Cracking food allergies

Every three minutes, a food allergy reaction sends someone to the emergency room. It’s an alarming statistic that puts parents and adults on their heels. In some extreme cases, mere nanograms of peanut protein can trigger a dangerous reaction and a mad dash to the hospital. 

The top 8 - milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat - cause about 90% of all food-allergic reactions. The marching order for decades has been avoidance and training children to become allergen inspectors before consuming certain foods. But it’s very difficult to track and vet every plated meal or crumb that a child with a food allergy might come across. Accidental ingestion happens, and for some, it can be fatal. 

Instead of avoidance, experts are looking at new ways to retrain the immune system and develop new treatments to desensitize food allergies. Dr. Kari Nadeau is on the frontlines, leading a team of specialists and running clinical trials at Stanford’s Sean N. Parker Center for Allergy & Asthma Research. You read that name right, it’s the same Sean Parker of Napster & Facebook fame who has his own nut allergies. 

On an upcoming episode, TechKnow visits Dr. Nadeau and reports on the latest findings from her clinical trials. The following was adapted from an interview with “TechKnow.” It has been edited for length and clarity.

TechKnow: Can you give us a broad-brush review of the status of food allergies in the U.S.?

Dr. Kari Nadeau: The numbers of patients with food allergies that our doctors diagnose is about 1 in 13 children. So that means out of any classroom, about 2 children will have a doctor’s diagnosis of food allergies.  The problem is really with the whole population, probably 17 million plus in the U.S. that have food allergies. We think that they have an 11 to 27% chance of having anaphylaxis sometime in their life.  

How do those numbers compare to worldwide statistics?

What’s interesting in different countries is they have different allergies. Here we have peanut in the U.S., Australia in some age groups, 1 in every 8 children can have food allergies there. Australia has one of the highest rates.  And they have cow’s milk, egg, and peanut.  Whereas let’s say a place like Italy and France, it’s more hazelnut allergies in children in terms of their nut allergies. So we’re trying to understand why these prevalences are developing and why this predilection toward certain food allergens is different countries.

Is that why Xolair is in the picture here? Tell us about it.

Xolair was manufactured by Genentech and is now licensed with Novardis. That medicine in and of itself is what we call monoclonal antibody. It is engineered to be able to bind to this molecule called Immunoglobulin E (IgE). IgE is the match that lights the fire behind allergy. Within 6 minutes you can have this positive feedback reaction in the human body that creates this really important and very serious allergic attack.  And so Xolair binds to this IgE and kind of covers it, so then that IgE can’t function to be able to cause that reaction.  

So we looked at that and we thought oh, if it’s working against IgE and we know that IgE is important in food allergy, what if we start giving it initially to people with food allergies and then we start giving them the food that they’re allergic to?  Could that protective cover help us increase the ability to get children and adults to food allergens to the same level that they’d like to eat them? 

That has to make a huge difference for the patients…

When so many people are suffering from food allergies and the only hope is to be able to avoid foods, that can be very disabling to patients.  And it’s anxiety provoking not to be able to go out to parties or not to be able to go to soccer games, and be in the same environment, and people have been coping. 

We hear about peanut allergies as being really troublesome, really severe, are they the most severe food allergy?

Each person is different, but as a population peanuts have the highest rate of being associated with anaphylaxis and near fatal or fatal events. That’s why we do have to be very careful at understanding different foods, changing labeling so we can make sure that we have educated consumers that if people do have an allergy to peanut or to another item and they know they have severe reactions, they need to avoid those items, for now. 

So that’s why in the past the American Association of Pediatrics recommended that we don’t feed young toddlers and infants peanuts, right?

Right, they were being very careful and in those days they didn’t have as much data as they do now.  Now we have studies showing that in infancy and in toddlerhood we have a unique period perhaps where we could train the body to prevent allergies. 

What is it that keeps you going?  What drives you here?

The satisfaction is team oriented as well as personal.  To be able to watch a child or an adult be able to eat the very same thing that months prior (they)wouldn’t even want to look at or they were scared that they couldn’t eat out at a restaurant.  What inspires me are those stories to make sure that patients have an improved quality of life.  Because in the end that’s what we all want for any disease, to have that improved quality of life where you can go socialize, where you can go eat a food without having to be worried.