There have been two reports of deaths related to food allergies in one week – the victims were 15 and 20 years old. Even though details are limited, it is believed they ingested unsafe food and were not given medical care on time. Deaths due to food allergies, such as these two are preventable. It is crucial that we learn how to better manage patients with food allergies, and when needed, how to advocate for them.
Around 4% of children have food allergies, an increase of 18% over ten years, The Center for Disease Control and Prevention (CDC) estimates. According to another recent study, however, up to 8% of children may suffer from food allergies, with almost 40% of them reporting severe reactions.
Funded by the Food Allergy Initiative and conducted by Dr. Ruchi Gupta and her colleagues at Northwestern University, this investigation revealed that peanut allergies among children have tripled, rising from 1 in 250 in 1997 to 1 in 70 in 2008. This figure of over 1% is similar to findings in the UK, Canada and Australia. Children also appear to be taking longer to get over their allergies, when compared to resolution rates for milk, egg, wheat and soy allergies a couple of decades ago. The authors wonder whether a potential epidemic is looming.
Although uncommon, when fatalities do occur, several studies identified a few common risk factors, such as delayed treatment with epinephrine, co-morbid asthma, and being a teenager or young adult.
The primary treatment for anaphylaxis is epinephrin, and for individuals with food-allergies an auto-injector should always be carried. Targeted medications appear to be underutilized and a surprising number of physicians do not seem to know how to administer them. It is vital that doctors and patients are educated on using this life-saving medication.
During a systemic (allergic) reaction, the lungs are a sensitive target, making asthma a likely risk factor. The authors stress that good asthma control is important for patients with food allergies.
Some children may be more willing to take risks in order to be more acceptable with their peers – in doing so, they are more likely to consume foods they are allergic to. Studies have demonstrated that teenagers with food-allergies wished that others, especially their peers, knew (more) about their condition.
This would likely reduce the feelings of awkwardness of having to carry around medications and having to ask questions regarding the safety of foods all the time. It is important physicians encourage peer education, as well as ensuring young patients are well educated on food allergy management.
The National Institutes of Allergy and Infectious Diseases (NIAID) of the NIH recently sponsored an “Expert Panel Report: Guidelines for the Diagnosis and Management of Food Allergy in the United States.” This report examines the several ways in which patients can be assisted in staying safe, starting with securing a diagnosis, educating patients on avoidance and treatment strategies, and understanding the considerable impact on quality of life.
The NIAID also sponsors a Consortium of Food Allergy Research (COFAR), which is researching enhanced treatment methods and is attempting to uncover risk factors and prevention strategies. The development of validated educational materials which are available to download, were among the programs within COFAR. For further educational information, patients may visit the websites of organizations, such as the Food Allergy & Anaphylaxis Network and Food Allergy Initiative, in addition to resources, including written anaphylaxis emergency plans.
Avoiding allergens and using epinephrine are not considered the optimum treatment approaches by patients. The group at the Jaffe Food Allergy Institute, in cooperation with investigators in COFAR and others, is examining several new therapies, including oral and sublingual immunotherapies, Chinese herbal remedies, immune modulators, among others.
As recently reported, they have discovered, for example, that among children with milk or egg allergies, some can tolerate them in extensively heated forms, such as cookies or muffins, and this type of exposure may be beneficial for the immune system. Although much more research is needed on these approaches, the future looks promising.
Written by Grace Rattue