Reliable Tests for Food Allergy Diagnosis

Skin tests and blood tests are the standards for initial diagnosis of food allergy. Unfortunately, neither are very reliable. I don't know about you, but when the doctor calls and starts reading off blood test results to me, I hang up the phone feeling more confused than ever. If the "almond number" rose from 2 to 15 in the past year, is my child way more allergic to almonds now than last year? What does, "off the chart for dairy" mean?  I've never felt like these numbers give me helpful information.

While the "gold standard" for diagnosing food allergy is the food challenge, it is helpful to have accurate information going into the challenge.

Christopher Love, an MIT engineer, is on the trail of a more precise way to measure food allergies in a blood test. His new technology, recently reported in Lab on a Chip, can analyze individual immune cells. Instead of detecting antibodies, like the current blood test does, Love's system screens the patient’s immune cells for small proteins known as cytokines. Immune cells such as T cells produce cytokines when an allergic response is initiated, attracting other cells to join in the response. Those cells are then exposed to the potential allergen for a precise measurement.

Research continues and human trials are the next step, but I'm hopeful that Love's work will allow those of us who deal with food allergies the abilibty to make better ecisions based on helpful and accurate information.

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Common Sense for Food Allergies

I heard on the news this morning that a recent study in the Archives of Pediatrics & Adolescent Medicine shows that changing to a later start time for high school students is good for adolescents.

 Makes perfect sens to me. Years of research has shown that the body clock during the teen years shifts to going to bed later and getting up later. We know this and should use this information wisely.

What does this have to do with food allergies, you may ask?

Well, this study seems like common sense to me. I don't believe we've used common sense for food allergies. Allergic to pollen? Get regular injections of minute doses of pollen to desensitize the body to pollen. Allergic to milk? Avoid it forever.

I've never thought that made sense. We do it in our house because that's the doctor's orders, but it doesn't seem like good common sense. Since getting the blood test results for my allergic child last week, I'm even more convinced. After 10 years of strict avoidance of multiple foods, all numbers are up- by a lot. My child is not out-growing any of these allergies. As a matter of fact, things are heading in the wrong direction.

This isn't good enough any more. I'm hopeful about  a cow's milk immunotherapy study published recently in the Journal of Allergy and Clinical Immunology. This study involved placing cow's milk protein on unbroken skin in an effort to desensitize people.

Just yesterday, DBV Technologies got the go-ahead from the FDA to begin human clinical investigation of peanut desensitization. Trials begin this month in six medical centers in the U.S.

Avoidance isn't working. Desensitization makes common sense when it comes to food allergy. I recognize there are risks involved and I certainly do not recommend desensitization at home right now. But, let's all keep talking to our allergists and pushing for something better than "strictly avoid".

Stay tuned. We're starting to use common sense in food allergy treatment.

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Food Allergy Cure With an Apple a Day?

The Journal of the British Society for Allergy & Clinical Immunology reports on a promising study with implications for food allergy. Egg allergic mice were fed a polyphenol-enriched apple extract and then underwent a food challenge for egg. The results showed the apple extract reduced allergy symptoms. A polyphenol is an antioxidant that occurs naturally in some plants and tends to prevent or neutralize the damaging effects of free radicals.

The role of polyphenols is also being studied in peanut allergy.

I don't claim to understand it, but I like it. The hope is for human trials to be conducted after the positive results of the mice study.

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Low Allergy Peanut on the Way

US researchers have been able to remove some of the compounds in a peanut that cause allergic reactions. US Professor Soheila Maleki, from the Agricultural Research Service, presented preliminary findings at the European Academy of Allergy and Clinical Immunology last Monday. Professor Maleki says they hope eventually to breed a peanut that will "lessen the development and the severity of the allergic response to peanuts".

You can read a summary of the project. Two thumbs up on this one!

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Food Allergy Research Findings Presented at Conference

The AAAAI (American Academy of Allergy, Asthma and Immunology) wrapped up its annual conference last week. Food allergy was the center of several prominent studies. Here is a re-cap of some of the big ones:

Oral Immunotherapy shows Promise for Egg Allergy- Early results from this study show that egg allergic children may be able to tolerate eggs following a course of ingesting increasing amounts of egg protein. Of course this has all been done in a carefully controlled setting and should not be tried at home. More about that in the video link at the end of this post.

Milk Allergic Children Tolerate Milk heated at high temperatures. The study shows that up to 80% of milk allergic children may be able to eat baked products like cookies and cakes containing milk. Something seems to change within the milk protein when it is heated at a high temperature. Research in this area continues.

Anaphylaxis to Meat is more common than originally thought. The message is that clinicians should investigate whether or not there is a meat allergy when there are unexplained allergy symptoms. In meat allergy, the allergic reaction is to the sugar in the meat, not the protein. This is the first food allergy to stem from sugars. The research shows that meat allergies tend to develop in adults who have tolerated meat all their lives, then, possibly due to a bee sting or tick bite, suddenly become meat allergic.

An Oral Immunotherapy for Peanut Allergy study revealed that children receiving increasing amount of peanut powder, could tolerate 20 peanuts after 10 months of treatment. A different three year study showed a significant number of children who were able to stop immunotherapy and can now eat peanuts successfully.

Check out this video from the conference about when oral immunotherapy may be ready to be used as a regular treatment for food allergy.

When you next visit your allergist, ask about these studies and how they may relate to your situation. I am glad to see that research is moving ahead, but I am also reminded that we have a ways to go before we can say food allergies are curable.

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The History of Peanut Allergies

There has been much speculation about the alarming increase in the number of people with peanut allergy. Over and over I hear people say, "I didn't know anyone with a peanut allergy when I was growing up and now most kids seem to be allergic to peanuts". Many of us have wondered what's happening to cause so many children to become peanut allergic.

