For some young study subjects, her multiple allergy desensitization work has been life-changing. They use words like “magic” and “miracle” to describe what life is like now that they don’t have to worry about accidental exposures at birthday parties or restaurants.
But their allergist is at pains to temper expectations. “These studies are at the neonatal stage. OIT is experimental and I don’t want to give people the wrong feeling that there is a perfect cure out there,” she says. “There is not.”
There are some drawbacks to Xolair: it’s very expensive, not every allergic person tolerates the injections well, and some people may have too high a level of IgE antibodies to qualify for trials. Plus, Nadeau echoes Wood and Burks when she notes: “We don’t know the long-term effects.”
Still, back in New York at Mount Sinai, Sampson and his colleagues are cautiously optimistic about the combination therapy. Dr. Scott Sicherer, chief of the school of medicine’s division of allergy and immunology, is also quick to point out other promising food allergy therapies on the drawing board. For instance, there’s the research of Mount Sinai’s Dr. Xiu-Min Li.
She has been working for several years with the Chinese herbal remedy called FAHF-2, which is meant to raise an allergic person’s threshold for allergenic foods. The formula, a highly specific blend of herbs, has worked extremely well in experiments with mice – and is now being studied in humans at Mount Sinai, Arkansas Children’s Hospital and Northwestern University. The researchers hope to have results in late 2013.
The downside of this approach is a practical one: a person needs to take 30 tablets a day to consume enough of the remedy to prevent reactions. “We’re working on getting the pills more concentrated, and getting that number down,” Sicherer says.
There are also high hopes for the allergy “patch,” where the strategy is to expose the patient to the allergenic food by putting it on the skin, like a nicotine patch in smoking cessation. While it’s early days for this research, Sicherer says “the thing that’s nice about that one is we anticipate fewer side effects because you’re not swallowing increasingly larger amounts of the food. Instead, you’re putting the food on the skin.”
He says other emerging lab work will attempt to answer: “Can you combine an allergen with an immune stimulator that tells the immune system to ‘see’ the food in a better way and have non-allergic responses to it?” OIT therapy of itself may also hold promise if approached differently.
Perhaps, says Sicherer, the dosing needs to continue for prolonged periods of time. “We may be expecting too much of a one-year or two-year therapy,” he says. “It may turn out that if you’re on this daily treatment for three or five years, maybe that is a cure.”
Among these top researchers, there is little sense of any academic race to be the scientist with the big answer, instead the approach is refreshingly collaborative. The day Allergic Living spoke to Sicherer, Nadeau was arriving from California – both to speak to a luncheon for FARE, the food allergy organization that contributes significant funding to research, and to visit the Mount Sinai team.
In that visit, she and Dr. Xiu-Min Li roughed out a unique new OIT study, one that would combine the FAHF-2 formula with OIT desensitization. “We hope, if possible and if safe, to use the herbal medicine in combination with multi-OIT to see if these are safe and efficacious together,” confirmed Nadeau. Quickly she added that “we have barely mapped out a study on a napkin, so I don’t want to say more until we have the regulatory approval and the right protocol.”
Yet it’s another example of leaders from different branches of food allergy research coming together with creative approaches. “Everybody just wants to solve this problem and work together to do it,” says Sicherer. “We are in this together. As a physician, it kills me to see the impact of food allergy on quality of life. You just want to make it better.”
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