Is There a Pathway to Prevention for Food Allergies?
By Taylor Smith
Food allergies, intolerances, and even sensitivities in children seem to be ubiquitous in 2020.
Whether it’s a life-threatening allergy to peanuts or a less-critical sensitivity towards eggs that inevitably ends in a stomachache, modern-day parents need to be more informed than ever when it comes to recipes, nutrition, ingredient lists, environmental influences, and medical options.
According to the Asthma and Allergy Foundation of America (aafa.org), the symptoms of an allergic reaction include stuffy nose, sneezing, itchy, runny nose, itching in ears/roof of mouth, watery eyes, hives, rash, asthma symptoms, coughing, wheezing, and shortness of breath. A life-threatening allergic reaction is anaphylaxis, which can result in difficulty breathing, low blood pressure, fainting, vomiting, diarrhea, and even death. Anaphylaxis can occur within seconds of exposure or 1-2 hours later. Young children with severe food allergies may not be able to accurately describe what they’re experiencing and may instead show signs of turning blue; swelling of the lips, tongue, or throat; and dizziness. Parents should immediately call 911 for emergency medical help. Both the child and caregivers need to have an epinephrine (adrenaline) auto-injector with them at all times for such emergencies.
Food allergies occur when a child’s immune system reacts to certain proteins found in food (mayoclinic.org). In most cases, reactions can be caused by even a small amount of a particular food, residue from that food (i.e. exposure), or a form of cross-contact (such as when a gluten-free product is prepared in the same pots and pans as food that does contain gluten). These factors can make it particularly difficult for families who want to keep their child safe, but also want to vacation, dine out, and send their child to summer camp. The experience of suffering a life-threatening food reaction can be traumatizing, especially for young children and teens. That is why it is recommended that parents, teachers, friends, and families are informed as to the best treatment options.
By contrast, according to the American Academy of Allergy Asthma and Immunology (aaaai.org), a food intolerance is not an immune response and is generally much less severe than a food allergy. Symptoms of food intolerance often include nausea, stomach pain, gas, cramps, bloating, diarrhea, skin redness/appearing flushed, runny nose, and/or indigestion. Clearly, if your child or teen experiences negative physical symptoms as a result of consuming dairy, elimination, at least for a period of time, is often a good course of action.
Dr. Pete Pellegrino of Princeton Nassau Pediatrics explains that the most common food allergy culprits for young children are peanuts, tree nuts, fish, egg, cow’s milk, soy, wheat, and shellfish. Interestingly, children who are allergic to one substance are more likely to have other forms of allergy as well. Another high-risk indicator of food, chemical, and environmental sensitivities is mild to moderate eczema. The link between childhood eczema and food allergies is well-documented according to the American College of Allergy, Asthma, and Immunology (acaai.org), which states, “Eczema most commonly shows up before the age of 5, but adolescents and adults can also develop the condition. About 60 percent of patients will experience eczema symptoms by age 1, and another 30 percent will experience symptoms by age 5. Children born into families that have a history of allergic diseases such as asthma or hay fever are at an increased risk for eczema.”
Children suffering from eczema will likely experience multiple food and environmental sensitivities because they essentially have a compromised skin barrier. Allergy testing and preventative measures can treat milder cases, but eczema flare-ups can easily occur due to illness (a generally weakened immune system), detergents, soaps, cold air, dry air, fragranced products (like scented candles), compromised sleep, and stress.
If you suspect your infant or child would benefit from allergy testing, the Food Allergy Center at Children’s Hospital of Philadelphia (CHOP) has one of the largest and most accomplished teams of pediatric food experts in the world. CHOP regularly treats egg allergies, milk allergies, peanut allergies, soy allergies, wheat allergy, food intolerance, food protein-induced enterocolitis syndrome (FPIES), IgE-mediated food allergies, and eosinophilic esophagitis. The team is led by Jonathan M. Spergel, MD, PhD; Terri F. Brown-Whitehorn, MD; and Megan O. Lewis, MSN, CRNP. Working with a multidisciplinary team, CHOP aims to provide parents and children with diagnosis, second opinions, and customized treatment options.
