Emberley 1
W. Conor Emberley
Prof. Theresa Walsh
11/24/13
UWP 1 2:10-4:00 MW
Assignment #4 Draft #1
Introduction
Food allergies are defined as “an adverse immune response to food proteins,”
and affects upwards of 6% of young children and 3%-4% of adults with their
occurrence becoming more and more common. 1 An array of foods can be linked to
food allergies making it a difficult disease to treat. There have been numerous
efforts in search for a possible cure, but a definite solution for food allergies has yet
to be found. There are many possible treatment options; it is a mater of finding the
most effective one. Food allergies present a growing problem because the numerous
tested short-term and long-term treatments have yet to provide a cure. This paper
will discuss and analyze different tested treatment methods for food allergies. It will
focus on each of the specific treatment option’s strengths and weaknesses. I will
limit my discussion to the most recent treatments tested for food allergies starting
from 1999.
A Discussion on Food Allergies
The broad term food allergies are difficult to define. Food allergy is in part
genetically determined.2 For example, a peanut allergy is about ten times more
Scott K. Sicherer, Hugh A. Sampson. Food Allergy: Recent Advances in Pathophysiology and Treatment, (Annu.
Rev. Med. 2009). pg 261.
2 Sicherer, Sampson. Food Allergy: Recent Advances in Pathophysiology and Treatment. Pg. 262
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likely appear in a child who shows evidence of peanut allergies in their family
compared to a family that shows no evidence of past peanut allergies.3 This means
that food allergies can be passed on from generation to generation.
Many types of foods can be linked to allergic responses. Foods like eggs,
peanuts, tree nuts, fish, shellfish, wheat, and soy are the most common foods.
Although these are not the only one, almost any food can cause an allergic
response.4 To put into perspective food allergies breadth, almost every single food
can invoke a different disorder. Disorders like Urticaria, Oral allergy syndrome,
Asthma, Anaphylaxis, Atopic dermatisis, Dietary protein enterocolitis, and Dietary
protein proctisis are the most common.5 While each is provoked by a different food,
they can all be classified as food allergy type disorders.6
Another distinction is the difference between “true food allergies” and “food
intolerances.”7 A true food allergy provokes a heightened response of the immune
system to components found in certain foods. Causing both “delayed
hypersensitivity reactions” and “immediate hypersensitivity reactions”8 As the
name infers, a delayed reaction is delayed, taking twenty-four hours or more to
show symptoms. An immediate reaction shows symptoms from any where between
just minutes to an hour.9 Food intolerances are a reaction to foods that don’t involve
the immune system. Individuals with a food intolerance are able to consume small
Sicherer, Sampson. Food Allergy: Recent Advances in Pathophysiology and Treatment. Pg. 262
Sicherer, Sampson. Food Allergy: Recent Advances in Pathophysiology and Treatment. Pg. 266
5 Sicherer, Sampson. Food Allergy: Recent Advances in Pathophysiology and Treatment. Pg. 263
6 Sicherer, Sampson. Food Allergy: Recent Advances in Pathophysiology and Treatment. Pg. 263
7 Steve L. Taylor, Ph. D. and Susan L. Hefle, Ph. D. Food Allergies and Other Food Sensitivities. Vol. 55, No. 9
(Institute of Food Technologists’ Expert Panel on Food Saftey and Nutrition, 2001). Pg. 69
8 Taylor, Helfe. Food allergies and Other Food Sensitivities. Pg. 69
9 Taylor, Helfe. Food allergies and Other Food Sensitivities. Pg. 69
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amounts of the food, but too much will cause a reaction.10 The assumption that true
food allergies are more serious than food intolerance can be made. Mere contact
with the allergenic food will cause a response for a true food allergenic individual. In
contrast an individual with food intolerance is able to consume small amounts of the
allergenic food and still be fine.
The preparation method of foods can cause allergens to be more prominent.
Comparing China and the United States, its peanut consumption is nearly equal.
