Eating away at food allergy

Abstract

Food allergy (FA) is a significant public health concern, with its prevalence rising globally and greatly affecting the lives of patients and their families. The increasing burden on healthcare systems and the impact on quality of life underscore the need for better understanding and management strategies. The dual-allergen hypothesis suggests that early skin exposure to allergens increases sensitization risk, while early oral exposure and sustained ingestion of foods promote tolerance While diet is not the only factor in FA development, eating allergenic foods early and often can profoundly prevent FA despite other risk factors such as eczema. Treatment approaches vary by a number of factors including patient preference. Avoidance remains an option, but tailored avoidance, such as allowing denatured food products with milk and egg is now commonplace. Food immunotherapy approaches via multiple routes and doses are becoming more available. Immunotherapy can result in marked reductions in food reactivity which may be sustained for weeks or months or even longer off treatment for some patients. Biologics are also being more widely offered to increase the amount of food that can be safely ingested to facilitate immunotherapy. With the current approaches, treatment at a time of low IgE formation, often associated with younger age, may be the most effective for remission, but older ages may benefit from the increase in the threshold of reactivity that food-based treatments can provide.

Keywords: biologics; food allergy; immunotherapy; peanut allergy; prevention.

FIGURE 1

IgE‐mediated allergy occurs when a parasitic immune response is inappropriately activated against foods.

FIGURE 2

An example of an egg food ladder and considerations for its use.

FIGURE 3

Different potencies (referring to the amount of protein per volume of food that causes an allergic reaction in allergic individuals) of different foods. High potency means at a population level a small amount can trigger an allergic reaction.

FIGURE 4

Threshold dose is typically established to be the amount of food protein that will cause allergic symptoms in an individual. It is a spectrum among individuals and can change in a specific individual depending on cofactors present and be increased by treatments. The threshold can be assessed after stopping treatment to see if the treatment effect has been maintained.

FIGURE 5

Fitness/endurance as an analogy to food desensitization. Both involve exposing the body to an activity initially poorly tolerated to gain capacity: In food treatments this is the capacity to eat more of the food and in exercise it is the capacity to exercise. When viewed as such it may not be surprising that with most currently available treatments the effect is diminished when the exposure is stopped. Intervening early with food when the allergy is not fully established may allow for more durable benefits and "eat away" at food allergy.