Significantly, CHOP’s Food Allergy Center was one of the research sites used to test and develop the new U.S. Food and Drug Administration (FDA)-approved Palforzia. Intended for patients ages 4 through 17 with a confirmed diagnosis of a peanut allergy, Palforzia is an oral immunotherapy of very, very small dosages of peanut allergen powder. The goal is to desensitize children and teens with peanut allergies, in a controlled manner, over time. Once a certain level of tolerance is established, patients and families will be provided with a maintenance plan that may include consuming two peanut M&M’s per day or the equivalent.
Over time, CHOP’s research showed that children can indeed experience a reduction in the severity of peanut allergies without the consequence of a life-threatening reaction. As reported by CHOP News at Chop.edu, “Oral immunotherapy is just one type of allergy treatment researchers at the Allergy Program at CHOP are studying. Designated as a Frontier Program in 2018, the Allergy Program at CHOP is also testing skin patches that could desensitize children with peanut and milk allergies. The FDA is expected to review these treatments later this year.” (“FDA Approves Breakthrough Treatment for Peanut Allergies,” Jan. 31, 2020.)
In 2019, the UK’s Enquiring About Tolerance (EAT) study indicated that “early introduction of allergenic foods did protect against food allergy for some children at high risk. Early introduction and exclusive breastfeeding were compared in babies who were already sensitized at age 3 months to one or more of the six foods featured in the study (milk, peanut, egg, sesame, fish, and wheat). Being sensitized meant that these babies were at higher risk of developing a food allergy because blood tests showed that they were already making allergy-related IgE antibodies to at least one of the six foods.”
Notably, early introduction of both peanuts and eggs lowered the risk of developing these allergies in babies sensitized to peanuts and eggs. Parents should consult their pediatrician in regards to guidance on early introduction of allergenic foods. For example, depending on whether an infant is considered low risk or high risk, early introduction of certain foods is generally encouraged.
For more tips on how families can adapt and best care for a child with food allergies, FARE (foodallergy.org) is a great resource. FARE is the largest private funder of food allergy research, promoting the development of new therapies and offering hope for effective treatments. FARE estimates that 32 million Americans currently live with potentially life-threatening food allergies and that every 3 minutes, a food allergy reaction sends someone to the emergency room.
The FARE Clinical Trial Finder, launched in July 2018, helps people “find relevant clinical trials that are currently recruiting or preparing to recruit patients with food allergy or healthy volunteers who do not have food allergies,” as noted at foodallergy.org/resources/clinical-trials. The purpose of a clinical trial is to pinpoint the most effective treatment for a specific disease/condition. Clinical trials are an integral step on the pathway towards the Food and Drug Administration’s drug approval process. Participation in human clinical studies is available in all 50 states and Washington, D.C. Food allergy patients may elect to participate in these trials in order to be on the cutting-edge of clinical therapies. Patients will be asked to complete a series of surveys sharing their experiences with the medical community, hopefully lending greater insight to researchers worldwide.
Whole Body Approach
Aly Cohen, MD, FACR, is triple board certified in internal medicine, rheumatology, and integrative medicine. She is also a trained specialist in environmental health and frequently lectures on the subject at New Jersey hospitals, elementary schools, high schools, and universities. The impact of environmental chemicals on the human nervous, immune, and endocrine systems is of particular importance to Dr. Cohen, who works with patients in her Princeton office to identify and implement both conventional and alternative therapies.
This whole body approach entails examining nutrition, household chemicals, air filtration, sleeping habits, lifestyle, genetics, and habitual stressors. Dr. Cohen believes that genetics and the environment are both significant factors as to whether or not a child suffers from food allergies.
