With oral immunotherapy, a Massachusetts facility is desensitizing some patients against common triggers, offering hope instead of a lifetime of fear.
Most of us know a child with a food allergy. It might even be your own child. And this is likely because researchers say food allergies are on the rise.
According to the non-profit Food Allergy Research and Education (FARE), researchers estimate that 32 million Americans have food allergies, including 5.6 million children under age 18. And the Centers for Disease Control & Prevention reports that the prevalence of food allergy in children increased by 50 percent between 1997 and 2011. Between 1997 and 2008, the prevalence of peanut or tree nut allergy appears to have more than tripled in U.S. children.
Food allergy symptoms can range from mild, like an itchy mouth or hives, to severe and life-threatening when the throat tightens and breathing becomes difficult. The life-threatening reaction is called anaphylaxis.
As the parent of a child with food allergies, I know the anxiety around birthday parties and other gatherings when kids are young. As a teenager, my son knows how to manage his allergy to nuts and certain fruits, and understands that he needs to be vigilant about what he eats and to avoid ingredients that could trigger a reaction for him.
But in his early years, I fretted every time he went to a social event or to a friend’s house. Will he accidentally eat something that could make him sick? Is it possible the food might contain allergen ingredients and he will forget to ask? It is indeed a trying time for many parents of vulnerable kids.
A new treatment center in Massachusetts aims to give families like mine and many others a new way to battle severe food allergies. The New England Food Allergy Treatment Center (NEFATC) in Quincy offers a treatment to desensitize patients to common food allergens using a process called oral immunotherapy (OIT).
“A significant benefit from this program is that it reduces anxiety and allows families to do things together that they may not otherwise do, out of fear for an accidental allergic reaction of one of the family members,” said Margaret Vallen, MD, who leads the treatment efforts at NEFATC.
According to her, OIT works in the following way: Patients are first given a sub threshold (tiny dose) of the allergen. For example, if a child is allergic to peanuts, the tiny dose administered is of a carefully-measured amount of peanut flour. On day one, the patient is given six increasingly higher doses. The dose is doubled every half hour. The tiny doses are increased over a five-hour period under supervision at NEFATC.
If the patient tolerates the initial doses at the center, they go home with a small amount of that allergen and take that specific amount every day for two weeks until their next visit. If the patient continues to tolerate this dose every day, on the next visit, they come in and updose, said Vallen. If they tolerate the higher dose, they go home with two weeks’ worth of that particular dosage. This procedure continues, every two or three weeks, until the patient gets to a point where they are eating an amount that is considered protective.
“What I mean by that (protective) is, should a patient have an accidental ingestion, this build up should result in an outcome where there is no adverse reaction to the accidental ingestion,” said Vallen. “We continue to slowly increase their threshold that would trigger an allergic reaction. As an anticipated outcome, for a peanut allergy, our goal is that after a period of nine to twelve months a patient should be able to eat four peanut M&Ms. At the end of a treatment for egg allergies, the patient should be able to eat one scrambled egg per day.”
The program requires a commitment of up to a year. The treatment is available for allergies to tree nuts, peanuts, sesame seeds, eggs, and milk at the Quincy location. At other NEFATC locations, there are treatments for allergies to wheat, shellfish, and other foods.
The doses are administered on what Vallen said is called a Mettler Balance, by trained technicians, under the supervision of RNs and physicians. The treatment protocols are based on allergy research at several respected centers, including Stanford University, Duke, and the University of Arkansas.
OIT does not cure the patient of allergies. Once patients have hit their goal, most need to continue a maintenance dose daily for a lifetime. But in the event of an accidental exposure an allergic reaction will not likely occur, said Vallen. This means less worry, fear, and anxiety, and an improved quality of life.
Vallen said children who undergo the treatment feel less anxious about going out to restaurants, or just going to new places and eating food. They feel safer when they travel. The prospect of getting on a plane and flying somewhere becomes a lot less frightening. There is less social isolation. And parents of children who have been desensitized feel more confident knowing that an allergic reaction will likely not occur with an accidental ingestion.
“The treatment for food allergies has historically been avoidance, and an EpiPen for the accidental ingestion. We see the process of desensitizing as breakthrough, and an important step toward helping families live better lives,” she said.