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.

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.

Who is Likely to Outgrow a Food Allergy?

“Will my child outgrow the allergy—and when?” This is typically one of the first questions parents ask when a child is diagnosed with a food allergy. Two recent studies shed light on this important issue.

researchNational Survey of U.S. Children
Few large studies have explored which factors could help predict whether or not a child will achieve tolerance—that is, outgrow an allergy. Between June 2009 and February 2010, Dr. Ruchi Gupta and colleagues (Ann & Robert H. Lurie Children’s Hospital, Chicago) surveyed the families of 40,104 children nationwide—the largest study of this kind to date. The researchers analyzed data for nine common food allergies: milk, peanut, shellfish, tree nuts, egg, fin fish, wheat, soy, and sesame.

The study, published online in the Annals of Allergy, Asthma and Clinical Immunology in July 2013, found that 3,188 children surveyed currently had a food allergy, while 1,245 had outgrown one. Key findings of this FARE-funded study include:

  • A little more than a quarter of the children—26.6%—outgrew their allergies, at an average age of 5.4 years old.
  • Children who were allergic to milk, egg, or soy were most likely to outgrow their allergies. The likelihood of outgrowing shellfish, tree nut, and peanut allergies was significantly lower.
  • The earlier a child’s first reaction, the more likely that child was to outgrow the allergy.

Other factors that contributed to outgrowing an allergy included having a history of only mild to moderate reactions, being allergic to only one food, and having eczema as the only symptom. Conversely, children with severe symptoms (trouble breathing, swelling, and anaphylaxis) and multiple food allergies were less likely to achieve tolerance.

  • Black children were less likely to outgrow their allergy than white children.
  • Boys were more likely to outgrow their allergy than girls.

Dr. Gupta and her team conclude that, while more studies over longer periods of
time are needed to confirm these findings, this data can improve the management of food allergies and aid in counseling food allergy families.

Outgrowing Peanut Allergy
Peanut allergy is one of the most common food allergies among children. In the United States, the number of children with peanut allergy more than tripled between 1997 and 2008. This allergy tends to be lifelong; only about 20 percent of children are fortunate enough to outgrow it. A Canadian research team reports that children are most likely to outgrow their peanut allergy by age six. After age 10, the chance of spontaneous resolution (i.e., of outgrowing the allergy) is much lower, according to this study, which was published online in the Journal of Allergy and Clinical Immunology: In Practice on June 27.

Between 1998 and 2011, the researchers, led by Dr. Anne Des Roches (Centre
Hospitalier Universitaire Sainte-Justine, Montreal), followed 202 children with peanut allergy from early childhood (18 months or younger) to adolescence. To confirm their diagnosis and monitor their allergies, the children periodically received skin prick tests, along with blood tests, which measured the amount of peanut IgE in their blood. (IgE is the antibody that triggers the symptoms of a food allergy.)

Starting at age five, children whose blood tests showed a comparatively low level of peanut IgE also had the opportunity to undergo food challenges, the most accurate test available.

At the end of the study, 51 of the original 202 participants—just over 25 percent—had outgrown their allergy. Further, 80 percent of the children in this group were allergy-free before age eight. Tests also showed that these children had low levels of peanut IgE in their blood. In children who remained allergic, the amount of peanut IgE in the blood increased over the years.

The Canadian team concluded that their findings are consistent with a previous study by researchers in Australia, which followed 267 children over five years. They recommend additional studies to examine “whether spontaneous resolution may still occur in this population in late adolescence or early adulthood.”

The studies discussed here help us understand the nature and progression of food allergies. For more information about progress in the field of food allergy, please visit www.foodallergy.org/research.

This article was originally published in the Summer 2013 issue of FARE’s Food Allergy News. Read more of the newsletter here.

FARE-Funded Researcher Featured in New York Times Article

FARE-funded researcher Dr. Kari Nadeau is featured in a New York Times Magazine article – “The Allergy Buster.”The piece is the magazine’s cover story for Sunday, March 10, 2013. FARE is proud to support world-class food allergy research and clinical trials nationwide, including Dr. Nadeau’s.

While oral immunotherapy, the treatment featured in the article, has shown encouraging results in clinical trials, it should not be performed outside the academic research setting.

Read the article >