“I kind of freaked out,” she admits, since her son had previously had an anaphylactic reaction to cottage cheese. Theo didn’t react to the crackers, but avoidance remained the family watchword.

The boy, however, turns out to be among the 75 per cent of kids allergic to dairy whom researchers now believe can actually tolerate milk – provided it has been extensively heated through baking. The same holds true for egg.

While under supervision at Johns Hopkins University School of Medicine in Baltimore, Theo on separate occasions was able to eat one-twelfth of an egg and a quarter cup of milk, both of which were baked into a cake. Emergency treatment was at the ready, but he didn’t react. By May, the boy had started a new diet at home that includes muffins, breads, even croissants; foods thoroughly baked at 350 degrees for at least 30 minutes. There has been a sanctioned bite of lasagna and, in the next phase, Theo will be testing out pizza, which isn’t cooked as long.

Allergists have long heard stories of allergic children who have accidentally eaten milk or egg – perhaps grandma fed the child an off-limits cupcake, or a daycare provider didn’t realize that cookies contained egg – without reactions.

But researchers are getting closer to understanding why kids like Theo can tolerate milk or egg that has been baked, while others still will react immediately. They’re also finding that introducing the baked food into the diet may actually help the child outgrow the allergy.

At Johns Hopkins, some dairy-allergic kids, including those who have had significant reactions to milk in the past, have even moved on to unheated foods such as yogurt and chocolate milk.

The best news: this is research that doesn’t have to wait for clinical trials and government approvals. As long as you begin at the office of your allergist, and he or she has the resources to perform food challenges safely, introducing baked milk or egg into your child’s diet is “something that can be done right now,” Dr. Wesley Burks, head of pediatric allergy and immunology at Duke University Medical Center, told the American Academy of Allergy, Asthma & Immunology conference in New Orleans earlier this year. He called this new way of treating milk and egg allergy a “paradigm change.”

Added Dr. Hugh Sampson, chief of allergy and immunology at New York’s Mount Sinai School of Medicine and leader of the research: “What it means is that as opposed to going to birthday parties and not being able to eat cake, or going to school and worrying about somebody eating a cookie that has milk or – they can suddenly do all this.”

***

THE CONCEPT of feeding allergic kids baked milk or egg goes against longstanding food allergy management practice and what parents like the Glaubers have been doing to protect their children. That is, they do everything in their power to ensure that not a morsel of the allergenic food crosses their child’s lips. A shift in thinking began a few years ago with a study performed by Sampson and his colleagues at Mount Sinai.

They gave each of 100 milk-allergic kids a muffin to eat that contained 1.3 grams of milk protein, in the form of dry milk powder. If a child was able to eat the muffin, baked for 30 minutes, without a reaction, two hours later he or she was served a waffle, which was only cooked for three minutes.

Sampson and his team found that 75 of the 100 children tolerated milk that had been extensively heated, and they were told to keep it in their diet.

While in the past it had been believed that kids were more likely to outgrow a milk allergy if they successfully avoided it, this study suggested otherwise. In follow-up appointments three months later, those children who had continued to eat baked milk products showed a significantly smaller

Peanut allergies are severe, often affecting children, and are increasing in prevalence. It’s no wonder researchers around the globe are looking at new, inventive ideas for how “cure” them, or at the very least, how to allow those with peanut allergies to tolerate at least a small amount of this legume’s protein.

Allergic Living looks at two of the latest ideas in the labs:

Peanut Allergy Vaccine

Researchers at Mount Sinai and Johns Hopkins University are studying a vaccine for peanut allergies to see if it is safe. The vaccine contains an altered peanut protein to “trick” the immune system. Dr. Scott Sicherer, an associate professor of pediatrics at the Mount Sinai School of Medicine in New York likens the changed peanut to a baby bracelet that spells “peanut.”

“If you altered that bracelet a little bit, let’s say you changed the ‘A’ in peanut to a ‘D’, then it would say PEDNUT instead of PEANUT,” he says.

