate?"

Well, yes...but. It turns out we have lots of questions and some logistics to figure out. The office requires a commitment of a two hour appointment every two weeks. Between appointments, we administer the serum at home. There can be no eating for 15 minutes before serum is given and then no eating for 30 minutes after.

It's a lot to ask of a kid.

And then there's the cost. I've seen figures upwards to $3000. Some insurance companies cover it, others don't. It appears that the serum is currently not covered.

We're being offered sublingual immunotherapy or SLIT. This is the process of placing a food extract under the tongue. This is not to be confused with oral immunotherapy (OIT), which is also being actively studied. OIT means increasing amounts of allergenic foods are fed to an allergic individual. This method had a high level of anaphylactic reactions in the past. According to the information we were given, less than 1% of individuals participating in SLIT have experienced allergic reactions.

The next step for me is a little more research, a call to the insurance company and a call to the allergist's office with our questions. I am cautiously excited and will keep you posted on our decision and progress.

A Little Market Competition for EpiPens

EpiPens by Mylar

Holy smokes! I just paid $44 for our back-to school EpiPens! A few years ago, I paid $10.

Now believe me, I'm always happy to give our unused pens to the doctor's office (although we first inject them in an orange for practice before turning them in). I'd rather pay and not have to use the epinephrine, than have a medical emergency requiring their use; however, with no competition, no matter how high the price may go, many of us are going to pay it.

We must. It's the only thing we've got in an emergency.

Things may change this fall when Sanofi introduces Auvi-Q and again in 2015 when Teva puts out a generic EpiPen (pending FDA approval).

We'll see. I was hopeful that Twinject may have been a competitor to the EpiPen in terms of pricing, but that hasn't happened. In this NY Times article, "Tiny Lifesaver for a Growing Worry",

an analyst at Cowen & Company questioned whether parents would be willing to switch to a different brand in such life-or-death situations, saying, “parents may want the real thing".

So, I'm wondering...are you willing to try something new or are you sticking with the tried and true EpiPen? Are you excited about Auvi-Q?  Are you buying fewer EpiPens as the prices have increased?

Newer Blood Tests for Food Allergies

This heart-lifting story from the Boston Globe tells about an 11-year-old getting the news that her blood test showed that she's not allergic to nuts, peanuts, other legumes and some fruits like she thought she was. Nope, she's really allergic to birch pollen and that rarely causes an anaphylactic reaction. So, on the way home from the doctor's office, she had her mom stop at the store to buy peanut butter, which she describes as "amazing".

While I'm having trouble finding anything about this "new experimental blood test" cited in the article (anyone know anything about it?), I've long been aware of pollen allergies causing food allergy-type symptoms. Personally, I find I get an itchy mouth when I eat certain foods such as raisins and apples during September- or ragweed season as I refer to this month. We've seen similar things with my food allergic child.

One of my go-to allergy books, Allergy Cooking With Ease, by Nicolette M. Dumke lists food family tables. It was in her book that I discovered that almond is really in the plum family. My nut allergic child eats almonds without any problems. Here's an in-depth article, "Molecular Properties of Plant Food Allergens: A Current Classification into Protein Families" that further outlines the classification of plant-derived food allergens. If blood tests are able to distinguish what is a true food allergy from allergies to pollens or plants, we may be able to cross some foods-to-avoid off the list.

Has anyone had experience with these new blood tests? Are you able to eat certain foods in a family but not others- like avoiding peanuts, but can eat peas (both in leguminosae family) or avoiding tree nuts, but can eat almonds?

I just think this is another piece of the food allergy puzzle...