Present in 6 to 8 percent of one-year-olds, with reported rates as high as 10 percent, food allergy is a problem that affects many families. Although the rate of food allergy falls progressively until late childhood, it then stabilizes at about 3 to 4 percent. That translates into about 10 million Americans affected by this disease. Currently, the only management strategies involve avoiding the offending food and managing severe reactions with self-injectable adrenaline. Fortunately, researchers around the world are committed to finding possible treatments for the future.
Immunotherapy is a time-tested method for treating allergies. The basic concept is to administer increasing amounts of allergen to an allergic individual (starting really small of course). Over time, the allergic person can become desensitized to that substance. A commonly used method of immunotherapy that has been used for over a century is the allergy shot. Here, allergens are delivered (via an injection) to an affected individual who is allergic to things like grass, cats, or dust mite. For food allergy, the shot form of immunotherapy led to a lot of severe reactions and was found to be too dangerous. But there are other ways of giving the allergen to the affected individual that are currently being researched. Across the world, scientists are investigating oral and sublingual immunotherapy with some potentially promising results. Instead of injecting the allergen, patients are asked to swallow (or hold under their tongue) tiny amounts of the food at first. Over time, the amount of food ingested is slowly increased until the patient becomes desensitized. This therapy is extremely promising, but is still risky. The biggest risk? The potential for severe allergic reaction during the therapy.
Another possible solution, herbs have been used in traditional Chinese medicine for many centuries, but not for food allergy. Currently, a mix of traditional Chinese herbs is being studied for its effectiveness in food allergy. Food allergy herbal formulation 2 (FAHF-2) is composed of nine herbs. In studies using mice, this therapy has shown tremendous potential in its ability to block anaphylaxis secondary to peanut allergy. One potential benefit of this therapy is that, in theory, it can be used for people with multiple food allergies. The human studies currently underway need to be completed prior to using this as a more mainstream treatment for food allergy.
Probiotics are live bacteria, or their components, that can have beneficial effects on our health, presumably by improving intestinal microbial balance. The major sources of probiotics are dairy products that contain Lactobacillus and Bifidobacterium species. Human trials of probiotics have focused on the prevention and treatment of atopic dermatitis (eczema), which includes a large subset of children with food allergy. Using probiotics as prenatal supplementation of mothers and postnatal supplementation of infants during the first 6 months have been reported to decrease the prevalence of atopic dermatitis. While there was no effect on food or environmental allergy, the therapy still deserves more investigation.
Hippocrates wrote that the physician must have two objectives, “to do good or to do no harm.” As physicians, we are challenged with the task of weighing the possible risks and benefits of treatment against those of taking no action. With all of the above therapies, although they show promise, we don’t yet know if we are doing more harm by using them versus not treating at all. As more studies are done, we will hopefully have an answer soon.