The idea is that the person’s immune system won’t recognize “pednut” and won’t mount an allergic reaction to it. However over time, if it sees “pednut” enough, it may learn to tolerate “peanut.”

Once the safety trials for the vaccine, which is administered rectally as a suppository and also contains heat-killed E. coli, are complete, researchers will begin to study if it actually reduces peanut allergy in humans.

The Desensitizing ‘Peanut Patch’

Researchers are also looking at the possibility of desensitizing people with peanut allergies through the skin.

Dr. Hugh Sampson, head of the Consortium of Food Allergy Research in the United States, told Allergic Living magazine that U.S. researchers got the idea from French research, in which scientists have developed immunotherapy patches for cow’s milk allergy.

Those researchers placed a milk-containing patch on dairy-allergic patients every other day for three months. The results were that the patients were able to consume, on average, 12 times more milk without a reaction than they could before the treatment.

Building Tolerance

Dr. Bob Anderson, a gastroenterologist in Melbourne, Australia, is heading the research on a celiac vaccine. His work focuses on desensitizing patients by injecting them with gluten peptides, amino acids that gang up to produce the immune reaction. “The idea is if you give one injection, you will activate a response but if you repeat it, you can use it as a treatment,” he tells Allergic Living.

Anderson has focused on a treatment that would allow people to eat gluten because he knows it’s hard to avoid the protein, no matter how diligent you are. He points to research that suggests about half of patients who are following gluten-free diets still have substantial damage in their small intestines. Results from the Phase I safety trial with patients should be compiled and ready by the middle of this year.

Gluten-free Wheat

The effort to change the very makeup of wheat is centred at Washington State University. Dr. Diter von Wettstein, a professor in the department of crop and soil sciences is trying to neutralize the parts of gluten that cause the immune reaction in the first place. The goals are to produce a celiac-friendly wheat that contains lysine, an essential amino acid often deficient in the grain, which would help to maintain the wheat’s baking texture and elasticity when it was made into dough.

“Creating new cultivars of wheat, arguably the most important crop grown … will be of tremendous benefit not only for sufferers of celiac disease, but for all consumers of wheat and wheat products,” von Wettstein said.

Popping a Pill

Research to develop a celiac “pill” includes trials taking place at Leiden University in The Netherlands, where Dr. Frits Koning and his team are testing a drug derived from a common fungus that can be found on decaying vegetation. Known as an AN-PEP, it is thought to break down both the gluten proteins and the T-cell peptides in the small intestine, preventing an adverse reaction. They’ve found the enzyme to be safe in humans, but haven’t yet proved its effectiveness.

In Baltimore, Dr. Alessio Fasano and his team have developed a pill that, rather than break down gluten, prevents gluten particles from penetrating the lining of the small intestine. Fasano says to imagine the small intestine as a gated community, with a protein called zonulin opening and closing the gates. In people with celiac disease, the gate is left ajar. A person would take the drug before eating, to block the release of zonulin. Phase III clinical trials for the pill are on hold, as the biotech firm that was to conduct them is struggling with funding. Fasano may partner with a larger firm. “One of the best assets of a scientist is perseverance. This drug could potentially be the next blockbuster. You have to have faith.”

First published in Allergic Living magazine.
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Idea: Hypoallergenic Cat

What’s Involved: Genetically engineering a cat that doesn’t have the gene that makes Fel d 1 protein, which causes the majority of allergic reaction. Once a colony of hypoallergenic cats is established, kittens could be bred using “traditional” methods.

Where We Stand: In 2006 a company called Allerca Inc. claimed to have bred the world’s first hypoallergenic kittens and Time magazine hailed them as one of the best inventions of the year.

But the company and its founder have been the subject of controversy, with the media and a dedicated website questioning whether the firm, now called Lifestyle Pets, really has sneeze-free cats.

But this is not the only company in the hunt for the hypoallergenic kitty. Dr. David Avner, an emergency room physician in Denver, has been working with molecular biologists on silencing the Fel d 1 gene for years, and so far has come up empty-handed.

