Oral imunotherapy

Oral immunotherapy is a new treatment for food allergy.  Actually it is not new, but new to US scientists.  Oral tolerance means foods are recognized by the immune system as not being harmful.  If they are classified as invaders, that is an allergy.  Current treatment for food allergies is almost always to stop eating the offending food.  This is ok in little kids who often outgrow their allergies.  But for people with severe reaction or many allergies, this is not a good solution.  In fact, studies have shown that avoiding a foods actually made patients more allergic to it.  Patients with anaphylaxis are in danger of dying from their allergy.

Allergy shots for inhaled allergies have been around in the US for a long time.  Usually patients have really good results, but some cannot achieve tolerance and must stop the treatment.  In Europe, sublingual immumotherapy has really taken off.  You can take drops under you tongue and slowly build up the dose, just like with the shots.  It’s faster to tolerance and easier to do.  I have heard some lame arguments from allergists on why they don’t use it in the US, from not being FDA approved (whole nother rant) to lack of research.  I think liability fears are holding allergists back.  Oral immunotherapy is just starting to be studied in the US.  Duke has been able to cure anaphylactic peanut allergy in small groups of children.  So instead of living in fear of dying, these kids can now eat all the peanuts they want.

My son had an egg allergy, but has never has anaphylaxis.  I read lots of studies and decided to try the immunotherapy. One study started with tiny doses off egg protein and increased it every 2 weeks.  If my son showed any distress I would stop.  So we started and there was no problem.  I kept logs and medication handy just in case.  He never had hives or diarrhea during those 6 months.  After while I got tired of all the measuring so I just let him eat a cookie every day, with no reaction.  At his 6 month follow up, skin prick testing showed no reaction.  Just to be cautious I did a little patch test for 48 hours (although I don’t know if I did it right), but no rash from that either.  Now all we have to do is retrain him that eggs are ok to eat, poor guy.  I asked many allergists if we could try this, but no one would say it was ok to start, although one suggested giving him occasional bites of foods with eggs cooked in them (since another oral immunotherapy study used bites of cake for oral immunotherapy).

Prenatal exposure to mom’s food proteins through the placenta and breastmilk are a child’s first oral immunotherapies. And breastmilk has anti-inflammatory proteins along with IgA to protect the GI mucosal surfaces.  My son used to get facial rashes which cleared up when I weaned him.  So something went terribly wrong with his oral tolerance.  Probably caused by the IV antibiotics in the NICU killing his gut flora, exposing him to food right after several GI surgeries, and perhaps unnecessary vaccines given when he was not even term.  There is a lot of research showing probiotic deficiency and lack of breastfeeding being implicated in food allergy development.  I’m not gonna beat myself up about it but I do blame the NICU staffs for not keeping up with the research.  Probiotics should be given to NICU babies who have had antibiotics.  Maybe even fecal transplants.  And I don’t blame parents who don’t breastfeed their children.  I blame this society for making it difficult for women to breastfeed.  This is a very costly decision.  For real healthcare reform, formula marketing should be banned and formula not given to low income women unless medically necessary.  Imagine how much money would be saved on formula (and medical complications) if WIC instead bought women a breastpump and access to a lactation consultant and milk banks.  (Ending rant because I could go on and on.)

Update February 2011 : Food avoidance alone is not going to help the eosinophilic esophagitis.  Something must be done to fix the underlying cause of the failure to achieve oral tolerance to food.

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