We were in unique times during this pandemic throughout all of 2020. Regardless of the challenges that occurred this year, there was still exciting news in food allergy. Let’s dive into the top allergy news topics of 2020.
The scientific report of 2020 dietary guidelines advisory committee was submitted this year to the United States Departments of Agriculture and Health and Human Services. This committee report informs the 2020-2025 DGAs. Very soon, the Secretaries of the Department of Agriculture (USDA) and the Department of Health and Human Services (DHHS) will release the 2020-2025 Dietary Guidelines for Americans (DGA).1
- Peanut Introduction: The Scientific Report stated that “Strong evidence suggests that introducing peanut in the first year of life (after 4 months of age) may reduce risk of food allergy to peanuts” and went on to state “This evidence is strongest for introducing peanut in infants at the highest risk (with severe atopic dermatitis and/or egg allergy)”
- Egg Introduction: The Scientific Report stated that “Moderate evidence suggests that introducing egg in the first year of life (after 4 months of age) may reduce risk of food allergy to egg.”
- Introducing Maternal and Early Childhood (0-24 Month) Guidelines – Due to rising health concerns for children including obesity, the 2020-2025 DGA will attempt for the first time to provide strong, evidence-based recommendations for pregnant women, infants, and young children.
- No Added Sugar for Children Under 2: As part of the new guidelines for babies and toddlers, the 2020-2025 DGA states “Avoid foods and beverages with added sugars during the first 2 years of life.”
If implemented, these changes will impact the health of millions of American families by improving health outcomes, including reducing the risk of food allergies.
For more information on preventing peanut allergies, visit PreventPeanutAllergies.org.
Guidelines for Food Allergy Management in K-12 Schools Released
This year school nutrition professionals have felt the direct impact of the pandemic. The paper Managing Food Allergies in Schools During the COVID-19 Pandemic was published this summer, in the midst of the pandemic, as a way to provide guidance on some of the keys to helping manage food allergies safely in this unprecedented time. In the paper the following best practices were recommended:
8 Guidelines from the Experts2:
- Wash hands, clean surfaces, and don’t share food
- Food allergen bans are not medically necessary
- Adapt 504 plans to work with new school restrictions
- Stock epinephrine in all schools
- Train all school personnel to recognize and treat anaphylaxis
- Zero tolerance for bullying
- Unique approaches may be necessary in some schools & classrooms
- Communication is paramount to ensure success
The pandemic also changed the way a lot of students went back to school this year. Yet, although some students learned virtually and some students attended in person, the basic management of allergies has remained the same. Dr. Shahzad Mustafa gave his thoughts on how the pandemic has impacted food allergic students at school: “…the basics are the basics: food avoidance, epinephrine for systemic reactions, everyone should have an emergency action plan, kids should not be food sharing, they should be respectful of space — these guidelines remain the same.”
New Practice Parameters for Early Peanut Introduction from the American College of Allergy, Asthma and Immunology (ACAAI)
At the 2020 annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) meeting, a new paper A Consensus Approach to the Primarily Prevention of Food Allergy Through Nutrition was released. These revised clinical guidelines were developed by a group of leading allergists and pediatricians in North America and have been endorsed by ACAAI, American Academy of Allergy, Asthma and Immunology (AAAAI) and Canadian Society for Allergy and Clinical Immunology (CSACI).
New Practice Parameters3:
- They include a strong recommendation to introduce cooked egg at around 6 months, but not before 4 (the same recommendation as for peanut).
- As with previous guidelines, having severe eczema is still considered an indicator of high-risk for developing food allergy.
- Further and similar to the NIAID guidelines, infants with mild to moderate eczema, a family history of atopy (i.e., allergic disease) in either or both parents, or infants with one known food allergy are potentially at some increased risk of developing food allergy (or an additional food allergy).
- In addition, these guidelines do not recommend automatic referral to pediatrician or allergist for evaluation in advance of introducing peanut, egg or any other allergenic food. However, they recommend shared decision making with the parents to help ensure that they do receive a referral if that will expedite or ensure the introduction of the allergenic foods, since some parents are so hesitant to introduce allergens otherwise.