This past summer his team thought they had successfully knocked out the gene, which could lead to the breakthrough they’ve hoped for.

While Avner admits to being “optimistic” in predicting when his company, Felix Pets, will have cats on the market, he says there’s little doubt that in 10 years, a hypoallergenic cat will be in people’s homes.

“Without question, someone is going to do it. It’s too obvious an application of the technology, and the desire for people to have allergen-free cats is too high for it to go unrealized.”

Idea: Herbal Tablets for Asthma

What’s Involved: The Antiasthma Herbal Formula (ASHMI) is a tablet containing three traditional Chinese herbs. A study of patients in China shows it improves lung function and reduces use of bronchodilators.

Where We Stand: Dr. Xiu-Min Li at the Mount Sinai School of Medicine and her colleagues continue to study ASHMI in mice and people, comparing it to using corticosteroids. New, unpublished data show that eight weeks after mice stop taking the corticosteroids, their asthma symptoms return when they are exposed to triggers.

However, the mice on the herbal formula are still protected eight weeks later. Safety studies in humans have been completed, and Phase 2 efficacy studies are continuing.

One of the benefits to using ASHMI, instead of a steroid, is that there are fewer side effects, such as weight gain. However, Li says corticosteroids will be the standard treatment for asthma for years to come.

“The practical protocol will be to have a herbal remedy that will reduce the steroid’s side effects and help to maintain the protective effect,” she says.

Idea: Quick-Acting Allergy Shots

What’s Involved: Currently, immunotherapy to environmental allergies such as trees, grass, ragweed and cats, sometimes called allergy shots, requires numerous needles over several years. The shots also carry the risk of anaphylaxis in some individuals. Now, a few companies are developing therapies to make the treatment process far shorter and also safer.

Idea: Peanut Allergy Vaccine

What’s Involved: The treatment is based on immunotherapy – that is, by slowly introducing the immune system to something it is allergic to, the system will eventually learn to tolerate the allergen. The problem is, with food allergy, anaphylaxis can occur.

To eliminate that risk, researchers have altered a peanut to “trick” the immune system. Dr. Scott Sicherer, an associate professor of pediatrics at the Mount Sinai School of Medicine in New York and a researcher at the school’s Jaffe Food Allergy Institute, explains the concept. He likens the changed peanut to a baby bracelet that spells the word “Peanut”.

“If you altered that bracelet a little bit, let’s say you changed the ‘A’ in peanut to a ‘D’, then it would say PEDNUT instead of PEANUT,” he says. His theory is that the allergic person’s immune system won’t recognize “pednut” and therefore will be less likely to mount an allergic reaction to it. Over time, if it sees “pednut” enough, the immune system might also learn to accept “peanut”. He does not yet know how often the treatment would need to be taken to make this happen.

Where We Stand: Researchers have developed the optimal “altered peanut” and the vaccine has, in fact, reversed peanut allergy in mice. They’ve also determined that the vaccine is best taken rectally, as a suppository. Along with the altered peanut, the vaccine contains heat-killed E. coli bacteria, to signal the immune system that it should react to a bacteria, rather than an allergen.

Now, teams at Mount Sinai and at Johns Hopkins Children’s Center in Baltimore have started a Phase 1 clinical trial with a small group of people to ensure the vaccine is safe. If all goes well, the researchers will move on to Phase 2 studies, which will determine if the vaccine actually helps to reduce peanut allergy in humans.

Idea: Herbal Formula for Food Allergy

What’s Involved: Dr. Xiu-Min Li has been toiling in her lab at the Mount Sinai School of Medicine for years, trying to zero in on the perfect concoction of Chinese herbs that can increase a person’s threshhold for allergenic foods.

She and her colleagues have tested the formula, which includes dried ginger root, processed plums, Chinese peppers and ginseng, extensively in mice. After they stopped the treatment, the mice still did not react to their former allergen six months later. Li hopes the herbal remedy will allow people to come in accidental contact with their allergens and not have a serious reaction.