That being said more people have peanut allergies in the United States than China.11
The reason is because in the United States peanuts are roasted compared to China
the peanuts are boiled or fried. The increased heat from roasting peanuts causes
heightened allergenicity.12
Now that we have a solid footing on food allergies, lets discuss some
potential treatment methods.
Oral Immunotherapy Treatment
A common potential treatment that is being tested is the oral desensitization
technique. Though the use of oral desensitization is a controversial method. The
reason being, it involves oral ingestion of the specific allergen that relates the
allergy of a patient.13 A study done by Patriacrca and Nucera and their colleagues,
shows a good example of oral desensitization’s effectiveness. Their study enrolled
Taylor, Helfe. Food allergies and Other Food Sensitivities. Pg. 77
Sicherer, Sampson. Food Allergy: Recent Advances in Pathophysiology and Treatment. Pg. 266
12 Sicherer, Sampson. Food Allergy: Recent Advances in Pathophysiology and Treatment. Pg. 266
13 G. Patriarca, E. Nucera, C. Roncallo, E. Pollastrini. Oral Desensitizing Treatment in Food Allergy: Clinical
Immunologicl Results. (Blackwell Publishing Ltd. 2003). Pg 459.
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fifty-nine patients, a mix of both children and adults.14 Oral desensitization was
performed on the patients over the course of eighteen months. The method for oral
desensitizing is administering progressively larger amounts of the allergen to the
patient every day over the course of a period of time. The fifty-nine patients differed,
twenty-nine were allergic to milk, fifteen to eggs, three to albumin, eleven to fish,
two to oranges, and six to either peanuts, corn, peaches, apples, lettuce, or beans.15
What they found was, out of all the patients, 83.3% were successfully desensitized
from their corresponding allergenic food. In the other 16.7%, treatment had to be
stopped because the patients experienced abdominal pain and skin rashes. Another
thing they concluded was that there was no difference between adults and children.
16
The Patriarca and Nucera study is just one example many involving the technique
of oral desensitization. The diversity in their patients is what makes their results
more reliable; multiple allergenic food allergies were tested. Based on the high
success rate shown in this study, oral desensitization looks like a very strong
candidate for becoming a potential treatment for food allergies. It has its drawbacks
though. The nine patients who weren’t successfully treated suffered through
urticara and gastronomical symptoms.17 While their results do show some
promising results, it it’s important not to overlook the side effects shown by patients
G. Patriarca, E. Nucera, C. Roncallo, E. Pollastrini. Oral Desensitizing Treatment in Food Allergy: Clinical
Immunologicl Results. Pg. 459-465
14
15 G. Patriarca, E. Nucera, C. Roncallo, E. Pollastrini. Oral Desensitizing Treatment in Food Allergy: Clinical
Immunologicl Results. Pg. 459-465
16 G. Patriarca, E. Nucera, C. Roncallo, E. Pollastrini. Oral Desensitizing Treatment in Food Allergy: Clinical
Immunologicl Results. Pg. 459-465
17 G. Patriarca, E. Nucera, C. Roncallo, E. Pollastrini. Oral Desensitizing Treatment in Food Allergy: Clinical
Immunologicl Results. Pg. 459-465
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in their study. For that reason, oral desensitization needs refinement and further
testing before it can be administered to the public.
Sublingual Immunotherapy Treatment
Sublingual Immunotherapy is another immunotherapy treatment method
being investigated. Comparatively, sublingual Immunotherapy involves
administration of the allergen under the tongue, compared to ingestion.18
In study performed by Enrique, Pineda, and colleagues, they tested the
effectiveness of the sublingual immunotherapy treatment technique on patients
with hazelnut allergies. Their experiment tested a sample size of forty-one patients,
all with a confirmed history of hazelnut allergy.19 Again the difference between
sublingual and oral immunotherapy is, sublingual involves administration under the
tongue as apposed to ingestion.
