Science at Work: Finding a Cure for Food Allergies

discovery_medicine_no_65_stephen_c_dreskin_figure_2A child in my area, Natalie Giorgi, died last weekend of the same food allergy that my daughter has (peanut).  My first impulse was to rant and rave about all the people who have died from food allergies, but a few minutes of googling that for gory details had me curled in fetal position and whimpering.  So instead here’s some news about possible upcoming treatments for peanut allergies.  It’s time for…SCIENCE!

Allergies happen when the immune system reacts to a food protein as though it is a threat.  Some allergies can be cured or  lessened by giving the patient very small doses of the allergen, and increasing the dose gradually until the body learns to accept the allergen.  As a kid, I had shots of grass pollen in my arm once a week until I could tolerate being outside in the Spring (I had, as a side effect, developed a strong aversion to doctor’s offices).  The tricky thing with food allergies is that the body reacts so violently to the allergen that it is difficult to desensitize the patient without, well, killing them.  But scientists are getting better at finessing the tiny, tiny doses that they have to start with, and experimental methods are making waves.

I cannot over-stress the fact that current treatments are in trials, and are conducted under immediate medical supervision.  Do NOT try this at home.

Most experimental treatment involve giving the patient proteins by mouth.  In sublingual immunotherapy, the patient holds some liquid containing peanut protein under their tongue for two minutes and then swallows this.  After 44 days of this treatment, patients showed significant improvement, although it was not as high as the experimenters had hoped.

In oral immunotherapy, you swallow some peanut protein, usually a higher amount than is involved with sublingual therapy.  The beneficial effects seem to be greater than those experienced by people who try sublingual immunotherapy, but the side effects are greater as well.

The new exciting thing is a therapy involving wearing a patch.  The patch would contain a peanut protein and gradually desensitize the wearer.  The idea is that because the proteins would be absorbed through the skin, there might not be the side effects that are associated with oral therapies.  It’s also much more convenient to wear a patch as you go about you daily life than to visit the doctor every day for a month and a half or more, as in sublingual therapy.  Eventually you take the patch off, and ta-da!  You are cured.

One research team has been working on a shot, Xolair, that blocks allergic reactions by blocking the antibody that causes the reaction.  Xolair is already approved for treating asthma.  Patients get a series of shots, and then start immunotherapy.  This seems to be helping kids who have extremely severe allergic reactions to many foods instead of a single food allergy.  It seems to work quickly and help with a range of allergens – but the process can be difficult and painful as many kids have mild to sever reactions during the course of the oral immunotherapy.

My daughter’s allergist predicts that we’ll have a cure for peanut allergies that is widely available in about five years.  For the child from my town who died last weekend, that is too late.  I have been blessed in finding nothing but kind support in my family and community, but not all people have been so lucky.  Please support those around you who have food allergies or who are parenting a child with food allergies even if you think they are crazy, or trendy, or over-protective.  Probably some of them are, but most of them aren’t, and our kids deserve the protection of their community.  This quote from The New York Times, by Melanie Thernstrom, does a beautiful job of summarizing the anxiety of being the parent of a child with a food allergy:

Food allergies are a peculiar disease, because most of the time the child is not sick — indeed, she may be bursting with health — but is in omnipresent danger. Statistically the chance of dying is slight. Although the number of emergency-room visits for anaphylaxis caused by food has gone up significantly in the past decade — to as many as 90,000 in a year — only 100 to 200 people die (although statistics are difficult to collect because such deaths are often coded as cardiac arrest). Even for a severely allergic child like Tessa, the mortality rate is estimated at roughly 1 in 1,000, because parents of such children tend to be extremely careful.  But food allergies amplify a kind of fear every parent experiences — of a child dashing suddenly into the street and, just like that, being gone. Your child is always playing near a precipice that is visible only to you: you may be able to keep her from falling off, but you can never move her away from the edge.

My daughter has a great life.  She has a family who adores her and an excellent school.  All her needs are met and quite a few of her wants.  She has every advantage that a middle-class kid can have – and that’s a lot.  There are so many kids who don’t have these advantages, and don’t have even their most basic needs met – not just in other countries, but here, in my country, in my city.  I never forget that.  I never stop appreciating our life and I hope I never stop working to help kids who need so much more than what life has given them so far.

But you know what, Natalie Giorgi had all the same advantages that my kid has, and she still died.  My child has a lot of good things going for her, and yet we live on the brink of disaster all the time.  My child is on a precipice.  Help me keep her from falling.  Thank you.