This guest post was written by Theresa MacPhail—assistant professor in the Science, Technology, and Society Program at Stevens Institute of Technology.
Last December, I wrote a blog post
about the early history of food allergies from the 1800s through the 1960-70s. In this installment, we’ll examine more recent food allergy chronicles, current treatments, and diagnosis debates. Despite advances in our understanding of the immune mechanisms involved, and the promising developments in allergy-related technologies (like the Allergy Amulet
), the lack of a cure or effective treatments for food allergies persists.The Discovery of IgE
Immunotherapy treatments were first tested in animals, and then cautiously applied in clinical settings for both respiratory allergies and food allergies beginning in 1911. The risk of an accidental anaphylactic response was, and is, ever present. Much of the early allergy testing and treatment remained unchanged until the mid-1960s when two separate research teams
working on immune response discovered immunoglobulin E, or IgE—a molecule that naturally forms in human blood.
IgE’s discovery led to a greater understanding of the inflammatory response following allergen exposure, sparking more research around the cause of allergic reactions. By 1975, the first commercially available and reliable blood test
for IgE became available for clinical use. IgE testing quickly became a significant aid in allergy diagnosis, since an elevated presence of IgE levels in the blood often indicates a food allergy.
IgE has played an enormous role in subsequent allergy research, diagnosis, and treatment. However, while IgE tests provide information as to the likelihood of having a food allergy, 50-60% of IgE blood tests yield a “false positive” result, creating a great deal of uncertainty in the diagnosis. IgE as an allergy biomarker is accordingly far from perfect.Food Allergies - A Rising Prevalence?
If you follow the news or social media, or have a young child in the school system, it certainly seems that food allergies are on the rise. Although food allergy awareness has increased over the last decade and has become a more popular topic of conversation, the food allergy prevalence rate has been difficult to measure with confidence.
Figures on the national and global food allergy population are unsettled. This is largely because the numbers rely on multiple data sets collected across different methods and research groups. Official estimates place the figure at around 15 million. Adding to this confusion is the difficulty in confirming the presence of an allergy with current diagnostic tools (often IgE testing, discussed above). The majority of cases of food allergy and food intolerance depend on self-reporting and sometimes self-diagnosis—and those numbers fluctuate greatly. A recent meta study looking at several different reports found
that: “Self-reported prevalence of food allergy varied from 1.2% to 17% for milk, 0.2% to 7% for egg, 0% to 2% for peanuts and fish, 0% to 10% for shellfish, and 3% to 35% for any food.” A 2013 paper
suggests that “at least 1%–2% and up to 10% of the US population suffers from food allergies, although this estimate includes self-report, skin prick test (SPT), serum-specific IgE (sIgE), and oral food challenges (OFC) as measures of food allergy.” Variation in the number of food allergy patients is largely based on food allergy type, reported severity, geographic region, and study design and testing method. In short, with no easy and standardized way to diagnose food allergy cases, it is difficult to confirm and measure the perceived rise in the food allergy population.The LEAP Study and the Future of Oral Immunotherapy
Perhaps the most significant study on food allergy in the last 50 years is the Learning Early About Peanut Allergy
(LEAP) study by the Immune Tolerance Network (ITN). In this study, infants at a higher risk of developing a severe allergy to peanuts were randomly assigned to one of two groups: one that would avoid ingesting peanut-containing foods until the age of 5, and one that would consume a peanut-containing snack (~6 grams of peanut protein) with three or more meals per week until the age of 5. Of the children who avoided peanut, 17% developed a peanut allergy compared to only 3% of the children in the control group. As one of the researchers noted in the press release for the study
, “For decades allergists have been recommending that young infants avoid consuming allergenic foods such as peanut to prevent food allergies. Our findings suggest that this advice was incorrect and may have contributed to the rise in the peanut and other food allergies.” The LEAP study overturned decades of prior advice and shook the allergy research community. It also gave extra credence to one of the oldest forms of treatment for allergy: immunotherapy.
After a decade of research, oral immunotherapy is becoming more widely accepted as effective for the most common food allergies (e.g., peanut), but little is known about its long-term effectiveness. If you’re not familiar, oral immunotherapy (OIT) is a method of food desensitization that involves re-introducing the immune system to the allergenic food in gradually increasing amounts over time, with the goal of eventual tolerance. Although researchers are optimistic about its potential, it is not without its drawbacks. You can learn more about OIT in Allergy Amulet’s blog post here
.The Promise and Peril of Epinephrine
Epinephrine (the hormone adrenaline) was first discovered in 1900 and marketed to treat asthma attacks and surgical shock. By 1906, with the development of a synthetic version, the drug was in common use by clinicians to treat severe asthma attacks. Immunologists and allergists experimented with dosages over the next few decades, standardizing treatment protocols.
In 1975, a biomechanical engineer developed the first auto-injector syringe for military use, which was then adapted for use with epinephrine. It wasn’t until 1987, however, that the FDA approved the epinephrine auto-injector for public use. Epinephrine auto-injectors proved so effective—and the dosage delivered was so consistent—that it became the standard prescription for anyone suffering from severe allergy. By the 1990s, food allergy patients were being advised to carry one at all times for their safety.
In 2016, the mother of a child with a severe food allergy began a campaign against the dramatic rise in the price of one of the most popular brands: EpiPen—which added up to over a 600% increase since 2004, from $100 to over $600. With few competitors on the market, Mylan Pharmaceuticals, the manufacturer of the EpiPen, felt no need to lower its prices. The story went viral and sparked debates about the pharmaceutical industry’s pricing policies and access to affordable healthcare. Since the scandal broke, there has been a call to develop alternative and less expensive epinephrine auto-injectors.
The Epi-Pen story—and this post—highlights the urgent need for greater investment in allergy research and innovation. Let’s hope that with new advancements in the coming years, food allergy itself will be history.