“This is a massive research project which will have far-reaching consequences for consumers and food producers,” said professor Clare Mills of the University of Manchester’s Allergy and Respiratory Centre and the new head of the $14 million iFAAM study, which stands for Integrated Approaches to Food Allergen and Allergy Risk Management.

One of the main goals of iFAAM is to reduce the use precautionary “may contain” labels on packages to those food products which truly require the label. As ‘may contains’ have flourished in the marketplace, the choices for food-allergic consumers have become increasingly limited. The researchers plan to develop standardized processes and enforcement rules for European food manufacturers to follow to reduce risks of cross-contamination with allergens, and streamline processes to test foods for allergens.

Another section of the study will attempt to explain why individuals develop food allergies. A research group will examine whether the early introduction of allergenic foods in a baby’s diet and other nutritional aspects play a role. A related group of researchers will try to identify who is more likely to suffer a severe allergic reaction, and whether diet during pregnancy is related to the onset of food allergy in infants.

This study builds on $21.9 million worth of research from the EuroPrevall project, which Mills also headed and which  focused on food allergy prevalence across Europe.

See the official iFAAM press release

“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.

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.

There is also optimism that information coming out of large-scale research in Europe on the “farming effect” will lead to a vaccine in the future. Perhaps one day doctors might advise getting a pet, or visiting a farm to prevent allergy: there is increasing evidence that being exposed to livestock, dogs (and in some cases, cats) as a young child can help the immune system switch into TH1 mode.

Other research is examining at things such as whether fish oil has a preventative role, as well as the timing of when certain allergenic foods are introduced.

While there’s no concrete evidence yet of what will prevent food allergy, rest assured that scientists are madly investigating every possible angle to come up with a way to foil this modern-day health scourge.

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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“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 wheal (hive) on a skin-prick test compared to the beginning of the study. They also had increased levels of milk protein IgG4 levels, an antibody associated with a protective effect against allergies. (A similar study, with similar results, was performed with baked egg.)

Researchers conducted a telephone survey in 2008 of more than 5,300 households and found that 3½ times more children have peanut allergy now than they did 11 years ago. In 1997, 0.4 per cent of children were reported to have peanut allergy, which doubled by 2002, to 0.8 per cent. In 2008, 1.4 per cent of children had peanut allergy.

The rate of tree nut allergy in children has similarly increased: from 0.2 per cent in 1997 to 0.5 per cent in 2002 and 1.1 per cent in 2008.

Dr. Robert Wood, chief of pediatric allergy and immunology at Johns Hopkins Children’s Center in Baltimore, told the conference that the survey, conducted using random digit dialing, could slightly overestimate the numbers because, “people might think they have an allergy but really don’t.”

But since the same same methodology was used in all three surveys, Wood notes: “We’re pretty confident that the increase that was seen, now in an 11-year period from 0.4 to 1.4 [per cent of children having peanut allergy], has to be real.”

Dr. Hugh Sampson, chief of allergy and immunology in the pediatrics department of the Mount Sinai School of Medicine in New York and one of the study’s authors, pointed out that questions were also asked to determine if the patient truly did have food allergy, such as whether the person experienced hives.

Next: Canadian Statistics