Food-Allergy Alert
School is back, and parents fear the danger posed by an innocent-seeming item on their child's plate in the cafeteria. But today, medicine is better able to protect kids.
There’s no need to sugarcoat it—food allergies are scary. They are one of the most common causes of anaphylaxis, a sudden, life-threatening reaction that brings a constriction of the airways that can make breathing difficult, according to the American College of Allergy Asthma and Immunology. (Other causes are insect stings, medications and latex.) And even when the danger is less dramatic, allergies to certain foods can threaten unpleasant reactions—particularly in children. That’s why the start of school each September can induce fresh anxiety to parents of kids who suffer from food allergies. Fortunately, however, knowledge in this area is advancing, as BERGEN learned in a recent chat with Tamar Weinberger, M.D., a pediatric allergist and immunologist at Hackensack Meridian Health. “There’s been a shift in the field over past five to 10 years,” says Dr. Weinberger. “For a long time, the only treatment for food allergies was avoidance of the item—and carrying an EpiPen.” (That’s an epinephrine autoinjector, which delivers a dose of adrenaline to quickly treat anaphylaxis.) “There are now desensitization treatments and medication to prevent accidents and reactions.”
One of these advancements is a drug called Xolair, or omalizumab. Explains Dr. Weinberger: “It’s a biologic medication that prevents allergen-specific immunoglobulin E (IgE), or allergic antibodies, from binding to mast cells.” That binding process is what starts the reaction itself. The result? A decrease in the severity of an allergic reaction. “It’s an option for patients with multiple food allergies,” the doctor says. “If it’s hard to eat out and there’s a constant fear of cross-contamination, Xolair provides some level of protection. It’s supposed to make it a little easier to navigate day-to-day life and improve some anxieties.” Xolair is FDA-approved for ages 1 and up. Important to note, though, is that Xolair does not reduce a person’s sensitivity to an allergen— only the severity of his or her reaction to being exposed to it. For example, Dr. Weinberger cautions with emphasis, a young peanut-allergy sufferer “doesn’t get on this medication and start eating peanut-butter sandwiches.”
Treatments aimed at desensitization—actually reducing sensitivity to the allergen—are an option as well. “Xolair can be used on its own or along with oral immunotherapy,” says Dr. Weinberger. She discusses the relatively new Palforzia, an oral immunotherapy for peanuts that was FDA-approved in 2020 for ages 4 through 17. “You start with a little bit of the allergen, and then you slowly build up. You go in every two weeks to your provider, eat a little more peanut under observation and, if you do well, you go home and continue to eat that every day for two weeks. Then it’s back to your provider, you eat a little more and then you go home and eat that for two weeks,” Dr. Weinberger explains. This continues until the patient gets to the top dose, at which point he or she continues eating it every day. If a little bit of peanut is eaten outside of this controlled circumstance, the patient will be protected and the reaction will be less severe.
Though Palforzia is aimed only at peanut allergies, Dr. Weinberger says that research is ongoing. “There’s a lot of research on doing food immunotherapy at higher doses and with different foods, both on its own or along with Xolair to make it more successful,” she says. Both advancements have their pros and cons, and what’s best for one child may not be best for another. “If you have a patient who’s having a multitude of accidental reactions right now, and they have sensitivities to multiple foods, Xolair is super-helpful in protecting them on a day-to-day basis,” says the doctor. “If you have a patient who has the time and energy and availability to do desensitization, and then continue taking it, that addresses one sensitivity. However, that’s not a good option for everyone— it’s time-consuming. You’re taking it every night, and you can’t exercise or take a hot shower within an hour of doing it.” Both, though, offer a chance of improving the quality of life for select patients with food allergies.
As for day-to-day life at school, Dr. Weinberger says that her communication with both families and school nurses shows that there has been an increase in awareness of the problems and dangers that food allergies cause, as well as in understanding of how to handle them. “It seems that, overall, there’s a lot more respect for food allergies, and a lot of options for kids to ensure that every environment is as safe for them as possible,” she says.
