Food Allergy Treatments - Where are we at?
Are you interested in hearing more about OIT, the peanut patch and other treatments being researched for food allergy? Want to know where we are at in Australia in the development of allergy treatments?
In a survey Allergy & Anaphylaxis Australia conducted last year, an overwhelming number of responders said they wanted to hear more about treatments for food allergies. Allergy & Anaphylaxis Australia is excited to bring you the first of three webinars we will be hosting in 2019.
Did you miss the live webinar?
The good news is that the informative webinar, FOOD ALLERGY TREATMENTS - WHERE ARE WE AT? presented by Dr Paxton Loke - Paediatric Allergist and Immunologist from the Murdoch Children’s Research Institute (MCRI) and Melbourne Allergy Centre and Children’s Specialists Medical Group - can be viewed below at your leisure.
- What treatments are available to assist with food allergy management?
- How effective are they and who can access them?
A&AA Food Allergy Treatment Webinar Questions & Answers
Written by Dr Paxton Loke
When will an approved oral immunotherapy (OIT) treatment be available in Australia?
There is currently no approved OIT treatment worldwide. A company in the United States of America (USA) is developing a peanut OIT product, however this has not yet been approved by the USA Food and Drug Administration (FDA). We are not aware of plans for registration of the peanut OIT treatment in Australia.
Thousands of people are currently undergoing OIT outside clinical trials in the USA. What is your opinion on OIT treatment overseas?
Although OIT is currently offered outside of clinical trials in a small number of private clinics and institutions in the USA, allergy experts in the USA and Australia remain concerned about the long-term safety of being desensitised with OIT and have advised patients to only take OIT within a clinical trial setting. This is because OIT has been shown to induce an immunological effect of desensitisation, but at the same time causes more allergic reactions (including anaphylaxis) than continuing with allergen avoidance. A recent study that analysed data from multiple individual OIT studies (also known as a meta-analysis) showed that children desensitised with OIT experienced 3 times more anaphylaxis and needed adrenaline twice as often as children who were simply avoiding their allergen. In other words, although desensitisation is suggested to provide protection against reactions to accidental ingestion of peanut, patients on OIT have more reactions than children avoiding their allergen. Since the desensitisation effect of OIT is only temporary, patients must continue to take a daily dose of OIT to maintain their protection; yet, because their underlying food allergy is still present, they commonly react to their OIT doses and these reactions can be anaphylaxis.
Based on all of the available evidence, allergy experts in the USA and Australia remain unsure about whether it is safe for patients to be desensitised in the longer-term and have therefore recommended that OIT should only be offered as part of a clinical trial. The Australasian Society of Clinical Immunology and Allergy (ASCIA) currently recommends that OIT for food allergy should not be performed outside of clinical trials (https://allergy.org.au/patients/allergy-treatment/oral-immunotherapy-for-food-allergy).
What are some of the lifestyle restrictions when doing OIT? Do I still need to carry my EpiPen®?
We know that certain situations increase the risk of reacting to the OIT dose – exercising within 4 hours of a dose, having a viral infection, asthma exacerbation, hay fever, or menstruating. In clinical trials, patients are asked not to exert themselves or participate in exercise or sport for 4 hours after a dose of OIT. This would mean restrictions on exercise, sporting and other activities that may increase your heart rate (such as rushing to the bus stop or running around the playground).
With regards to the EpiPen®, anyone who is on OIT treatment will need to carry an EpiPen®. This includes someone who does not have a prior history of anaphylaxis. As current published approaches to OIT mainly result in desensitisation, the underlying food allergy is still present and therefore there is a risk of having an allergic reaction to the doses of OIT.
There have been many OIT trials for egg, milk and peanut. What other OIT trials are currently available (i.e. wheat, tree nuts, sesame, etc.)?
OIT has been tested in a range of food allergies. Some examples of OIT trials in other food allergies include wheat and tree nuts (e.g. walnut as a single tree nut or cashew/pistachio in combination) – these trials are being performed overseas.
Should I be taking a probiotic to help my child’s food allergies? Is there any benefit from giving my child probiotics on its own?
There is currently no evidence that probiotics used on their own (not in conjunction with another treatment) provide any benefit for the treatment of food allergies. The Murdoch Children’s Research Institute (MCRI) has been working on a potential treatment for food allergy that combines a specific probiotic bacterial adjuvant (a substance which enhances the body’s immune response) with food OIT which has shown promising results, however this is still under development. While probiotics have other roles including improving gut health, probiotics alone are currently not recommended for food allergies.
What are the requirements for a patient to participate in an OIT trial?
Different OIT trials have different entry requirements. Some trials require an entry food challenge to ensure that the patient is still allergic to that particular food. Most trials will require that the patient is generally healthy, does not have a history of severe anaphylaxis, poorly controlled asthma or other medical conditions which may prevent a patient from taking the treatment in a safe manner (e.g. eosinophilic esophagitis/EoE, heart or chronic lung disease). In trials performed in children, there will be an upper age limit for participating.
What other types of food allergy treatments are being developed besides OIT?
Other food allergy treatments currently under development include epicutaneous immunotherapy (through the skin; eg a patch with food protein on it applied to the skin), OIT together with a specific probiotic bacterial adjuvant, sublingual immunotherapy (SLIT; drops or tablet placed under the tongue) and subcutaneous immunotherapy (SCIT; injection into the fatty layer under the skin) with modified food allergens.
How can the allergy community help to increase the research being carried out into new food allergy treatments occurring so that a solution can be reached sooner?
Before any food allergy treatment can be offered to patients in the clinic setting, it must be tested in clinical trials to prove that it is safe and effective. The allergy community can help to bring a treatment to patients more quickly by participating in such trials and supporting patients who are part of clinical trials. Food allergy research groups are grateful to the allergy community for their participation in clinical trials (for both treatment and prevention of food allergy), and we continue to encourage active participation when possible. More awareness can be raised by joining active consumer groups such as Allergy & Anaphylaxis Australia, and speaking to your local member of parliament to raise the issue of food allergy nationwide. Funding is also necessary to conduct clinical research so supporting research through fundraising activities is always welcome.
Are there any OIT trials for adults? Have previous OIT trials been effective in adults?
The majority of OIT trials have been performed in children, however some trials have included adults. At this stage, it is uncertain if OIT is effective in adults. For example, results from a large peanut OIT trial (PALISADE) published recently showed that OIT was not better than placebo in subjects who were 18 – 55 years. More studies are required in adults.
FAQs created May 2019
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Content updated May 2019