The forty-one patients were given doses of hazelnut extract over the course
of a couple months. Progressively receiving a higher and higher dose as time went
on. Their results are promising, over 50% of the patients in the study were able to
tolerate the highest dosage, which is equivalent to about fifteen hazelnuts. In the
other patients, there were side effects; they experienced gastrointestinal symptoms
and abdominal pain. While these side effects aren’t serious, they can’t be overlooked
as they caused major discomfort for those patients.20
The point of immunotherapy is to help the patient build up a tolerance to the
allergenic food so that in the case that they were to accidently ingest a small amount
Ernesto Enrique, MD, PhD, Fernando Pineda, PhD. Sublingual Immunotherapy for Hazelnut
Food Allergy. (J Allergy Clin Immunol, 2005). Pg 1073.
19 Enrique, Pineda. Sublingual Immunotherapy for Hazelnut Food Allergy. Pg. 1075.
20 Enrique, Pineda. Sublingual Immunotherapy for Hazelnut Food Allergy. Pg. 1075.
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it wouldn’t be harmful. With that in mind, I feel the Enrique and Pineda experiment
shows sublingual immunotherapy’s potential for success. While their experiment
shows promising results, they state clearly in their concluding remarks,
“Nevertheless, further studies and others on the long-term efficacy of SLIT with food
extracts are required”21 The search for a cure for food allergies is ongoing. While
oral and sublingual immunization techniques showed to be effective in some
patients, they showed significant side effects in other patients. They can’t be claimed
as a solution because of their side effects meaning further research and testing is
needed.
Self-Administered Epinephrine
Food allergies have the potential to be life threatening. Food allergies are the
most common cause for anaphylaxis, an allergic response that can become fatal.22
The immediate treatment for someone entering anaphylactic shock is epinephrine,
commonly delivered by an administering device called an EpiPen.23 It’s an
important tool for the immediate treatment of an allergen-induced reaction. It can
be life saving in the event of accidental contact. Because food allergies are provoked
by contact with allergenic food, the responsibility is placed on the individual with
the allergies to avoid contact at all times. In the case of a reaction, the individual or a
trained guardian must also know how to properly use an EpiPen.
In a study done by Sicherer and Forman, they tested a total sample size of
one hundred families with members affected by food allergies. When the families
Enrique, Pineda. Sublingual Immunotherapy for Hazelnut Food Allergy. Pg. 1078
Scott H. Sicherer MD, Joel A. Forman, Use Assessment of Self-Administered Epinephrine Among Food-Allergic
Children and Pediatricians. (American Academy of Pediatrics. 2013). Pg. 359.
23 Sicherer, Forman, Use Assessment of Self-Administered Epinephrine Among Food-Allergic Children and
Pediatricians. Pg. 359
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were tested on their proper use of an EpiPen, only 32% of the families were able to
show correct use of the device. Its important to understand the families were
unaware that they were going to be tested.24 Such a low percentage is unsettling for
something that can mean life or death. It does no good to have EpiPens if they aren’t
being used properly.
Sicherer and Forman backed up their results by concluding that;
“Pediatricians are not familiar with these devices and may fail to review their use
with patients.”25 It’s worrisome to see that pediatricians aren’t being given even
information about the use of EpiPens, it appears to be they a simply being instructed
to hand them. Before EpiPen’s can become a really effective life saving device, they
need to be better understood by both medical staff and individuals with food
allergies. Doing so will allow for a higher rate of survival for food allergy victims.
Again, because EpiPen’s are most simply a lifesaving device, not a cure, emphasis
still needs to be placed on finding an effective long-term cure for food allergies.
Sicherer, Forman, Use Assessment of Self-Administered Epinephrine Among Food-Allergic Children and
Pediatricians. Pg. 359
25 Sicherer, Forman, Use Assessment of Self-Administered Epinephrine Among Food-Allergic Children and
Pediatricians. Pg. 359, Paragraph 4.
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