Treating food allergies: Is there light at the horizon?
Is it possible to identify the fraction of patients that will not outgrow the food allergy or will one just have to wait until the child grows older and it becomes evident?
Diagnostic tests to distinguish these patients are being developed for milk and egg. For wheat this has not been done yet, so you will have to, basically, wait to know which group a patient belongs to.
Which diagnostic tools are available to predict the patients risk for severe reactions, chance to lose the allergy in adolescence and success of immunotherapy?
There are two diagnostic tools that appear most promising at the moment. One is the epitope analysis, where one is looking at specific food protein epitope profiles, respectively the amount of IgE they have to various epitopes on that food protein.
The other diagnostic tool is the Basophile Activation Test (BAT). The test has a high diagnostic accuracy, it can be particularly helpful in cases where skin prick test and specific IgE are equivocal. Also it may allow reducing the need for oral food challenges.
Another test, called Mast Cell Activation Test, is in a very early stage of research.
But: All these diagnostic tools have to be validated with bigger studies.
Are there any other risk factors for severe reactions?
There are some indicators that suggest that a patient might fall into a more severe category, but these are not accurate. Possible risk factors for severe reactions are, e.g., presence of poorly controlled asthma, a very high IgE-level to the particular food and multiple allergies.
Dr. Sampson, thank you very much for this interview!
1)The PALISADE Group of Clinical Investigators, AR101 Oral Immunotherapy for Peanut Allergy, The New England Journal of Medicine, November 18, 2018, DOI: 10.1056/NEJMoa1812856, (https://www.nejm.org/doi/full/10.1056/NEJMoa1812856)
2)Nowak-Węgrzyn A, Wood RA, Nadeau KC, Pongracic JA, Henning AK, Lindblad RW, Beyer K, Sampson HA, Multicenter, randomized, double-blind, placebo-controlled clinical trial of vital wheat gluten oral immunotherapy, . Send to
3)J Allergy Clin Immunol. 2018 Oct 24. pii: S0091-6749(18)31294-6. doi: 10.1016/j.jaci.2018.08.041. [Epub ahead of print],(https://www.ncbi.nlm.nih.gov/pubmed/30389226)