In her recent text, Integrative Environmental Medicine, Dr. Cohen details how families can reduce their habitual exposure to chemicals, many of which, are linked to “everything from type 2 diabetes, obesity, thyroid disease, asthma, allergy, autoimmune disease,” and more. This work is a literary extension of The Smart Human LLC (thesmarthuman.com), a company she founded in 2013 that “seeks to educate, coach, and empower everyday people to make safer, smarter choices for human health.”
As indicated on The Smart Human’s website, “There are over 90,000 chemicals currently registered and available for commercial use in the United States … to make all kinds of things like plastics, cosmetics, food additives and preservatives, computers, fabrics, toys, furniture, cars, etc. Known as ‘EDCs,’ these endocrine disrupting chemicals can antagonize the body’s entire system through allergies, sleep disruption, hormone imbalance, sugar regulation, anxiety, and inflammation. “
Slated to be released this year, Dr. Cohen’s new book, Non-Toxic: Guide to Living Healthy in a Chemical World, seeks to educate the general public on how they can take matters related to allergies and chronic illness into their own hands. According to Dr. Cohen, increased exposure to toxic chemicals within our environment is leading to greater rates of both allergies and chronic illness. Factors like contaminated drinking water, abrasive household cleaning products, air pollution, air fresheners, hairspray, shampoos, and beauty products serve as irritants for a host of allergy-related illnesses. One simple way to improve these matters is to remove synthetic/chemical products from the home. Also helpful are changing the filters on your HVAC system regularly and vacuuming with a HEPA filter vacuum to remove dust and pesticides from the furniture.
So, what role does geography play in the rise of childhood allergies? While peanut and shellfish allergies are generally prevalent everywhere, children in urban areas are increasingly challenged by environmental factors related to high population densities, such as diesel exhaust, tobacco smoke, ozone, and NO2 (a gaseous air pollutant composed of nitrogen and oxygen). The article “Geographic Variability of Childhood Food Allergy in the United States,” published in the journal Clinical Pediatrics (Volume 51, Issue 9), notes that repeated exposure to these conditions increases the risk of developing asthma and allergies.
According to NJ.gov, “All of New Jersey’s 8 million residents are breathing in unhealthy amounts of ozone pollution at some point during the summer. Approximately 620,000 N.J. residents have been diagnosed with asthma, which can make them more sensitive to air pollution. In general, children and the elderly are more sensitive to air pollution.”
The New Jersey Department of Environmental Protection (DEP) offers programs aimed at cleaning-up the state’s air. It is recommended that families and sensitive groups monitor air pollution levels in their town by checking the Air Quality Index (AQI ) or calling 800.782.0160. The five pollutants used in the AQI are: carbon monoxide, nitrogen dioxide, ground-level ozone, particulates, and sulfur dioxide.
The American Lung Association in New Jersey (lung.org) actively works to protect the quality of the air that New Jersey residents breathe. This includes keeping children off tobacco, helping people to quit smoking, and making strides to reduce the concentration of soot and general pollution in our backyards. As recently as 2017, PSEG closed its two coal-burning power plants in New Jersey. The Hamilton and Jersey City plants were sold to a Chicago-based developer with the intention of transforming the sprawling industrial sites into “state-of-the-art industrial parks to serve the growing need for regional warehouse-distribution hubs in central and Northern New Jersey.” (“PSEG Sells Defunct Coal Plants in Jersey City and Hamilton for Redevelopment,” NJspotlight.com). PSEG has also sold its interest in two coal-fired plants in Pennsylvania and appears to be moving to be moving towards cleaner energy initiatives, such as off-shore wind and solar energy.
Orsted, the world leader in offshore wind development (orsted.com/en), is currently working with PSEG to operate New Jersey’s first utility-scale offshore wind farm known as Ocean Wind (oceanwind.com). Located 15 miles off the coast of Atlantic City, Ocean Wind is intended to produce 1,100MW of electricity and reliable energy and is expected to be fully operational by 2024.
Although food and environmental allergies are more prevalent, families should take heart that food labels are becoming more transparent, and that access to public information on safety precautions, air quality and water alerts, medical services, and allergen-free options is finally becoming mainstream.