by Gary Emmett, M.D.
The New England Journal of Medicine recently published an original research article on a new concept in eliminating food allergy in children. Over 5 percent of children have serious food allergies and egg allergy is one of the most common. That’s a real challenge, because eggs are almost unavoidable in modern food. They’re included in many prepared and processed foods and being use commonly as a “binder” in almost all pastries and cakes.
This new approach isn’t ready for widespread use - yet. It’s still experimental, but could one day offer new hope to kids and their families. The study included 55 children with egg allergy, between 5 and 11 years old. Forty kids received an egg-white powder as daily oral immunotherapy for 24 months - under careful supervision, of course. The other 15 children received a cornstarch powder “placebo” for 24 months. Throughout the study, all of the young volunteers were given “food challenges” - they consumed gradually-increasing amounts of the food they were allergic to, under medical supervision, to see if they would experience an allergic reaction.
After 22 months, 75 percent of the egg-white power group passed the food challenge (none of the control group did). That meant they were able to eat some egg without having an allergic reaction. Researchers took them off their therapy and retested a few weeks later. One-third of the egg-therapy group passed the challenge - and was still able to eat eggs a year later, report researchers from Mount Sinai School of Medicine.
Although still in the experimental stage, this technique could be expanded to eliminate other dangerous food allergies such as peanuts, cow’s milk protein and shell fish that can cause serious, even fatal, reactions. This paper appears to be of high quality because it is a statistically valid, double-blinded study with over 50 patients and the results are likely to be repeatable.
"We found that oral immunotherapy provides protection in a majority of children with egg allergy by raising the reaction threshold," said Hugh Sampson, M.D., Dean for Translational Biomedical Sciences, Professor of Pediatrics, and director of the Jaffe Food Allergy Institute at Mount Sinai School of Medicine. "It represents a promising therapeutic intervention for food allergy and the approach is relatively safe, with most of the reactions to dosing categorized as mild."
It’s important to note two things. This was done under close medical supervision. And 15 percent of kids with egg allergies who tried the therapy had significant reactions and had to stop.
But it could help many children if future studies confirm the benefits - and can identify which kids would be helped. Fear of food allergy has changed little children’s lives. Many preschools have banned peanut butter because those children with peanut allergy can get seriously ill even by smelling the peanuts. Severe food allergies have made ordering in restaurants a nightmare for parents (and even a bigger nightmare for kitchen and serving staffs). The rate of food allergies appears to be increasing and reasons why this is happening is unclear. Exposing infants’ guts to complex organic proteins too young (under 4 months) causes increased sensitivity as does waiting too long.
The American Academy of Pediatrics recommends the introduction of foods other than breast milk or formula at about 6 months. Doctors suspect that any food other than breast milk or formula under 4 months increases allergies and also it is clear that waiting too long (after 8 months) produces children who refuse to chew. If this new study can be reproduced and expanded to other common allergens, we could really improve children’s lives.
Does your child have a food allergy? How does your family cope?
Garry A. Emmett, M.D., F.A.A.P., has been a primary care pediatrician in South Philadelphia and Center City since 1979.