Where We Stand: Li has tested the treatment in humans and concluded the formula called FAHF-2 is safe and well-tolerated. She also found that people who took FAHF-2 tablets for six months had a reduction of basophil blood cell activity, which suggests a reduction in a person’s allergic tendency.

Now, the work ahead is to prove the treatment is effective, and to determine how much and how often a person should take it. Li was set to begin a Phase 2 study in March in which patients will take FAHF-2 or a placebo for several months. At the moment, this entails taking 24 tablets a day, but Li is working on reducing that number. The theory is that the effect of the treatment will last some time after the person stops taking the tablets.

Li’s goal is to develop a drug that can be taken by prescription, but she says that once the formula is proven effective, she could begin marketing it as a dietary supplement in the U.S. and Canada, perhaps as early as next year, while she continues to get drug approval.

Idea: Oral Immunotherapy or Desensitization

What’s Involved: In this experimental food allergy treatment, doctors give allergic patients increasingly larger doses of their allergen, starting with tiny amounts, to teach their immune systems to build up tolerance to it.

Allergists Dr. Wesley Burks and Dr. Stacie Jones are running numerous trials of oral immunotherapy (OIT) in Arkansas and North Carolina. Most (but not all) children have been able to build up a tolerance to allergens like peanuts, eggs and milk.

Where We Stand: Burks and Jones continue to research the intricacies of OIT, including who should and shouldn’t try it. They’ve found the most common side effects include runny nose, itchy skin, mild wheezing, or abdominal symptoms. They also found that children react to their daily peanut dose less than 5 per cent of the time, but the reactions that do occur are unpredictable. However, it was discovered that more reactions will occur if a child has a viral infection and more if he or she eats the food on an empty stomach. Trials at other centres are also taking place.

In Canada, Dr. Susan Waserman of McMaster University and Dr. Wade Watson of Dalhousie University have secured a grant from the research network AllerGen to start up a small Canadian trial of peanut oral immunotherapy in Hamilton and Halifax. The study will enroll patients 6 years of age and older. In each city, five patients in a “low-dose” group will work their way up to a fraction of a peanut a day, and 10 higher-dose patients will aim to eat the equivalent of 10 peanuts a day. (There will also be a peanut-allergic control group.)

Investigators will draw blood and give patients an oral challenge every three months in order to pin down the stage at which desensitization truly begins. Waserman hopes to begin recruiting patients this spring. Burks suggests that having a desensitization protocol in place that can be widely used by allergists is still several years away.

IN LABS in universities and hospitals across North America and Europe, these are exciting and competitive times in allergy research. There are strong prospects for a vaccine that would significantly increase a peanut-allergic individual’s tolerance to the dread legume. And, while farther off into the future, scientists are speaking with cautious optimism about the possibility of one day preventing allergic responses altogether.

At the forefront of the research is Xolair, a drug that U.S. specialists in allergic science are now testing on peanut-allergic individuals, while Canadian researchers prepare to do the same in parallel studies. Xolair is injected as a vaccine and has already proved highly successful in a slightly different application in the treatment of asthma. The hope is that it will do the same in peanut allergy.

Yet Xolair is but one of the strategies on the drawing board. In November 2004, California’s Stanford University announced that allergic dogs had remarkably tolerated handfuls of ground peanuts after a course of a vaccine that employs heat-killed bacteria mixed with peanut protein, while researchers at the world-renowned Jaffe Food Allergy Institute at the Mount Sinai School of Medicine in New York found success in mice with a different dead-bacteria-based vaccine, this one employing the common E.coli.

“I think as every day goes by, you could say that there is more and more in the pipeline in terms of trying to treat food allergy and peanut allergy in particular,” says Dr. Scott Sicherer, associate professor of pediatrics at the Jaffe Institute. “There are a lot of strategies that are being looked at simultaneously.”

