It seems more Americans than ever have food allergies these days, especially kids. However, a recent report by the National Academies of Sciences, Engineering, and Medicine says questions persist about whether food allergies are really on the rise. For example, the report cites a lot of confusion about what's truly a potentially life-threatening "allergy," which is triggered by the immune system, and what might be an intolerance or a sensitivity, triggered by the digestive system, instead. Meanwhile, new advances in food allergy treatment include patches and oral therapy.
- Dr. Wayne Shreffler - Chief of pediatric allergy and immunology and the Director of the Food Allergy Research Center at Massachusetts General Hospital.
- Dr. Amitha Harish - Allergist-immunologist with Southern New Hampshire Asthma and Allergy.
Dr. Amitha Harish, an allergist-immunologist with Southern New Hampshire Asthma and Allergy, says that she has seen an increase in media attention toward not just food allergies, but also to intolerances, which might contribute to the rise in patients seeking screenings. "A lot of times, food is blamed," she says, "when it might not be the cause, or it may not be a life threatening injury."
Dr. Wayne Shreffler, chief of pediatric allergy and immunology and director of the Food Allergy Research Center at Massachusetts General Hospital, agrees that are several factors that contribute to the rise in allergy diagnoses.
There's probably a true rise in real food allergy, a rise in the presence of allergy-positive testing - and that can be a combination of people seeking the testing as well as changes leading to more allergic responses - and then also just a lot more awareness and attention.
For many years, parents were told not to feed their infants or toddlers nuts or eggs until they reached a certain age, and both Dr. Harish and Dr. Shreffler agree that avoiding these foods might have actually contributed to the rise in allergies, rather than prevented them. Dr. Shreffler says,
Beginning already by the mid-2000s, we were seeing some studies, epidemiology studies, kind of questioning [the practice of avoiding allergens during infancy] and showing evidence that perhaps the late introduction was associated with increased risk, especially in kids who themselves were at an increased risk for developing allergies, because maybe they had bad eczema when they were little...A really landmark study in February 2015 [called the] Leap Study conducted in the UK really demonstrated for the first time...that introducing peanuts during infancy in high risk kids reduced the prevalence of peanut allergy.
Listener Jonathan from Wakefield wanted to know whether increased use of pesticides in food harms gut bacteria, and he cited a study conducted by Stephanie Seneff and others at the Massachusetts Institute of Technology titled "The High Cost of Pesticides: Human and Animal Diseases."
Dr. Shreffler says this study does show a connection between pesticides and illness, and acknowledges that there may be a link between the way we prepare our food and the prevalence of certain illnesses, but he also says it is difficult to strictly correlate pesticides with increased allergies.
Dr. Harish says that currently, clinics have a few methods for treatment and management of food allergies, but that she thinks more radical therapy may be available in the next few years. As for right now, she says, management of food allergies involves "avoidance and safety measures such as an Epipen and having an anaphylaxis plan."
Dr. Shreffler gives examples of several new treatment options that are currently in trial.
One of them is oral immunotherapy, as Dr. Harish said, and the other is the patch [worn over time to help overcome a peanut allergy]. And there is also a...study for a milk patch and plans to do a clinical trial for other food allergies as well like milk, eggs, etc, by the oral route.
Listener Joan from Nottingham has a daughter who was diagnosed with the mononucleosis virus in high school, and afterwards suffered from serious respiratory infections, respiratory allergies, and food allergies. Joan wanted to know if there was a connection between the immune response to viruses and the immune response to allergens. Dr. Harish says that there is definitely a correlation between respiratory illness and respiratory infections.
An area that's been better studied is respiratory illnesses in early childhood and infancy leading to the development of asthma, so that is not uncommon. I think that we would have to do more research to see if this would pan out with food allergies as well.
Dr. Shreffler says that other allergies, especially in adolescents, may be associated with an immune response to called cross-reactivity.
Some people with hay fever will develop a form of food allergy that we all see especially in older kids and adults that is often called oral allergy syndrome. This is due to making, first, an allergic immune response to pollen allergens, especially birch in this part of the country...and then having cross-reactivity...so the allergic antibodies that are recognizing something in the pollen also recognize - because of their physical similarity - allergens present usually in fresh fruits and sometimes nuts. And it causes oral itching and sometimes swelling.
Find more information on Dr. Shreffler's research with the Food Allergy Science Initiative.