By Dr. Julie Wang
When I talk to my patients and their families about managing their food allergies, I am reminded by the challenges they face on a daily basis. Having treated children in particular, I am also witnessing some encouraging improvements. As more children with food allergies enter the educational system, a greater number of schools are reviewing existing or creating new food allergy policies. Earlier this year, I reassured a mom who was nervous about her daughter starting school in the fall, and told her to ask the school directly about their policies and experiences. She was pleasantly surprised about the guidelines that were already in place, including situations she had not even anticipated. Mom was so relieved. Now she could focus on this exciting transition for her daughter to kindergarten.
With increased awareness, food allergies are also gradually losing their stigma and schools have become more accommodating. Children with special food requirements may have lunch buddies for instance. Some schools are finding ways to celebrate special occasions with less emphasis on food. For example, instead of bringing a cake, a birthday child may bring a special book to share with the class and donate it to the class library. Taken together, the level of awareness, individual and institutional involvement, and above all optimism represents a big change from the loneliness and fear that we used to see.
Although these are all welcome changes, continuing education is still necessary. Not only is there plenty of loneliness and fear, but there are lingering misconceptions about how severe food allergies can be and how and why reactions occur. For example, some people believe that only certain food allergies are dangerous and that strict avoidance is only appropriate for selected patients. I often hear people tell me that their child’s allergies are not as “severe” as another child with peanut allergy, for example. I strongly advise them not to make assumptions about what may be wishful thinking. No parent wants to believe his child is “really sick” but food allergies demand extra care.
Parents may also occasionally give their child a little bit of the offending food to see if the allergy is still there. This may reflect an increased awareness about studies on oral immunotherapy, which look at the gradual introduction of food allergens over a long period of time under doctor supervision, as a possible treatment. Parents are naturally optimistic and think this is something they can try at home, but they aren’t aware of the possibility of severe allergic reactions that may require treatment with epinephrine. In addition to known side effects of oral immunotherapy, it is still unclear if this will work for everyone or if this can permanently cure a person of their allergy. Do it yourself is not the right way to go.
Since food allergy is a chronic illness with potentially life threatening complications, there is understandably a lot of anxiety for families with severe cases. I am optimistic about several clinical trials currently underway looking at possible treatments. In addition to oral immunotherapy mentioned above, another treatment under investigating entails the use of Chinese herbal therapy (described in this website here). The formula currently under clinical trial contains 9 herbs that have been used in China and Japan for thousands of years. Unlike oral immunotherapy, this medication is not directed to any one particular food. If found to be effective, it could be the ideal treatment for those who suffer from multiple food allergies. More and more of my patients now ask my colleagues and me about the status of various studies and about opportunities to participate. I recently met a family who travelled four hours just to ask questions about one of our studies. This highlights the desperate need for effective therapies. We also have several people currently participating in our trials who are actively helping to spread the word about our studies. One young man asked if he could tell all his food allergic friends to come. Another patient’s mother has been enthusiastically brainstorming ideas to advertise our studies to the food allergy community. Participating in clinical trials is the best way to establish the effectiveness of new treatments, and I am heartened by my patients’ willingness to participate and their eagerness to help us find a much needed treatment for food allergies.
Food allergies are challenging for both patients and their caretakers. I am encouraged that some of the obstacles being faced by young children are improving due to increased school and societal awareness and am excited that many potential new therapies are currently in clinical trials. In the next 5 years, we may well have even better news for our food allergic patients.
Dr. Wang is an Assistant Professor of Pediatrics at the Mount Sinai
School of Medicine. She received her medical degree from Weill
Medical College of Cornell University, and her pediatric training at
New York Presbyterian Hospital – Cornell. She completed a
fellowship in allergy and immunology at Mount Sinai and joined the
faculty after completing fellowship. She is board certified in
pediatrics and in allergy and immunology. At the Jaffe Food Allergy
Institute, Dr, Wang’s research interests include food allergy and
asthma in the inner city and treatments of food allergy. Her work
is funded by the NIAID.