Untangling the web of symptoms that can signal an allergic
response requires a team with deep knowledge and access to the latest research.
With three locations in the area, Allergy Partners of Fredericksburg gives
families access to the largest physician-owned national allergy and immunology
specialty group. Four local providers and dedicated office staff help guide
children and adults through the journey of diagnosis, treatment and ongoing
management to ensure allergies do not get in the way of enjoying everyday life.
As our March expert, Allergy Partners offers expertise on
food allergies—a problem that impacts an estimated 1 in 13 American children
and 1 in 10 adults, according to Food Allergy Research & Education. This
information comes from Allergy Partners’ four board-certified,
fellowship-trained providers, who see patients from offices in Fredericksburg,
Spotsylvania and Stafford.
How
prevalent are food allergies in American youth, and what are the most common
foods that cause allergic reactions?
Food allergies have
dramatically increased in prevalence over the last 20-30 years. Egg and milk
allergies are the most common. Although 90% of children will eventually outgrow
their egg or milk allergy only 15-20% of individuals will outgrow an allergy to
peanut or tree nuts.
The most common food
allergies include:
· Peanuts
· Tree nuts
· Shellfish
· fish
· Eggs
· Milk
· Soy
· Sesame
What
has changed in recent years about our understanding of how food allergy works,
especially in children?
In the early ‘90s and
2000s, the recommendation was to hold off on introducing potentially allergic
foods until children were much older. During that time, we witnessed a
significant increase in the incidence of food allergies, particularly peanut,
in children. From 2005 to 2015, the prevalence of peanut allergy among children
in Western countries actually doubled, according to a pivotal study known as
the Learning Early About Peanuts—or LEAP—Trial. The LEAP Trial taught us that
children exposed to peanuts early on were significantly less likely to develop
peanut allergy. Consequently, the pendulum has now swung in the other direction
and physicians are now stressing the importantance of early introduction of
foods -between 4 to 6 months of age—as this is felt to represent an
‘immunologic window’ by which to develop tolerance to otherwise allergenic
foods.
How
do you work with families to help them figure out what is causing what may look
like an allergic reaction in their child?
The most important part
in determining the cause of a suspected food allergy is the clinical history or
story. Oftentimes, what a parent or even another doctor might think is a food
allergy can be something else entirely. There are a lot of adverse food
reactions which can mimic food allergy. Additionally, viruses and
vaccines can sometimes trigger rashes and hives which can mimic a food allergy.
The important thing to know about food allergy is that it is consistent and
reproducible meaning that every time you eat that food you are going to see a
reaction. A comprehensive medical history in combination with allergy testing
(skin testing and lab work) is the gold standard for diagnosing and quantifying
a food allergy.
What
is new in 2025 when it comes to treatment options for food allergy?
For patients diagnosed with a food allergy, there are now a
variety of treatment options available. The emerging data on young children is
especially encouraging, with studies showing that earlier intervention produces
a greater chance of long-term remission of food allergy. This is thought to be
due to an increased degree of immunoplasticity within the infant/toddler immune
system when compared to adults. In essence, the younger someone is, the easier
it is to teach their immune systems to be less allergic to a food.
Oral immunotherapy (OIT) is the oldest treatment for food
allergy and involves administering escalating doses of a food allergen to
achieve desensitization. The first report of OIT being used for food allergy
was published over 100 years ago in 1908. OIT targets a relatively large dose
of the food allergen between 300 and 2000 milligrams. For peanuts this would be
equivalent to 3-10 peanuts or a teaspoon of peanut butter. OIT can achieve bite
protection for most patients and can result in some individuals ultimately
being able to freely eat the food. More recently sublingual immunotherapy
(SLIT) has been introduced for the treatment of food allergy. SLIT uses much
lower doses of a food than OIT, typically less than 4mg (about 1/100 of a
peanut), decreasing the potential for adverse reactions. SLIT/OIT hybrid
protocols are also in use and can combine the benefits of both treatment
modalities.
Last, but not least, Xolair, a medication which has been used to
manage allergic asthma in children and adults for two decades, is now approved
for treatment of food allergies in patients 1 year and older. Xolair can very
rapidly, reliably and safely increase the amount of a food that an allergic
patient can tolerate before anaphylaxis occurs. The largest study of Xolair for
food allergy, the OUTMATCH trial, was recently completed at Johns Hopkins and
demonstrated this medication’s safety and effectiveness in adult and pediatric
patients. Xolair can be used in combination with OIT/SLIT desensitization
regimens and is especially ideal for patients who have a combination of food
allergy, hives and asthma.
Overall, groundbreaking progress has been made in the management
of food allergy over the last few years. The benefits of treating food allergy
extend beyond preventing anaphylactic reactions. Studies have shown that
patients with food allergies score higher on measurements of generalized
anxiety. This is understandable when they live in a world where a single bite
of food might result in a trip to the emergency room. These same studies show a
decrease in anxiety scores, after food allergy patients undergo treatments such
as OIT or SLIT. The constantly evolving therapeutic landscape for managing food
allergies, makes it vital that patients with this condition follow up regularly
with a specialist who is board-certified in Allergy and Immunology to determine
what treatment options are best for them.
To learn more or to schedule an appointment for an
evaluation for allergy or immune problems, visit www.allergypartners.com/fredericksburg/.
