FARE Supports Research Community at AAAAI’s 2014 Annual Meeting

For the food allergy research community, the annual meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) is one of the most important events of the year. FARE maintained a high profile at this year’s meeting, which was held in San Diego from February 27-March 4.  FARE’s Medical and Research Advisory Boards met, and FARE representatives offered information about our programs at our booth in the exhibit hall. Most importantly, FARE-funded researchers, along with our medical advisors, gave presentations and led informative sessions.

Less than 10 years ago, few sessions focused on food allergy. This year’s meeting showed how far the field has come, with a wide range of sessions and presentations devoted to potential new therapies, basic science, managing food allergies in schools and restaurants, and psychosocial issues.

Of particular note, researchers presented data on potential treatments for food allergy, with a strong focus on oral immunotherapy (OIT).  Although OIT is one of the most promising treatments in development, researchers still have many questions, including:  What is the optimal dosage?  How can we prevent patients on OIT from experiencing serious reactions?  Can OIT result in tolerance – long-lasting immunological changes that will protect patients even after they stop the treatment? Several new studies are bringing us closer to finding the answers. (It is important to note that the results discussed here are preliminary, and have not yet been published in peer-reviewed scientific journals.)

  • Researchers at the University of Virginia reported on a clinical trial of patients who had been desensitized to peanut after a course of OIT.  By eating a daily maintenance dose of one or two peanuts, some participants were able to achieve sustained unresponsiveness – meaning that they were able to eat peanut without having an allergic reaction.
  • On the other hand, prolonged avoidance of peanuts after completing OIT may lead to a reversal of the beneficial effects of the treatment, according to a study conducted by investigators at the University of North Carolina at Chapel Hill.
  • In a late-breaking abstract, researchers reported that combining OIT with omalizumab (Xolair®), an asthma medication, significantly reduced dosing-related side effects and the time needed to reach the maintenance dose in patients with milk allergy. FARE and the National Institutes of Health (NIH) are funding this multi-center study – the first randomized, double-blinded, placebo-controlled trial to demonstrate the effects of this combination therapy.
  • For more than a decade, FARE has provided partial funding for the development of a Chinese herbal treatment, Food Allergy Herbal Formula-2 (FAHF-2).  A Phase 2 clinical trial is currently underway to test the effectiveness and safety of FAHF-2 in treating peanut, tree nut, fish, shellfish and sesame allergies. At the AAAAI meeting, Dr. Xiu-Min Li (Icahn School of Medicine at Mount Sinai) presented the results of a pre-clinical study, which showed that combining the Chinese herbal formula with OIT reduced adverse reactions and produced greater post-OIT protection in mice with multiple nut allergies. Further studies are needed to evaluate this combination therapy in humans.

As the world’s largest source of private funding for food allergy research, FARE is committed to partnering with AAAAI to attract the most talented investigators to the field. At a benefit held during the meeting, AAAAI announced that FARE had contributed $50,000 to help establish the Allergy, Asthma & Immunology Education and Research Organization, Inc.’s (ARTrust™) $4 million Donald Leung and JACI Editors Allergy/Immunology Research Fund. Currently, the two leading contributors to the fund are FARE and Steve & Nancy Carell. In addition, since 2008, FARE has funded the AAAAI/Food Allergy Research & Education Howard J. Gittis Memorial Fellowship/Instructor Research Awards, which aim to shape the next generation of food allergy investigators. The recipient of the 2014 Gittis Award, who will be selected by an AAAAI committee, will be announced within the coming weeks. Finally, FARE invited young researchers to a reception, where they learned about our research grant program and strategic plan.

To learn more about current food allergy research, visit www.foodallergy.org/research.

Q&A with Dr. Michael Young: Does Early Exposure to Nuts Lower a Child’s Allergy Risk?

Last month, we received significant feedback from the food allergy community on our blog post about a recently published study, “Prospective study of peripregnancy consumption of peanuts or tree nuts by mothers and the risk of peanut or tree nut allergy in their offspring,” which was published in JAMA Pediatrics. To help clarify some of the key takeaways from the study, we asked Dr. Michael Young, one of the study’s authors, to answer a few questions about the study’s results and what that means for individuals and families managing food allergy.

1. Briefly, can you explain the findings of this study?

The children of women who ate peanut/tree nuts 5 or more times a week while pregnant had a 70% reduced risk of developing peanut/tree nut allergies compared to the children of women who consumed nuts less than once a month while pregnant.

2. In one sentence, what’s the main take away?

If a mother eats peanut/tree nuts while pregnant, it does not cause or increase the risk of peanut/tree nut allergies in her children.

3. How do the findings compare to other studies on this topic? 

There are other studies examining the correlation of eating peanuts during pregnancy and the risk of peanut allergy in the children. Some show increased risk, others show that diet makes no difference. One of the strengths of our study is in the methodology, which minimized recall bias (meaning that the reports that mothers gave on their diets were as accurate as possible). Also, our analysis consisted of cases of clinical peanut allergy (both a positive allergy test and history of reaction to peanuts) rather than cases with only one of those components. Our study is the only study to show that higher levels of maternal nut consumption leads to a reduced risk of children with nut allergies, which is more consistent with current studies on early infant diets showing that earlier exposure to food allergens, such as peanut, milk, egg, and wheat, is associated with reduced risk of allergies to these foods.

