By Anna Nowak-Wegrzyn, MD
The food allergy epidemic is now big enough and public enough that we have to come to grips with what it means for the future of American society, and indeed for the rest of the industrialized world, where atopic diseases seem to go hand in hand with “progress.” While we are not the world’s leader in food allergies—Australia has even more per capita—there is no question that how we cope with this epidemic has implications for other countries.
One area I am asked about now and then is what this epidemic means for the military. The United States maintains a large military presence in countries around the world. The Defense Department has to consider the effect on manpower needs decades into the future. With 6-8 percent of U.S. children estimated to have significant food allergies, and up to 1.5 percent with peanut allergies, the numbers are large enough to warrant the concern of military planners. While the percentages are likely to plateau in years to come, as asthma seems to have done, the trend is still upwards. Already, asthmatics and diabetics are disqualified. While some of the food-allergy population overlaps with asthma, many more candidates would find a military career foreclosed.
The reasons are straightforward. The military runs on mass procurement of standardized materiel, from clothing (they call them uniforms for a reason) to weaponry. You can’t have field rations guaranteed peanut free, or dairy free, or soy free. It’s hard enough for mass producers like Kraft to avoid contamination with trace amounts of allergens, let alone military caterers. It’s unrealistic for soldiers deployed around the world to manage their own diets day in and day out while trying to focus on their demanding jobs. In addition, the military is a team operation, and if one member of the team becomes incapacitated by a sudden illness [i.e. food-induced anaphylaxis], the rest are put at risk.
I know that some young people with food allergies aspire to military careers, and have undertaken oral immunotherapy (OIT) with the hope that they can persuade recruiters that they can serve safely. At this stage, I am concerned that such exceptions would be a mistake. We have enough evidence to state that OIT causes desensitization for some of the treated individuals, but desensitization at best is not the same as cure, at least not at current levels of knowledge. Even with allergy shots for insect sting or airborne allergies, which have been widely used for many decades, there is plenty of evidence that they wear off with time for some patients. In the short term, the protection provided by food oral immunotherapy can be disrupted by viruses and febrile illness—sudden-onset fever. It’s one thing to start sneezing again because of dust or pollen and another to be anaphylactic to food.
Still there is plenty of promising research going on in medical schools around the country and around the world, including, of course, the one where I work in New York City. Every day my colleagues and I learn more about the nature of the disease, and plot new approaches to treatment, such as alternative forms of food allergen delivery (under the tongue and through the skin), vaccines with foods modified to be less allergenic, or Chinese herbs.
The military could be uniquely valuable in the search for cures if it decided that food-allergy research is crucial to meeting its long-term manpower requirements. Currently, the Defense Department is using its procurement muscle to try to meet its energy requirements through green sourcing, which may lead to more sustainable civilian technologies as well. That kind of resolve and concentration of resources ought to extend to not only to the health of future soldier, sailors, and aviators but to their education—a strong military needs educated recruits. The history of civilian medicine owes a great deal to the military. Maybe it will be part of this solution, too.
Dr. Nowak-Wegrzyn is one of the leading authorities on food allergies in the world. She is a clinician and clinical researcher in the Jaffe Food Allergy Institute at Mount Sinai Medical Center in New York City. Her research interests, funded by in part by the National Institutes of Health and Food Allergy Initiative, include: egg and milk allergy, food-induced anaphylaxis treatment and risk factors, diagnostic issues in food allergy, food protein-induced enterocolitis syndrome and pollen-food allergy syndrome (oral allergy). She also chairs the Adverse Reactions to Food Committee of the American Academy of Allergy, Asthma & Immunology.
Photograph mountsinai.org