For decades, the advice doctors could give food allergy sufferers and their parents has been simple, but somewhat unhelpful: Avoid the allergen, because there’s nothing we can do to fix the allergy.
Now, that may be changing. Immunotherapy for food allergies, in which the immune system is trained to tolerate allergens, is being tested in two major studies with the Food and Drug Administration in conjunction with the UNC Food Allergy Initiative and other leading research centers. The FDA immunotherapy studies have been fast-tracked in response to the growing problem of food allergies among children. (While the research now is focused on children, and especially very young children, immunotherapy could benefit adult allergy sufferers as well.)
If immunotherapy is approved for allergy treatment, it could be available in the next three years or so, says Edwin Kim, MD, director of the UNC Food Allergy Initiative. Dr. Kim works closely with Wesley Burks, MD, one of the first to publish on oral immunotherapy.
“We’re getting closer and closer to having a product on the market,” Dr. Kim says. “This is not quite ready for prime time, but it could be soon.”
The research studies are testing the safety and efficacy of two types of immunotherapy for peanut allergy. The first, oral immunotherapy, involves mixing peanut flour into a “vehicle food” for patients to eat. Then there’s the immunotherapy patch, which is a bandagelike application containing the peanut allergen that is placed on the skin. At UNC, researchers are also testing sublingual immunotherapy, which involves placing a small amount of liquefied peanut extract under the tongue. (There’s good news for kids who hate or fear the taste of peanuts: The extract tastes like cold medicine.)
All these methods have been shown to retrain the immune system to tolerate the allergen, but the effect is often temporary and the treatment must be administered daily, Dr. Kim says. It is likely to take several years of treatment to achieve long-lasting changes to the immune system.
Dr. Kim advises that private allergists and pediatricians not offer immunotherapy independently before FDA approval. The amounts given are specifically formulated for protein count, and reactions are rare but possible. Parents administer most of the therapy to kids at home, and they are counseled extensively on what to do in case of reactions. Fortunately, reactions are rare and tend to be mild, Dr. Kim says, such as itchiness around the mouth or a rash or stomachache.
“It can be scary for patients, but what we have discovered over 10-plus years is that this treatment, when done properly, is extremely safe,” Dr. Kim says.
Edwin Kim, MD, MS, is an allergist at the UNC Allergy and Immunology Clinic in Chapel Hill and an assistant professor of allergy and immunology at the UNC School of Medicine. He is also the director of the UNC Food Allergy initiative.