4. We’ve heard from many women who ate nuts while pregnant and had children who were born with allergies to peanuts and/or tree nuts. Can you explain why their personal experiences differ from what you found?

While our study shows a reduction in risk of approximately 70% with increased nut consumption, it is not 100% risk reduction; there are undoubtedly other risk factors. The cause of the increased prevalence of peanut allergy is presently unknown, but likely has many factors. Further research may well reveal other risk factors that will help explain why this is happening.

5. Based on the findings of this study, what would your message be to mothers who have children with nut allergies?  

The conclusions from our data should reassure these mothers that eating nuts during their pregnancy did not cause their children to develop peanut and tree nut allergies.

6. What about to women who are wondering if they should or should not eat nuts during their next pregnancy? 

Our study did not specifically examine the diets of mothers of children with known nut allergies during subsequent pregnancies and clinical outcomes. In general, our data would indicate that eating peanuts/tree nuts during pregnancy does not cause nut allergies in children. So, a pregnant woman who wished to include nuts in her diet should feel free to do so.

FARE Researcher Receives NIH Grant

We are pleased to announce that a FARE-funded researcher, Dr. Cathryn Nagler of the University of Chicago, has received a multi-year, $1.4 million grant from the National Institutes of Health (NIH). Over several years, FARE has provided more than $1.5 million to Dr. Nagler and her team.

FARE’s support has enabled Dr. Nagler to identify a new strain of “good” intestinal bacteria that may protect the body against allergic sensitization to food. In September 2013, FARE awarded a bridge grant to Dr. Nagler, which allowed her to pursue her studies while awaiting the NIH’s response to her application for a more extensive grant that continues to explore the therapeutic potential of these bacteria.

Dr. Nagler and other experts believe that genetics alone cannot account for the dramatic increase in food allergies. They are exploring the theory that environmental stimuli interact with the immune system to promote allergic disease. To this end, researchers are studying how the microbiome – the vast collection of microbes, such as bacteria and viruses, that inhabit our bodies – influences our health. While some of these microbes cause disease, others keep us healthy. For example, some probiotics (that is, “good” bacteria) help us digest our food, while others regulate the immune system and protect us against “bad” bacteria.

Dr. Nagler and her team have been studying mice to learn how specific environmental factors – such as diet, antibiotics, intestinal worms, and “bad” bacteria – alter the environment of the gut, making the rodents more susceptible to food allergies. Data from previous studies support their theory. Antibiotic use in infancy, in particular, has been linked to the rising incidence of allergic disease. Dr. Nagler has shown that administering oral antibiotics to mice before they are weaned depletes populations of good bacteria from the intestines. As a result, these mice are predisposed to allergic responses to food.

If successful, this mouse model ultimately may enable scientists to develop and test new probiotic formulations, which would be used to prevent food allergy in infants or to enhance the protection that  existing treatments, such as oral immunotherapy, might provide. It is important to keep in mind that, while promising, this potential therapy has not yet been studied in humans.

This innovative research exemplifies a crucial goal of FARE’s strategic plan for food allergy research: attracting gifted investigators to the field of food allergy by providing long-term support that allows them to advance their work and generate enough data to merit larger grants from the NIH and other federal agencies.

To learn more about current FARE studies and our research vision, please visit www.foodallergy.org/research.

Does Early Exposure to Nuts Lower a Child’s Allergy Risk?

ImageAre children more likely to develop a peanut or tree nut allergy if their mothers eat nuts during pregnancy or while nursing? Over the years, a number of studies have attempted to answer this question, but the results have been inconclusive. According to a new FARE-funded study, eating nuts during pregnancy does not cause food allergies in children. Further, although more studies are needed, it is possible that eating nuts may prevent a child from developing a food allergy.

In an article published online by JAMA Pediatrics on December 23, a research team affiliated with Harvard Medical School reported on their study, which suggests that mothers who do not have allergies and who eat nuts during pregnancy may lower their children’s risk of developing a peanut or tree nut allergy. The study, which was funded by FARE, received considerable media coverage.

The team, led by Dr. A. Lindsay Frazier, looked at the history of 8,205 participants in the Growing Up Today Study 2 (GUTS2) – children who were born between 1990 and 1994. The researchers reviewed records of the mothers’ diet immediately before and during pregnancy, and shortly after the infants’ birth. Of this group, 308 children had a food allergy, including 140 cases of peanut or tree nut allergy.

The incidence of peanut or nut allergies was significantly lower among the children of mothers who did not have food allergies themselves and who ate nuts at least five times per month compared to those who ate these foods less than once per month. “Our study supports the hypothesis that early allergen exposure increases the likelihood of tolerance and thereby lowers the risk of childhood food allergy,” the researchers concluded. They noted, however, that additional studies are needed. “The data are not strong enough to prove a cause-and-effect relationship,” commented one of the authors, Dr. Michael Young. “Therefore, we can’t say with certainty that eating more peanuts during pregnancy will prevent allergy in children. But we can say that peanut consumption during pregnancy doesn’t cause peanut allergy in children.”

