House CallJun/Jul 2013 Issue

Allergies Q & A- Seasonal Allergies, Oral Desensitization, & More!

Medical experts answer your questions about allergies and sensitivities

© Shestakoff/Shutterstock

© Shestakoff/Shutterstock

Global Warming

The unusual weather in the past few years seems to be making my seasonal allergies worse. Is this my imagination?

Dr. Leo Respected aero-allergist/biologist Richard W. Weber, MD, the current president of the American College of Allergy, Asthma and Immunology, recently noted that climate change has impacted traditional allergy season, not just here in the United States but across the world. This overall warming trend has not only prolonged pollination season, but invasive (non-traditional) plants are now growing in areas where they historically hadn’t taken root before. Furthermore, scientists are noting trends that plants are pollinating with more intensity due to these changes. All this directly affects those with seasonal allergic rhinitis and asthma. Clinicians report that they have been seeing more significant systemic attacks in their patients over the past several months.

Oral Desensitization

I’m hearing great things about oral desensitization for treating severe food allergies and wanted to know when this would be available to the public. My 2-year-old son has been diagnosed with multiple food allergies, including milk, egg and several nuts.
Dr. Leo Several large studies on oral desensitization to cow’s milk, hen’s eggs and peanuts in food-allergic children have been published and presented at major medical meetings. The mainstream press is now reporting on these significant advances in food-allergy research. Although oral desensitization appears to benefit certain food-allergic children, the research on this treatment is far from decisive and many questions remain.   

Recently, Robert W. Wood, MD, professor of pediatrics and chief of pediatric allergy and Immunology at Johns Hopkins Children’s Center, presented research findings from a cohort of children who were orally desensitized to cow’s milk. He noted that a fair number of these children relapsed several years after the procedure was completed. Initially, many children appeared to tolerate milk in many forms but after some time (up to a few years later), the children would re-develop symptoms and had to avoid the offending food (in this case, milk).  
Other studies have noted the appearance of eosinophilic esophagitis in food-allergic children who have undergone oral desensitization. At this time, researchers don’t know if this occurred as a result of the procedure or as a natural process that would have developed regardless.

Despite the excitement, researchers feel that further study is needed before oral desensitization is used clinically to treat large groups of food-allergic children.

Allergy Cure?

Back in March, The New York Times published an article about severely allergic kids undergoing oral immunotherapy in clinical trials conducted by Kari Nadeau, MD. These kids seemed to be cured of their allergy. Dare we hope?

Dr. Pistiner This eloquently written, powerful article captured what a few very brave children and their families are going through. This clinical trial is exciting and shows great promise—but it’s still experimental. As with similar trials, it is not a proven treatment. Safety, effectiveness and other issues still need to be determined.

For now, what we do know is that prevention and emergency preparedness must be implemented at all times and in all situations. It’s important to emphasize that food allergies can be managed. Kids need to live in the here and now and parents need to help them become empowered and confident. Everyone should keep their eye on the prize, which is having happy, healthy kids who happen to have a food allergy. We all have an opportunity to have that right now. Looking to the future is really great—and it’s exciting to know there’s potential treatment—but at the same time being happy, healthy, and well adjusted is really important and needs to be priority number one.

Study Participation

Can I enroll my child in one of these trials?

Dr. Lee Given the limited number of clinical trials and the very large number of children with food allergies, only a tiny percentage of kids can enroll in these trials. The researchers who run these trials strongly emphasize that oral immunotherapy is not ready for prime time and that there is still much to learn. All hospitals have Institutional Review Boards who carefully vet these studies. They ensure studies do not place too much stress or risk on participants. Safety should be paramount in clinical trials, particularly in pediatric research. Any research trial involving children should meet a very high ethical standard before it is undertaken.

Oral desensitization is promising. I tell families that even though they may not be able or eligible to enroll in one of these trials, I believe these therapies will be available to them in the not-too-distant future.

No Shots!

My child has very bad seasonal allergies and is terrified of shots. In the past, I was told that sublingual immunotherapy was not available in the United States. Have there been any advances?

Dr. Leo Recent solid studies support the efficacy of sublingual immunotherapy as a viable treatment for some forms of seasonal allergy. (Sublingual immunotherapy is a procedure where small doses of an allergen are placed under the tongue to desensitize the patient over time.) Studies of allergic children reveal that many significantly benefitted from this treatment, showing reduced symptoms and very few side effects.

Sublingual immunotherapy works well for those who have a single seasonal allergy, i.e., grass. It holds promise but it is not yet approved by the FDA and it will likely be a few more years before the FDA fully reviews it. In the meantime, talk to your child’s allergist about the options. Traditional allergy shots (sub-cutaneous treatment) are now routinely offered in most allergy clinics across the country. In time, there will be other options available.

Bright Side

Are there any positive aspects to having food allergies and sensitivities?  

Dr. Pistiner Most definitely. As a pediatric allergist and the father of a child with food allergies, I believe having a food allergy can strengthen important skills. It is true that having a food allergy or sensitivity complicates social activity and can make spontaneity difficult. But with the negatives comes the positives. Food-allergic children and their siblings take on some responsibilities that other children don’t, teaching children a sense of responsibility, accountability and self respect. They must be cognizant of taking good care of themselves, of making healthy choices and developing healthy habits. They grow up really knowing and respecting their bodies. They learn how to ask for what they need, how to get their needs met and how to plan and prepare for every situation.  

To help families achieve these goals, I’ve had the honor to co-author a free, easy-to-read, downloadable handbook, Living Confidently with Food Allergy. This book for U.S. and Canadian audiences contains practical strategies and teaching tips to empower children and their parents. It’s available at anaphylaxis.ca and AllergyHome.org.

Harvey L. Leo, MD, is a board-certified pediatric allergist with Allergy and Immunology Associates of Ann Arbor and an assistant research scientist with the Center for Managing Chronic Disease at the University of Michigan.
John Lee, MD, is a board-certified pediatric allergist with Boston Children’s Hospital where he serves as co-director of the Eosinophilic Gastrointestinal Disease Program. He is clinical instructor of pediatrics at Harvard Medical School.
Michael Pistiner, MD, MMSc, is a board-certified pediatric allergist with Harvard Vanguard Medical Associates and an instructor of pediatrics at Boston Children’s Hospital. Lee and Pistiner are creators of AllergyHome.org, a free website dedicated to educating others about allergic diseases.

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