Over the last few years there has been a lot of "good starts" when it comes to novel treatments of allergies and asthma. From a vaccine for cat allergies to bronchial thermoplasty for asthmatics, there have been a myriad of treatments, in varying stages of testing, that offer hope for the millions who suffer from environmental and food allergies as well as asthma. As the latest in this line, the FDA recently "fast tracked" a novel approach to desensitizing those with peanut allergies.
This new therapy is Viaskin® Peanut. From their website,
"Epicutaneous immunotherapy (EPIT®) consists in repeated application of antigen with Viaskin® on intact skin. EPIT induces a decrease of allergen specific responses (i.e. decrease of allergen-specific IgE, decrease of TH2 cytokine production, and decrease of local and systemic response after exposure to allergen) and increase of regulatory responses (i.e. increase of allergen-specific IgG2a or IgG4, increase of regulatory T cells (Tregs)."
In plain English, this is a patch that allows small but steady amounts of the peanut allergen (antigen) to be absorbed by the skin. This patch has a small air pocket built into it where it moisture condenses. This allows the antigen to combine with the moisture and be more readily absorbed by the skin. Langerhans cells, specialized immune system cells, capture the allergen in this outermost layer of the skin and migrate it to the lymph nodes. Here is where the modification (desensitization) takes places. As this process repeats it essentially trains the immune system to down-regulate and promote a long term tolerance of the allergen.
Upon reviewing the performance of the patch in earlier rounds of clinical trials, the Food and Drug Administration granted the patch a breakthrough therapy designation. This allows for faster development and review of the treatment. This the first drug designed for food allergies, that has received this designation. So why do certain treatments get this "fast track"? It all comes down to results. From adults to children as young as 12, test results show year long treatments with the patch resulted in patients demonstrating the ability to be exposed to at least ten times the amount of the allergen previously needed to elicit a response.
With this type of treatment, there are no painful shots or needles, or weekly appointments for sublingual drops. This patch bypasses traditional sublingual and desensitization treatments. There's also less risk to the patient actually having an allergic reaction since the allergen never reaches the bloodstream to trigger a full-fledged allergic response.
An easy way to visualize this is to think of a brownie. Before the treatment a patient may have an allergic reaction after eating a brownie that had a single, small piece of peanut in it. After the treatment, the patient could eat a handful of peanuts with no reaction. For those with food allergies, this kind of cushion can represent the difference between a trip to the emergency room after snack time and being just fine.
Now, with the FDA designation, there's a very real chance that this treatment could be available within in the next five years.
For more information on the clinical trials.
For more information on Viaskin and DBV Technologies.
Author: K. Gilmore
The team introduced Viaskin® Peanut, an epicutaneous immunotherapy (EPIT/ allergy patch), to encourage peanut tolerance via patches containing micro doses of peanut proteins. The epidermis is potentially ideal for allergen administration, as it is a safer route of allergen absorption in lieu of direct exposure to the vascularized circulatory system. Another factor that makes it prime location are the presence of Langerhans cells that specialize in antigen presentation. These act as "mediators of tolerance" for the immune system in the skin, and can be used in the favor of building peanut protein tolerances.
The year long therapy trial consisted of 221 peanut-allergic individuals who were treated with patches consisting of a various doses of peanut protein. All patients were tested at the beginning of the study to measure their initial peanut protein tolerance. After administering doses of the protein, ranging from 50 micrograms to 250 micrograms, their baseline test results were then compared to their tolerance levels at the end of the study.
Results showed that greater than 95% of the patients complied to the study (1% dropping out due to adverse affects) , and children treated with 250 microgram patches experienced a 19-fold increase in tolerance to peanut allergies! This means that at the end of the study they were able to tolerate 1 gram of peanut protein, the equivalent of 4 peanuts.
Viaskin® Peanut is the first of it's kind for combating food allergies, but initial results hint that it could be the first food allergy patch for other food allergies as well (seafood, tree nuts, soy, etc.). Beyond the patch itself, this study can also help us better understand how the body builds a defense for allergens. Understanding the mechanism is critical, particularly since food allergies are complex and usually require food avoidance, low dose immunotherapy or special diets. They cannot treated like environmental allergies such as pet dander allergies or pollen allergies, which can be treated with allergy shots, pills or sublingual immunotherapy (SLIT).
