Sadly, recent news reports described two food allergy-related deaths in a single week. Although the details are scant, the victims were a 15 year old and a 20 year old, who apparently ingested unsafe foods and were not treated promptly. These preventable tragedies behoove us to learn how to better manage our food-allergic patients and advocate for them as well.
The Centers for Disease Control and Prevention (CDC) estimated that approximately 4% of children have food allergies, an increase of 18% over a decade. Another recent study estimated that as many as 8% of children have food allergies, with nearly 40% reporting severe reactions. The studies conducted by the Mount Sinai Jaffe Food Allergy Institute, in collaboration with the Food Allergy & Anaphylaxis Network and funded by the Food Allergy Initiative, showed a tripling in reported peanut allergy among children, from one in 250 in 1997 to 1 in 70 in 2008. This figure of over 1% matches studies from Canada, the UK and Australia. Also worrisome are recent studies indicating that resolution of allergies such as milk, egg, wheat and soy appear to be slowing compared to reports of decades ago. There appears to be a possible epidemic of this potentially fatal problem.
Understanding the risk factors and addressing them
Thankfully, fatalities are uncommon, but when they do occur, a variety of studies have identified some common risk factors: delayed treatment with epinephrine, co-morbid asthma, and being a teenager or young adult.
Epinephrine is the primary therapy for anaphylaxis, and an auto-injector should be carried at all times. Our studies have shown that the medication is often underutilized and many physicians are not familiar with the technique of administration. It is imperative that we educate ourselves and our patients on the use of this life-saving medication.
Asthma is presumably a risk factor because the lungs are a sensitive target organ during a systemic reaction, indicating that good asthma control is also imperative.
Finally, the most vulnerable group are comprised of those who are at an age of risk-taking and prone to ingest possibly unsafe foods to “fit in” with peers and avoid discussing their allergy because of embarrassment. Our studies of food-allergic teenagers found that their strongest wish was that others, particularly their peers, knew about food allergy; presumably this would reduce the self-perceived awkwardness of having to carry medications and constantly ask questions about the safety of foods. As physicians we must encourage peer education, but also ensure that our young patients are well informed on food allergy management.
New resources for physicians and patients
The National Institutes of Allergy and Infectious Diseases (NIAID) of the NIH recently sponsored an Expert Panel Report: Guidelines for the Diagnosis and Management of Food Allergy in the United States. This document reviews the many ways in which we can assist our patients in staying safe, beginning with securing a diagnosis, educating patients on avoidance strategies, treatment strategies and understanding the significant impact on quality of life that is associated with this illness. The NIAID also sponsors a Consortium of Food Allergy Research (COFAR), which is investigating improved treatment strategies and is attempting to determine risk factors and prevention strategies. Among the programs within COFAR was the development of validated educational materials, which are available for download. Additional resources, includingwritten anaphylaxis emergency plans are available and patients may wish to visit the websites of organizations such as the Food Allergy & Anaphylaxis Network and Food Allergy Initiative for more educational information.
What the future holds
Avoidance of allergens and reactionary treatment with epinephrine are not satisfying approaches to treatment. Our group at the Jaffe Food Allergy Institute, in collaboration with researchers in COFAR and others, are evaluating numerous novel therapies for treatment including oral and sublingual immunotherapies, Chinese herbal remedies, immune modulators and many other approaches. As we recently reported, we have found, for example, that some children with milk or egg allergies can tolerate these foods in extensively heated forms as found, for example, in cookies or muffins, and this type of exposure may prove to be beneficial for the immune system. While much more research must be done on these approaches, the future appears promising. You can read more about these studies and our clinical trials by visiting the Mount Sinai Jaffe Food Allergy Institute, or search “food allergy” on www.clinicaltrials.com.
Scott H. Sicherer is Chief of the Division on Allergy and Immunology in the Department of Pediatrics, Mount Sinai Medical Center, New York City, NY.
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