A study that should shed more light on this issue is currently underway. The LEAP (for “Learning Early About Peanut Allergy”) Study, conducted by Dr. Gideon Lack and colleagues at King’s College London, has been following 640 children since infancy to determine whether or not exposure to peanuts early in life can prevent the development of peanut allergy. This study, which is co-funded by the National Institutes of Health and FARE, should be completed in 2014.

Food Allergy Research Update

FARE’s Fall edition of Food Allergy News contained a research update on four new food allergy studies, two of which received funding from FARE. Excerpts about the findings of each study are below; click the links to read the full text in our e-newsletter.

Awareness May Be Stabilizing Emergency Department Visits

In 2011, researchers reported that food allergies were responsible for a significantly higher number of emergency department (ED) visits than previously thought. That FARE-funded study, published in the Journal of Allergy and Clinical Immunology, found that food allergies caused 224,000 visits to the ED each year. The prevalence of food allergy continues to rise and one might expect that this growing number of people with food allergy would increase the number of ED visits caused by food allergy. However, a new study conducted by the same research team, also with funding from FARE, suggests that ED visits are not keeping pace with population increases in food allergy. The data suggest that greater awareness and education are having a favorable effect on the number of ED visits caused by food allergy.

Read more on page 4>

Impact of Food Allergy on Inner-City Children with Asthma

Food allergies and asthma often go hand-in-hand, but researchers do not fully understand the relationship between the two diseases. A research team led by Dr. James L. Friedlander (Boston Children’s Hospital/Harvard Medical School) surveyed 300 elementary school students with asthma who participated in the School Inner City Asthma Study (SICAS) from 2008 to 2011 to learn more about the connections between food allergy and asthma. Read more about the findings of the study, published online by the Journal of Allergy and Clinical Immunology: In Practice in September 2013.

Read more on page 4 >

Understanding Anaphylaxis

A new study out of Australia examines a large number of cases of anaphylaxis. This analysis also provides information about the many different inflammatory mediators—proteins and other substances released by the cells of the immune system—that play a role in potentially life-threatening reactions.

Read more on page 5 >

Vitamin D and Food Allergy

Babies who are deficient in vitamin D are more likely to have a food allergy, according to a study of over 5,000 one-year-old infants conducted by Australian researchers. The study, published in the April 2013 issue of the Journal of Allergy and Clinical Immunology (JACI), provided the first direct evidence that an adequate vitamin D level may protect babies against food allergies.

Read more on page 5 >

The full research update was published in the Fall 2013 issue of FARE’s Food Allergy News. Read more of the newsletter here.

New Study: Asthma Medication May Facilitate Peanut Oral Immunotherapy

In numerous studies, oral immunotherapy (OIT) has successfully desensitized a significant number of individuals with food allergies, with most able to ingest more of the food protein than prior to treatment. However, the desensitization process can take months, and patients can experience allergic reactions. Led by Drs. Lynda C. Schneider and Andrew Mac Ginnittie, researchers at Boston Children’s Hospital/Harvard Medical School conducted a pilot study to determine whether combining OIT with omalizumab (Xolair®), an asthma medication, might speed up the desensitization process and reduce the number and severity of allergic reactions during treatment. The study evaluated this treatment regimen in 13 children with peanut allergy who were at high risk for severe reactions.

This study, which was co-funded by FARE and featured in the December 2013 issue of the Journal of Allergy & Clinical Immunology, had encouraging results. Before treatment, all 13 children failed an oral food challenge, during which they were fed peanut flour in doses of 100mg or less. Within a median period of eight weeks of combination therapy, 12 of the children were able to reach the maintenance dose, 4000mg of peanut flour per day. They then stopped taking omalizumab and continued on the maintenance dose. A final oral food challenge showed that all 12 were able to tolerate 8,000mg of peanut flour, the equivalent of 20 peanuts. During the maintenance phase, most patients had no reactions or only mild reactions, but three required treatment with epinephrine. The researchers believe that longer treatment with omalizumab might reduce the number of reactions.

These results are promising, but larger studies that include a comparison group not treated with Xolair® must be conducted to determine the effectiveness and safety of this approach.  A randomized trial of milk OIT/Xolair® with 56 participants, performed at Mount Sinai (NY, NY), Johns Hopkins (Baltimore, MD) and Stanford University (Stanford, CA) is near completion.  Additionally,  FARE recently approved funding for a new clinical trial, the PRROTECT study (“Peanut Reactivity Reduced by Oral Tolerance in an anti-IgE Clinical Trial”), which is recruiting 36 patients at four sites – Boston Children’s/Harvard, Children’s Hospital of Philadelphia/University of Pennsylvania, Stanford University (Stanford, CA), and Lurie Children’s Hospital/Northwestern University (Chicago). For more information, please visit this link on ClinicalTrials.gov.