This EPIT therapy is promising for parents, patients, and practitioners. Food allergies are particularly challenging for parents who must constantly watch their younger children's diets, which can be strained in social or school related situations. Food allergies also affect nutrient intake, which can lead to potential growth hindrance and nutrient deficiency, as reported by the Journal of Academy of Nutrition and Dietetics. Practitioners may soon be able to give more options to patients, providing relief in fighting potentially lethal peanut allergies. We hope to see more advancement in this study, and see it become an accessible form of immunotherapy on the pharmacy shelves.
Author: R. Power
This question can be a very difficult one to answer. Alcohol, though consumed like juice, food, or soda (though your liver hopes not with the same frequency!), isn't governed by the same regulations or even the same agency as these others. While foods and most beverages fall under the domain of the Food and Drug Administration (FDA), alcohol falls under the guidance and regulations of the Alcohol and Tobacco Tax and Trade Bureau, a subdivision of the Department of Treasury. This INCLUDES labeling rules and regulations. So while your mega-jumbo-can-o-caffeinated-monkey-juice will most certainly have a label listing the nutritional value and all the ingredients, alcohol is almost always devoid of the former (and often the latter as well). Though it is often easier to determine how many calories are in your alcoholic beverage of choice, finding the actual ingredients that make up that drink is another story entirely.
Many producers do list ingredients on their website or have at least become savvy enough to list some of the common allergens that are NOT in their products, particularly nuts or nut derivatives. Beyond visiting websites and doing your own investigative research, many people are left with only anecdotal evidence as to whether a type of drink can cause a reaction or not.
Distilled spirits (think whiskey, rum, etc.) have a list of standard requirements when it comes to labeling. These include
- Alcohol Content
- Address of Distiller Country of Origin
- Net Contents (a metric measurement of volume)
- Coloring Agents (colored with caramel, annatto, etc.)
- Wood Treatment ("beechwood aged" ring a bell?)
- Other Ingredients like Dyes, (Yellow #5), Saccharin, or Sulfites
- Specific Type of Commodity (redistilled, blended, compounded, etc.)
- Statement of Age
- Distillation/Production Location
- A Health Warning
As of right now, major food allergens can voluntarily be listed for wines, distilled spirits, and malt beverages, but again, this is only voluntary. There has been a proposal to make this mandatory, and since 2006, nothing has been finalized... eight years later.
And, even if you do find a list of ingredients, this still may not cover a statement regarding the processing. Though some can tell you that there are no nuts in their products, many can't ensure their products were produced in a facility that is also nut-free. This touches on another problem, cross-contamination.
Bartenders and those mixing drinks work in fast paced environments and worrying about cross contaminating a drink is likely not high on the priority list when there are half a dozen orders rolling in at a time. A good general tip is to skip the garnish. One garnish in particular that can be troublesome for those with nut allergies is maraschino cherries. These are often processed or flavored with almond extract. If you know a favorite mix or type of drink that is safe for you and you order it with no garnish, you can dramatically reduce any risk. At that point ingredients should be coming straight from the bottle to your glass.
For reference purposes, here's a quick list of some common alcoholic beverages that contain nuts or nut extracts. Keep in mind, things can and do change, so contacting the producer is still your best bet.
- Creme de noyaux
- Creme de noix
- Kahana Royale
- Bombay Sapphire
- Harp Lager
- Phillips Dirty Squirrel
- Southern Comfort
This list is by no means comprehensive, and there are MANY varieties of wines, beers, champagnes and other types of alcohol I excluded because they to be rather obvious choices to avoid (many had things like "Nut", "Cashew", or "Almond" in the actual name).
In general, I advise people to stick with what they know. For people with severe nut allergies being adventurous around the holidays can likely lead to some not-so-festive memories. Check producers websites whenever possible, and if you don't see the information you need listed, call or email them. Most producers would much prefer you contact them and err on the side of safety when consuming their products. Lastly, make sure you keep your auto injector (and a backup!) handy at all times.
Unfortunately, all we've covered today is nuts. If you are one of the rare people who has a wheat or gluten allergy, that's a whole other ball of wax. Be safe and enjoy the holidays responsibly!
