Clin A/Prof Richard Loh, Head of Dermatology, Immunology and Allergy, PCH and Co-chair National Allergy Strategy

One in 10 infants in Australia by age 12 months have a documented food allergy. Currently there is no cure for food allergy and management consists of strict avoidance and treatment of accidental exposure.

However accidental exposures are not uncommon – an estimated >50% of people with food allergy have one accidental exposure every three years.

ED: Scared parents of children with food allergy may be relieved by oral challenges done with child safety in mind.

Cure – oral immunotherapy?

Graduated does of peanut protein powder could help protect against the consequences of accidental peanut exposure. However, rates of severe adverse reactions, study withdrawal due to adverse events, and adrenaline administration were all higher in treatment groups. Oral immunotherapy (OIT) remains a mystery and it is still unknown – will permanent sustained unresponsiveness be independent of regular food intake and maintained even if the food is eliminated from the diet for long periods?

A recent paper using peanut protein coupled with an immunostimulatory adjuvant (in this case a probiotic) suggests that sustained unresponsiveness may be a possibility. A larger follow-up multicentre study (that includes Perth Children’s Hospital) is currently underway.

Most studies of OIT involve treatment with a single food but because many children have multiple food allergies, researchers are exploring OIT with multiple food allergens.

In addition, approaches include:

  • OIT with modified food allergens
  • OIT combined with anti-immunoglobulin E (anti-IgE)
  • Sublingual immunotherapy
  • Epicutaneous (patch) immunotherapy
  • Peptide Immunotherapy

If treatments are ready for routine clinical use they are likely to be expensive – an estimated $5-10,000 to cover peanut protein powder for the first 6 months of treatment in the US.

Prevention – using the window of opportunity

With no “cure”, can we prevent food allergies from developing? The recent Learning Early About Peanut (LEAP) study, provides evidence that the introduction of peanut between 4-11 months of age can reduce peanut allergy by 80% in high risk infants (infants with severe eczema or immediate family history of allergies). The Australasian Society of Clinical Immunology and Allergy (ASCIA) Guidelines for infant feeding and allergy prevention encourage introduction of the common food allergens by 12 months of age.

Parents, particularly parents of high-risk infants, are too scared to introduce the common food allergens in the first year, preferring to see an allergy specialist beforehand. However, with the infant often over 12 months when they see the specialist the ‘window of opportunity’ to prevent food allergy, particularly peanut allergy, has been missed.

GPs can support and encourage parents to introduce the common food allergens. If willing, GPs can introduce peanut to the infant in their clinic if the parents are overly concerned. ASCIA has developed information to assist GPs to do this. See: www.preventallergies.org.au

Some parents may just need reassurance that someone is there should a reaction occur and may introduce the food themselves in their GP’s waiting room.

  1. The author acknowledges the support of Sandra Vale (NAS Co-ordinator) in preparing this article.

Author competing interests: nil relevant disclosures.

Questions? Contact the editor.

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