New Developments in Food Allergy Presented at International Conference

Newswise — Reports on progress in the diagnosis and management of food allergies, and promising new treatments under investigation are highlights presented at the XI International Food Allergy Symposium, Nov. 6, preceding the Annual Meeting of the American College of Allergy, Asthma and Immunology (ACAAI).

Food allergy, which affects about 2-5 percent of the U.S. population, is the single leading cause of anaphylaxis according to studies discussed at the conference. It is estimated that food allergy accounts for about 30,000 systemic anaphylactic reactions, 2,000 hospitalizations, and as many as 200 deaths in the United States each year.

Recent reports indicate the most common triggers of food-induced anaphylaxis in children and adults are peanuts, tree nuts, shellfish and fish. Additional triggers in children which are commonly outgrown are milk, egg, soy and wheat. The number of peanut sensitized individuals doubled in the last ten years.

Anaphylaxis is the most severe form of allergic reactions, affecting multiple organ systems. Symptoms can include chest tightness, wheezing, nausea, vomiting, cramping, hives and swelling of the lips and joints. The most dangerous symptoms are breathing difficulties, throat swelling, chest wheezing, dizziness, low blood pressure, shock and loss of consciousness, all of which can be fatal.

Currently, there is no radical treatment for food allergies, so allergic individuals must strictly avoid the offending food and its products. Patients with severe reactions should have continued access to self-administered epinephrine injections.

"Scientific investigations discussed at this conference demonstrate how fear of accidental exposure can significantly impact the quality of life for food-allergic individuals and their families," said program co-chair Sami Bahna, M.D., DrPH, professor of pediatrics and medicine, and director, Allergy & Immunology Training Program, Louisiana State University School of Medicine, Shreveport, La.

"Food allergic individuals must not only be vigilant in checking ingredients of foods, but they must be aware of potential hidden allergens from food processing, accidental exposure in meals prepared outside the home, and reactions caused by cross-reactivity with similar foods or even with rubber latex or pollens."

"We are also discussing the roles of the gut immunity and probiotics in the development of food allergy, the recent advances in testing for food allergies, and several new promising modalities under investigation for food immunotherapy. Because of the strong relationship between atopic dermatitis and food allergy, a whole session has been assigned to this subject," Dr. Bahna said.

Current issues in food allergens

Allergens may be unintentionally added to food as a result of manufacturing practices such as incorrect packaging of allergen containing products, replacement of ingredients without updating the food label and through use of shared lines and/or equipment that has not been sufficiently cleaned according to a presentation by Stefano Luccioli, M.D., senior medical advisor, Office of Food Additive Safety Center for Food Safety and Applied Nutrition, FDA, College Park, Md.

Relevant issues in the evaluation of food allergens that have been and are currently facing the FDA are predicting novel proteins in bio-engineered foods that will be allergenic to the general population or a subset of the population, and identifying the threshold doses for proteins known to induce IgE-mediated responses.

In his discussion on clinical tolerance of processed foods, Alessandro Fiocchi, M.D., director of pediatrics, Melloni University Hospital, Milan, Italy, concludes that many different processes, such as washing, mincing, dry heating, steam cooking, boiling, canning, under various conditions of atmospheric pressure can impact food allergenicity. Heating, freezing, storage conditions and maturing of foods can also modify their allergenicity and be relevant to the everyday care of children with food allergies.

Current investigations in genetic modification have demonstrated the ability to produce safer allergy vaccines and hypoallergenic foods according to Samuel B. Lehrer, Ph.D., Research Professor of Medicine, Tulane University Health Sciences Center, New Orleans. Technological advances in genetic modification can result is less expensive, healthier and hypoallergenic foods.

Concerns with the health effects and environmental impact of the new technology have led to a global process whereby companies and regulatory agencies apply principles of allergen assessment to identify potential allergy risks.

Promising treatment modalities

The benefit-to-risk ratio for traditional immunotherapy is unacceptable, but several novel immunotherapeutic strategies are being examined as treatment for food allergy according to Hugh A. Sampson, M.D., professor of pediatrics & immunobiology, director, General Clinical Research Center, at Mount Sinai School of Medicine, New York. Therapies currently under investigation for food allergy include humanized anti-IgE monoclonal antibody therapy; engineered allergen protein immunotherapy; peptide immunotherapy; plasmid-DNA immunotherapy; cytokine-modulated immunotherapy; and traditional Chinese herbal medicine.

The gastrointestinal mucosal immunopathology in food-sensitive patients was presented by Joseph Bellanti, M.D., Professor of Pediatrics and Microbiology/Immunology, and Director of the International Center for Interdisciplinary studies of Immunology at Georgetown University Medical Center, Washington, DC. Although much progress has been made in the field of IgE-mediated food allergy, recent studies suggest a role for non-IgE-mediated food allergy.

Probiotic therapy, presented by Jon A. Vanderhoof, M.D., chief, Section of Pediatric Gastroenterology, University of Nebraska Medical Center, Omaha, Neb., is a novel approach using a healthy, live microbial food ingredient. Current investigations demonstrate its effectiveness in the treatment of inflammatory and allergic disorders including acute, severe dehydrating diarrhea and use in gut inflammatory disorders. Probiotics appear to be safe, even for infants.

The ACAAI is a professional medical organization, headquartered in Arlington Heights, Ill., comprised of 4,963 qualified allergists-immunologists and related health care professionals. The College is dedicated to the clinical practice of allergy, asthma and immunology through education and research to promote the highest quality of patient care. ACAAI conference information is available at http://www.acaaiplanner.com