Researchers started by examining the role gut bacteria play in food sensitivities and food allergies in two groups of mice. Playing on the "hygiene hypothesis" researchers put together one group of mice that were raised in a sterile environment. In the other group, the mice were given a large dose of antibiotics at just two weeks of age. After being given peanut extract, both groups were observed, and from here researchers began introduction specific groups of bacteria to see if they had any effect on the allergic response. Specifically, Bacteroides and Clostridia bacteria groups were the focus, two types that are commonly found in wild mice.
The results were very interesting. First, mice that were given antibiotics showed a high sensitivity to the peanut extract. Antibiotics given early in life have recently been shown to be linked to a myriad of problems later on, including things like the development of allergies and asthma. Of the second group, the reaction to the peanut allergen was even more severe with some showing signs of anaphylaxis. While the introducing Bacteroides into the gut of mice had little effect, Clostridia was another story.
In both groups of mice, the introduction of Clostridia bacteria into the mice resulted in reduced allergic responses to the peanut allergen. This is extremely important for two reasons. First, it shows a link between specific gut bacteria and the development of allergies, again highlighting the link between the microbiome and the health of the animal. Second, these results point toward the potential of treating food allergies with the use of probiotics.
This study also refines the "hygiene theory" somewhat. While traditionally, it was suggested that a lack of exposure to germs and microbes early on could lead to the immune system overreacting to innocuous substances like dust mites, peanuts, or pollen, these results would suggest that a more sterile environment or perhaps even an overuse of antibiotics could lead to less diverse and less numerous gut bacteria, which would in turn be setting the stage for allergen sensitivity.
While the notion of treating allergies or food sensitivities with probiotics are still many years away, this latest research solidifies the link between gut bacteria and allergies. More importantly, it opens the door for potentially novel, new treatments of allergies, asthma and possibly other allergic diseases.
To read the abstract of this study.
Allergy-free peanuts? While it may seem a bit farfetched, this is just what they are working on. Started with a cashew extract (oil), researchers are treating the proteins found in the oil with heat and sodium sulfite. You may recognize sodium sulfite, as it's a preservative commonly found in a variety of foods. What this process does is change the molecular look of reaction-causing protein in the cashew, making it more difficult for immunoglobin (IgE - the antibody that kicks off your body's response, aka, allergic reaction) to recognize and bind with the protein.
Test results showed that when mixing unmodified and modified cashew proteins with the IgE of a nut allergic person, 50% fewer of the IgE molecules bonded with the altered proteins. This is important for a few reasons. Even though this isn't the first experiment to attempt this, it is the first that uses a compound generally regarded as safe (GRAS) to disrupt the protein structure of the allergen. It is also important because unlike other treatments, it is aimed at treating the food, not the person. Lastly, its success shows the potential for reducing or possibly even eliminating the binding of IgE to food allergens, the root of the allergic response.
For now results show a allergy-reduced nut, which isn't as helpful a non-allergenic one. However, these results at least point towards the possibility of this as a solution. What's up next for researchers? Modifying whole cashews then ensuring the cashews still taste they way they should! Until then, avoidance remains the best option for most dealing with severe food allergies.
To read the full abstract of the research.
For more information on food allergies.
Author: K. Gilmore
Switzerland has a history of being a very innovative and efficient country, so it doesn’t surprise me that they would make such an impression with the airline industry as they have done with chocolate, banks and pharmaceuticals.
Here’s what their allergy-minded airline includes to minimize the presence of allergens within the cabin and lounge areas:
- High efficiency air conditioning to filter out pollen, pet hair and dander and any airborne particulates on board.
- Removal of air fresheners for flyers with chemical sensitivities.
- Selection and use of hypoallergenic fabric for upholstered items.
- In the lavatories they provide soap friendly for those with sensitive skin.
- Your meal, snack and drink selections are free of glucose, lactose and a variety of other common allergens. Swiss Airline cabin crew members are trained to respond, and are equipped with the histamine tablets in the case of allergic reactions and emergencies.
Author: R. Power
Just a reminder for those local to the Atlanta area, if you have peanut allergies but want to catch a game at Turner field Saturday as part of your Memorial Day Weekend, they do have a Peanut Free Section. Check out the Braves site for more details, and Have a Happy Memorial Day!