These developments can’t come quickly enough. In May, 2004, Dr. Hugh Sampson, the director of the Jaffe Institute and Sicherer’s colleague, published a report analyzing studies over five years and concluded that ?nearly 4 per cent of Americans are afflicted with food allergies.? That is a rate of allergy far higher than had been found before 1997. In Canada, the percentage incidence is estimated to be similar, if slightly less. Sampson also found that peanut allergy alone…

for the rest of this article, see the Spring 2005 issue of Allergic Living magazine.
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The data from the nation-wide Surveying Canadians to Assess the Prevalence of Common Food Allergies and Attitudes towards Food Labelling and Risk (SCAAALAR) telephone survey, sponsored by Health Canada and the AllerGen research network, was presented at the American Academy of Allergy, Asthma & Immunology’s conference in March, 2009.

While the information is not complete – it reflects about 90 per cent of the 9,000 individuals on whom data was collected: “We do find a greater prevalence of peanut allergy in Canadian children, and a greater prevalence of tree nut allergy overall, and in Canadian children,” says Dr. Ann Clarke, an allergist at the McGill University Health Centre, who discussed the results with Allergic Living.

In Canada, 1.52 per cent of children are allergic to peanuts, based on a history of allergic reaction. The comparable figure in the U.S., from a 2002 survey, is .83 per cent, representing an 83 per cent higher rate in Canada. Similarly, the rate of tree nut allergy is about 120 per cent higher for Canadian children: 1.13 per cent have a history of reaction here, compared to .51 per cent in the United States.

When Clarke and her team looked at the rates of shellfish allergy in both countries, they found a 50 per cent higher rate of the allergy in U.S. adults compared to Canadian adults.

Clarke cautions, however, that the differences come with a few caveats: the Canadian data was collected six years after the U.S. data, and some of the difference could be attributed to an increase in food allergies over that time. Also, the SCAAALAR team has not analyzed the demographics of the Canadian survey respondents yet, so it’s unclear if the studies represent the same socio-economic groups. This analysis will be done before the final results are published next year. (Updated U.S. statistics are also coming next year.)

While the rates of allergy that Clarke and her team used to compare to U.S. figures are based on having a history of food allergy reactions, they also collected data on those who have had a medical diagnosis of food allergy, without a previous reaction. “It might mean that the parent is going in with a child and saying, well, his brother has peanut allergies so I’m concerned he might be allergic, but he’s never eaten it,” says Clarke.

The physician then does a skin or blood test and makes a diagnosis based on the results. The SCAAALAR team is currently contacting all physicians who made the diagnoses in these cases to confirm that yes, that patient is deemed to have a true food allergy.

The final figures for food allergy prevalence in Canada for individual foods, as well as overall incidence figures, will be based on those who have had a history of allergic reaction, as well as those who have a confirmed physician diagnosis.
First published in the Summer 2009 issue of Allergic Living.

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TORONTO, April 14, 2010 – In its 5th Anniversary issue, Allergic Living magazine looks 10 years ahead in a 20-page special section: “The Future of Allergies.”

From the front lines of research into food allergy, celiac disease and environmental allergies, Allergic Living’s journalists report that a therapy revolution is coming.

By the next decade, there will be therapies for food allergies and celiac disease – currently there is only food avoidance. And not just one treatment. If all goes to plan, there should be:

• A “Pednut” vaccine that tricks the immune system into accepting peanut.
• Chinese herbal tablets that would prevent allergic reactions or asthma attacks.
• A hypoallergenic peanut plant.
• A hypoallergenic cat.
• Desensitization clinics for peanut, milk and egg allergies.
• A celiac pill that stops gluten from penetrating the small intestine.
• The emergence of gluten-free wheat in the marketplace.

For more information about “The Future of Allergies” or to arrange an interview with Allergic Living Editor Gwen Smith, call Beth Sulman at 416-628-5602 or bsulman@hccink.com

Allergic Living is available by subscription (www.allergicliving.com) and at Chapters bookstores,
Shoppers Drug Mart and London Drugs.

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Other Media Releases:

• Spring 2010: Allergic Living’s 5th Anniversary Milestone
• Summer 2009: Planet Allergy
• Spring 2009 – Backlash: The Nutty Debate over Food Allergies
• January 2009 – Airlines and Allergies