“How many people have food allergies?”
It seems like a simple question with a simple answer. However, a recent report from the National Academies of Science, Engineering and Medicine has stated that because of a lack of rigor in the research we don’t really know how many people have true food allergies. (National Academies of Science, Engineering & Medicine, 2017) While we may not know the actual number, it definitely seems that food allergy diagnoses have been on the rise, including to peanuts. The good news is that research in the area of food allergies is exciting and dynamic with much promise on the horizon.
According to the recent expert report, current diagnostic tests (skin prick and serum IgE) current tests are not 100% accurate and cannot diagnose food allergies on their own. The only way to definitively diagnose food allergies at this time is using an oral food challenge, but this can be both risky and costly. New diagnostic measures are on the horizon, including the basophil activation test (BAT). The BAT may be a more accurate blood test, because it may better identify reactions which are clinically relevant (those that result in actual symptoms) as compared to current blood and skin testing methods. (Hoffman H, 2015) Trials are ongoing to determine the accuracy, feasibility, and practicality of using BAT to more accurately diagnose food allergies.
Preventing Food Allergies
While not every food allergy can be prevented, current research shows that peanut allergies can be prevented in those at high risk, including those with moderate to severe eczema, egg allergy, or both. (Du Toit G, 2015) Other studies show promise in the early introduction of egg and cow’s milk. Studies are ongoing, but research does not yet definitively support the early introduction of other foods specifically to prevent food allergies. Yet, research does support the safety of early introduction for all foods if they’re introduced in an appropriate form and avoidance does not prevent food allergies from developing. Future research will help answer the questions about optimal timing of foods to prevent allergy.
Another focus for preventing food allergies is in preventing the allergic march. The allergic march refers to the progression of atopic disease that usually starts with eczema, progresses to environmental allergies and finally to food allergy within the first few years of life. Some researchers believe that if eczema can be prevented or if it can be well-managed, that may slow or prevent the progression of the allergic march.
Reversing Peanut Allergies
For those who have already developed allergies—and until all allergies can be prevented—treatments to reverse food allergies are needed. Currently research continues to determine how to desensitize allergic individuals or induce tolerance. Oral immunotherapy, sublingual immunotherapy, and epicutaneous immunotherapy are all still considered experimental, but have all shown promise in inducing tolerance. While not a complete cure for allergies, these treatments offer opportunities to reverse reactions to peanuts for many. Currently two are in phase 3 trials, one studying epicutaneous peanut immunotherapy and a second researching peanut oral immunotherapy trial each scheduled to end in late 2017.
Peanut and other food allergies aren’t going to disappear population-wide immediately. However, researchers are working hard to make the future brighter by offering hope for individuals today and tomorrow through better diagnostics, preventing food allergies, and reversing existing allergies.