The new guidelines represent an evolution of current guidelines that incorporate the latest research on early infant feeding, diet diversity, breastfeeding and more, because so much research has been published in this area since the National Institute of Allergy and Infectious Diseases (NIAID) published their addendum guidelines for preventing peanut allergies in 2017. It’s important to note that the NIAID guidelines still stand and are the current federal recommendations for early introduction of peanut to help prevent a potential peanut allergy.
Approval of PALFORZIA: The First FDA-Approved Treatment for Peanut Allergy
In January 2020, the U.S. Food and Drug Administration (FDA) approved Palforzia, produced by Aimmune Therapeutics, to lessen allergic reactions, including anaphylaxis, that may occur with accidental exposure to peanuts. Palforzia, which would desensitize children ages 4 through 17 years to peanuts over a period of about six months, is a treatment, but not a cure.
Palforzia is an oral immunotherapy (OIT) shown to help some children and teens increase tolerance to peanuts, reducing the likelihood of a serious reaction from accidental exposure to peanuts. It uses increasing doses of peanut flour to help a body deal with the ingestion of protein powder, reducing a serious systemic reaction, such as anaphylaxis.
Antihistamines and epinephrine can be used to treat allergic reactions, but severe reactions can be fatal even with appropriate prompt treatment. Palforzia cannot be used for the emergency treatment of allergic reactions, including anaphylaxis.
If you have a peanut allergy or have a child that may have one it is very important to work with a board certified allergist. For those that are looking for a treatment option, Palforzia, in conjunction with a peanut-avoidant diet, could be an option to help create a more comfortable quality of life. This truly is a breakthrough in the world of treatment for peanut allergies!
More Treatments on the Horizon
A second potential treatment option for peanut allergy is DBV’s Viaskin peanut patch. Viaskin’s biologic license application (BLA) was accepted by FDA in October 2019 and is to be reviewed by August 2020. In the BLA, DBV has requested approval for the epicutaneous patch therapy for children with peanut allergy ages 4-11 years. Viaskin delivers tiny amounts of peanut protein transdermally (through the skin) in order to increase the threshold for reactions. Like Palforzia, Viaskin is not a cure for peanut allergies. “According to the DBV website, this potential new treatment is not a promise or guarantee for all children and it involves some risk.” Results described in the clinical study may vary in different patient populations.
Passage of the FASTER legislation
The U.S. House of Representatives unanimously passed the Food Allergy Safety, Treatment, Education, and Research Act of 2020 or the FASTER Act, which expands the definition of major food allergen. Sesame is now added to the “top 8” allergens which brings the number to 9 for food allergens required to be labeled by the USA food allergen labeling act (FALCPA). This is major news! The FASTER act is also encouraging funding for food allergy research.
With the highs and lows of 2020, we are proud to say that the National Peanut Board has allocated more than $32 million since its inception toward funding outreach, education, and research on food allergies. Each year our mission is to improve the economic condition of USA peanut farmers and their families through compelling promotion and groundbreaking research, and we are looking forward to continuing this important work in 2021!
You should always consult an allergist if you have concern about a food allergy. Working with an allergist who is familiar with your health history would assist in managing a food allergy risk.
- Dietary Guidelines Advisory Committee. 2020.Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. U.S. Department of Agriculture, Agricultural Research Service, Washington, DC. https://www.dietaryguidelines.gov/sites/default/files/2020-07/ScientificReport_of_the_2020DietaryGuidelinesAdvisoryCommittee_first-print.pdf
- Greenhawt, M., Shaker, M., Stukus, D. R., Fleischer, D. M., Hourihane, J., Tang, M., Abrams, E. M., Wang, J., Bingemann, T. A., Chan, E. S., Lieberman, J., Sampson, H. A., Bock, S. A., Young, M. C., Waserman, S., & Mack, D. P. (2020). Managing Food Allergy in Schools During the COVID-19 Pandemic. The journal of allergy and clinical immunology. In practice, 8(9), 2845–2850. https://doi.org/10.1016/j.jaip.2020.07.016
- David M. Fleischer, Edmond S. Chan, Carina Venter, Jonathan M. Spergel, Elissa M. Abrams, David Stukus, Marion Groetch, Marcus Shaker, Matthew Greenhawt,
- A Consensus Approach to the Primary Prevention of Food Allergy Through Nutrition: Guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical Immunology, The Journal of Allergy and Clinical Immunology: In Practice(2020). ISSN 2213-2198, https://doi.org/10.1016/j.jaip.2020.11.002