Introducing Drug-Based Immunotherapy For Food Allergies

A breakthrough treatment to help children fight against allergens comes just as COVID-19 creates new “challenges” for this patient population. 

For patients who live with chronic food allergies, the positives of social distancing may be subsequently resulting in a dangerous dynamic of social distractions that could compromise their health. Government-mandated stay-at-home quarantines have compounded the general anxiety that people are experiencing during a pandemic that has healthcare experts across the country and around the globe unsure about when mass hospitalizations will end and society’s “new normal” might commence.
Although some of the most recent projections on the death toll and infections as a result of the novel coronavirus (COVID-19) have been lowered as of one month ago, or even one week ago, many of the 32 million Americans diagnosed with potentially life-threatening allergies, are facing consequences such as shortages of safe foods due panicked bulk buying and an inability to easily confirm that food ordered online or over the phone is not cross-contaminated by the overwhelmed food-service industry. 

“My biggest concern is that people are not on their normal ‘food allergy game’ today,” said John Oppenheimer, MD, FAAAAI, chief of allergy at Atlantic Health System in New Jersey and professor of clinical medicine at Rutgers University of Medicine and Dentistry of New Jersey.We’re all cooped up in our homes. People are getting frustrated. People can’t go out to eat, and so they’re ordering in. And so the potential of cross-contamination of food is a big concern.”

It’s but one of various new concerns faced by a population that generally has mounting complicating factors with which to contend with. And this all comes at a time when a groundbreaking new medical therapy should be exploited as a possibly life-altering approach to care.

FDA Approves 1st Medical Immunotherapy

Consistently reliable solutions for the treatment of food allergies have evaded patients and their families over time, making the condition especially trepidations for parents of young children who are afflicted by the illness. There aren’t any truly reliable diagnostic testing options, with both skin testing and blood testing accounting for a 50 percent false-positive rate, according to Oppenheimer. 

Because such tests are frequently inconclusive, today’s allergy specialists often engage the practice of oral food challenges in children, a method of attempting to confirm or rule out allergies in kids by feeding them small quantities of that food and gradually increasing the amount under medical supervision during a scheduled office visit. These challenges are scheduled only after a child has exhibited some form of suspected allergic reaction to foods, which typically manifests in rashes, hives, and/or abdominal pain and diarrhea when exposed to certain foods at home. By observing the incrementally ingesting of food and potential reactions as the food is progressively eaten, the existence of an allergy versus an intolerance (or sensitivity), which is defined as having difficulty with digesting particular foods, which can result in similar allergy symptoms minus the chance of anaphylaxis. Oral immunotherapy (OIT) has also become a utilized strategy in which a known allergen is permitted to be given to children in small quantities every day at home before gradually increasing the amount under medical supervision with the goal of desensitizing the child to the allergen over time.  

As of Jan. 31, the U.S. Food & Drug Administration (FDA), approved of the prescribing of  Palforzia,TM an oral immunotherapy indicated for the mitigation of allergic reactions associated with exposure specifically to peanut, which is one of the eight most common food allergens, along with dairy, egg, fish, shellfish, tree nuts, wheat, and soy, according to the American Academy of Allergy, Asthma, and Immunology. The first form of medical OIT approved by the FDA, is approved in patients ages 4-17 years old who have a confirmed diagnosis of peanut allergy. The drug is taking in capsule form and contains a powered peanut protein that’s increased in dosage as the patient successfully consumes the OIT over time. 

Complicating Challenging Factors
Of course, the presence of this new therapeutic option is not absent with concerns that come with new drug modalities. Additionally, however, and more precarious, is the issue that the overcrowding of the nation’s emergency departments (EDs) renders food challenges and new drugs somewhat obsolete. The risk of a patient requiring an ED visit due to a serious allergic reaction is too serious a problem that is only intensified with the chance of exposure to COVID-19.

“This is not the time to overrun an already taxed system [with food allergy patients],” said Oppenheimer. Food challenges are elective procedures, and if you look at the risk-benefit at this point, the advice is that people hold off from having them done for their children until the health system is not so taxed with COVID patients.”

Instead, Oppenheimer said that specialists are warning people who are food allergic, and parents of children who are food allergic, that this is more so a time to be more vigilant about allergies on a daily, lifestyle basis as they remain quarantined and subject to being outside the typical “comfort zones” that they’ve likely become accustomed to. This is especially crucial during times when food is being prepared from outside the home.

“The most important thing is reminding patients that they need to have a conversation with whoever is making their food,” Oppenheimer said. “When you can talk to the person you’re ordering from – tell them that you or your child has a life-threatening food allergy and that you need confirmation from the chef that allergens are not in that food. We need to remind people that the EDs are overwhelmed right now with COVID-19 patients, and that puts people at risk with even being there. If the person who’s taking that order can’t confirm that they feel comfortable in achieving your goal, then don’t get that food.”

As for the future of immunotherapy, Oppenheimer is hopeful that time will allow for more clarity sooner rather than later. “The hope is that we’re going to have more options for people with food allergies in the future,” he said. 

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