Food allergy is estimated to affect 15 million Americans- approximately 4% of children and 1% of adults. This data suggests an increased prevalence in the past 2 decades. 8 foods are considered the most common food allergens in the United States and these include milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish. The apparent increases in the prevalence of food allergy and overall allergic disease are unexplained. Changing practices and food manufacturing, decreases in microbial exposure in early life, changing microbiology are speculated to contribute to increases in the prevalence of allergic disease.
Food allergy results from a breakdown or a delay in the development of oral tolerance or lack of clinical reactivity to a food substance. This is most common in persons who are genetically and possibly environmentally predisposed to the development of allergic conditions.
There are several risk factors that are strongly associated with severe reactions that can be life-threatening due to a food allergy. These risk factors include adolescence or young adulthood, presence of concomitant asthma, delayed use of or lack of access to an epinephrine autoinjector. In addition several factors including exercise, viral infections, menses, emotional stress and alcohol consumption placed some persons at increased risk by lowering the reaction threshold after exposure to an allergen.
Recent efforts have been focused on early prevention to help reduce the increased prevalence of food allergies in our country. Due to a study called LEAP (Learning Early About Peanut Allergy), we now know that regular consumption of peanut-containing products, when started during infancy, would elicit a protective immune response. Therefore it is recommended to introduce peanut in a child’s diet as soon as possible, as soon as 4 months old.
During the past decade, substantial progress has been made for the development of allergen specific immunotherapy for food allergy. Oral immunotherapy has resulted in the highest rates of desensitization and sustained unresponsiveness. This treatment’s goal is to have the child be able to eat the offending food normally or ingest a “bite proof” dose. This will reduce accidental severe reactions leading to ER visits and increase the safety of the patient. It also eases fear in both parents and children with food allergy. It can be associated with risk of serious adverse events, including episodic anaphylaxis, eosinophilic esophagitis and dose-limiting gastrointestinal side effects. We take care to take all precautions with managing these adverse reactions.
We are happy to introduce this treatment option to our patients for peanut, milk, egg and wheat allergy. We aim to have other tree nuts available soon. This is a lifelong treatment which requires regular ingestion of the offending food, so it does require a commitment from the patient.
Talk to your allergist today at, The Allergy Group, if you are interested in this treatment option!
Reference: Jones, Stacie M. M.D., Burks, A. Wesley M.D. “Food Allergy” The New England Journal of Medicine, 2017.