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.

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.

Food Allergy Desensitization May be coming to an Office Near You

If you haven't spoken to your allergist in the past 6 months, you may want to check in. Food allergy desensitization programs like this one are becoming more prevalent. I found out over the summer that our allergist office will begin peanut desensitization in December. They chose peanut to start because they have a peanut allergic allergist who is willing to be the first desensitization patient in the practice. My 12-year-old may enter the peanut program this summer, although were are just as anxious for a milk desensitization program.

I'm really excited about this works. I recognize the risks, but I hope with a slow progression, an active watch for symptoms of an allergic reaction and keeping epinephrine close at hand, there will be success. This living in fear of accidental ingestion due to cross contamination or incomplete food labels is no good. Finally, some help may be on the way!

Food Allergy Desensitization Programs

Okay, its controversial, but I'm keeping a close eye on this. Dr. Richard Wasserman, a pediatric allergist in Dallas TX, has been using desensitization to treat food allergy in his private practice. Some patients have had great success, others, not so much. Food desensitization is handled in much the same way as traditional allergy therapy. Someone allergic to cat, dust, mold or oak trees is given increasing amounts of their allergen in the form of an allergy shot. Over time, most people can better tolerate the allergen. In Wasserman's practice, someone allergic to milk or eggs can be given tiny doses of the offending food in increasing amounts.

Dr. Wasserman admits that many allergists find his food allergy treatment too risky. There are a few other practices throughout the U.S. who perform oral desensitization for food allergy. However, most desensitization studies are currently in clinical trials.

Wasserman reports that the program takes place over many months and costs about $5000. A few insurance companies cover the cost.

Does anyone have direct experience with this treatment for food allergy?  I'd love to talk to some food allergy families who've contemplated, or gone through, a program like this.