Author and historian Heather Fraser, wondered the same thing. After extensive research, Heather has put her findings in a book due out later this month, The History of the Peanut Allergy Epidemic.

I recently had the opportunity to ask Heather some questions about her research and interest in this subject. Read on, it's fascinating...

What compelled you to write a book about the history of peanut allergy?

I am the mother of a peanut/tree nut allergic child and an historian trained in academic research. Over a year ago, I began to read in-depth about the history of food allergy. I learned about Charles Richet, who coined the term "anaphylaxis" (c.1913) and Clemens von Pirquet who in 1906 called these altered reactions "allergy". I combed the literature and discovered that outbreaks of peanut allergy began to occur only after WWII. The medical literature revealed a slow but noticeable growth of the allergy in children through the late 1960s up until the late 1980s. Around 1990, there was a sudden explosion of this allergy just in toddlers. This moment of acceleration is well-documented by ER records, cohort studies of the time and eyewitness accounts. Society finally noticed that something was wrong when these kids showed up for kindergarten. The sudden surge of peanut and food allergic kids took everyone by surprise -- school systems, teachers, parents, communities.

I knew that this story would be important to parents of peanut allergic children. We are living in something of an information vacuum.

Was it difficult to track down research on this topic?

No. It was not difficult at all, but it was time consuming. The events that led up to the epidemic of peanut allergy in children unfolded in plain sight – medical journals, newspapers, magazines, and books all document what took place.

The History of the Peanut Allergy Epidemic pinpoints the precise moment of the allergy’s appearance and describes the perfect storm of social, medical, political and economic factors from which it has grown. My thesis, regarding the precipitating cause of the peanut allergy epidemic will challenge every parent. I hesitate to cut to the chase because a full appreciation of the causes should be revealed gradually within the context of over 100 years of history. Otherwise, the conclusion may come as too big of a shock to the reader – my goal is to get people thinking and talking about the peanut allergy from a new direction -- which is, how we as a society have created this epidemic.

A 2010 statistic from Australia shows that now 3% of school aged children have peanut allergy – this ballooning PA population has developed in just 20 years. All stats show that UK has been the worst hit by PA followed by parts of Australia, Canada, Sweden, the US. I would expect our numbers to be similar to those in Australia (ACT).

What was the most surprising thing you learned about peanut allergy while researching The History of the Peanut Allergy Epidemic?

I discovered that I had defined anaphylaxis too narrowly. After reading Margie Profet’s The Function of Allergy: Immunological Defense Against Toxicity (1991), everything began to make sense.

According to Profet, anaphylaxis is a potentially deadly but evolutionarily programmed response to toxins/proteins that have penetrated first lines of natural defense and managed to enter the blood stream. All mammals exhibit anaphylaxis and have IgE. There is a debate in the medical literature over whether allergy is the outcome of a roulette style genetic predisposition to immune dysfunction OR is allergy an innate, purposeful immune response. It came as a surprise to me that allergy should have a function. The function is to protect the body against acute toxicity – the sneezing, itching, vomiting, diarrhea are attempts to eject a toxin as fast as possible; the drop in blood pressure to prevent the toxin from circulating to vital organs.

And researchers know “how to” create anaphylaxis – they create the condition regularly and easily in mice and other animals in labs. Richet created anaphylaxis time and again in his raw meat experiments with dogs and other animals over 100 years ago. None of the functional mechanisms of sensitizing a mammal are new to medicine. What seems to have happened today is that we have lost the threads and landmarks of the story as a whole. My book attempts to bring back the history and answer the question: how did millions of people, especially children, in the last 20 years become allergic to this one food? Although my conclusions are meticulously if not obsessively documented, they may still be difficult to accept.

What is the take-away you hope people will get after reading the book?

I hope to get parents thinking and talking about peanut allergy in more complete and broader terms than we do now. It is not a coincidence that hundreds of thousands of toddlers became allergic to the same food, at the same time, around 1990, and in just certain countries. Something precipitated and continues to cause this allergy almost exclusively in children – and more in boys than girls in a 2:1 ratio.

Where can people learn more about the book?

Visit http://www.peanutallergyepidemic.com for a time line and a first chapter free download. Next week I will begin selling copies of the book from the site via credit card (Visa®).
There is a contact form at the website and I do have advance copies of the book available. Feel free to contact me with any questions.

We've all been wondering. Heather's research will now give us some of the answers. I couldn't help but shake my head as I read the first downloaded chapter. I had no idea...

Buy a copy for yourself, your allergist, the school nurse and your peanut allergic child. This book will clear up many questions and will, no doubt, have you shaking your head too.

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Many Diagnosed With Peanut Allergy may Not Be Allergic

A study was recently conducted to determine if those patients who test positive for peanut allergy through a blood or skin test could really tolerate peanut. Of the 933 children who tested positive for peanut allergy, the majority didn't have a peanut allergy when orally challenged. Isn't that something????

Now, this is not something to be tried at home; however, it may be something worth discussing with your allergist. I know that my peanut allergic child has never had peanuts, nor has he been orally challenged to peanuts. We're just going with the allergy on the basis of blood and skin test results.

In the same study in The Journal of Allergy and Immunology also used component-resolved diagnostics (a more sophisticated blood test) to determine if they could find differences between the children with peanut allergy and those who could tolerate peanut. Researchers determined that component-resolved diagnostics may indeed help in determining whether or not a person truly is peanut allergic.

I'm finding this all very interesting. I don't want to put my child through inaccurate tests. I really want to know if a food is dangerous for him or not!

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