Immunotherapy has been a successful form of allergy relief for wasp-sting allergies and grass pollen. At its core, immunotherapy is a long, slow process of reintroducing tiny amounts of a particular allergen to patients. Over time, the amounts of the substance patients ingest or are exposed to increases with that hope of leading to a higher, long term tolerance of the allergen. With regard to peanut allergies, this has been the most successful study so far, and gives hope to parents who are constantly on the lookout for even trace amounts of peanuts that can send the severely allergic into anaphylactic shock. In the future this type of treatment could relieve much of the worry associated with trace amounts of allergens causing severe reactions and help lift many of the precautionary diet restrictions those with food allergies often have to impose.
While we wait for more research, long term test results, and potential FDA approval for this treatment, avoidance remains one of the best options for those dealing with food allergies. Though peanut butter might not be one the menu just yet, here are some Peanut/ nut substitute suggestions without the risk of allergic reactions.
- Sunflower seed butter
- Soy nut butter
Author: R. Power
Cooking oils used by most restaurants, especially the big commercial franchises that use peanut oil, use a highly processed, refined peanut oil. Why is this important? The refining process involves high heat, deodorization, bleaching, purification, and other methods of processing to strip away the peanut proteins that are responsible for the allergic reaction to peanuts and leaves a purified, refined oil.
The peanut oils to avoid are often the gourmet peanut oils. These types of oils may have things like "cold-pressed," "natural," "unrefined," "gourmet" or "aromatic" on the labeling of the bottle. Found in the cooking oil aisles at supermarkets or specialty stores, these oils often forego the refining process and retain allergic proteins.
There are research studies that back up these findings, and the FDA makes specific note of oils in Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA) [Paragraph 1-201.10(B)]. So, if you are craving those fries cooked in the peanut oil, chances are you can probably feel safe eating them. Now, the only reasons to avoid Five Guys might be the actual peanuts in their restaurants or your expanding waistline.
Always inquire about the oil before ordering, and discuss with your allergist if you have any questions or reservations.
For more information on FDA guidelines concerning food allergens or for a convenient way to let restaurant staff know about your food allergies, try our convenient food allergy cards.
With the "No" vote totaling 76.6%, most of those who responded are opposed to banning peanuts in school. This is interesting for a few reasons. First, food allergies in general but nut allergies in particular, have been trending sharply upward in recent years. In part because of better awareness surrounding food allergies, the number of cases of peanut allergies has been on the rise. Secondly, as more school districts and states across the nation are developing plans to keep Epi-Pens on hand, there has been a response to the growing number of severe allergic reaction cases by administrators, parents and legislators.
This is a sticky situation (sorry for the poor peanut butter pun) for several reasons. Peanuts have been a staple in the American diet for a very long time. On average, a typical American consumes over 3 lbs. of peanuts every year. Now this doesn't mean we're all sitting around at the ballpark, the local Five Guys, your nearest steakhouse or on airplanes just munching away. Peanut oil and the ever-favorite peanut butter is consumed and used in a variety of foods and for food preparation across the nation. Peanuts have traditionally been a low cost source of nutrients and protein, far cheaper than meat.
On the other side are the health risks for those who are allergic. Part of what makes the increase in food allergies so alarming is how severe they can be. Why have schools and state legislatures been pushing to enact laws that require schools to carry auto-injectors? Fatalities. Though the number of food allergy related deaths each year is small, typically a couple hundred, they are alarming, in large part because they are so preventable. And, for parents of children with severe food allergies, this no small matter, so much so that some parents have turned to home schooling or specially trained dogs to help their child avoid food they're allergic to.
There are also other issues in play with this debate, cost, effectiveness, and even concerns regarding civil liberties. The issue is a difficult one, but one where opinions can be very sharp and not in short supply. So where do you stand? Should they be banned in schools for allergy reasons? If not, what should schools and others do to help prevent these preventable deaths?
Author: Kevin Gilmore
She needs some advice on how to get around offering him dairy products, while meeting nutritional requirements and maintaining the boy’s interest in eating. She has tried rice milk, almond milk, and coconut milk without much success. The parents were advised against using soy milk and other soy products due to estrogen content.
Does anyone have a similar situation? Can you share your experiences with what foods you offer your child that might work? How did you explain to your child why they can’t have regular milk, ice cream, and cheese? Any words of wisdom or advice would be helpful and appreciated. Thanks in advance for your comments and posts.