Indy Food Allergy Support Groups
This past Tuesday (March 16, 2010)Â I was asked to speak to the Southside Indianapolis Food Allergy Support Group. Last spring I talked about food challenges and what Dr. Vitalpur and I are doing at Riley hospital regarding food challenges. This time I gave an update from the annual meeting of the American Academy of Allergy, Asthma, and Immunology (AAAAI) on food allergy topics. I also shared with the group the request for public commentary on a draft of “Guidelines for the Diagnosis and Management of Food Allergy”. This was a great meeting. I had a very attentive audience who asked many great and probing questions. I reformatted my notes from the conference gave this presentation without any slides to hide behind- now that is a great accomplishment.
We talked about the findings at the meeting. We shared experiences and concerns and we talked about a number of great ideas to help children with food allergy. One of the most thought provoking topics was looking at food allergy as a public health problem. This is definitely a public health problem. As an aside, the request for comments on the ‘ Food Allergy Mangement…’ draft began with a very effective attention getting statement-’Food allergy is an important public health problem….’ . To my dismay (that recent Masters of Public Health degree affecting my perspective again), the guidelines’ intention was to help with diagnosing and managing food allergy and not the public health issues. I applaud this work and the work of the committee that put this together. I have never made any responses to requests for comments on guideline drafts in the past. This draft of the guidelines stimulated me to offer a few comments. The acceptance of these food allergy guidelines is important and desperately needed before we can be effective in any public health approach to food allergy. We need to critically look at what food allergy is and what is not food allergy. We need to listen to the story of what happens with exposures to food and carefully select the appropriate tools/tests to make the diagnosis. We also need to support efforts to help treat current food allergy issues and hopefully prevent the development of food allergy.
I shared with the group a review by Scott Sicherer on ‘What is New in Pediatric Allergy’. In this session Dr. Sicherer selected a few key articles that have appeared over the past year dealing with food allergy. A few of the food allergy topics included; The Natural History of Wheat Allergy (Keet, 2009), Food Protein-Induced Enterocolitis Syndrome (Mehr, 2009), Timing of Food Introduction and the Development of Atopy (Nwaru, 2010), and Dietary Advice, Dietary Adherence, and the Acquisition of Tolerance in Egg-allergic Children (Allen, 2009).
1. Wheat allergy resolved faster than egg or milk allergy.
2. FPIES- depending on the population studied, different foods are causitive and there seems to be differences in the rate of resolution. The overall prognosis is good.
3. Sensitization (having a positive allergy test, not necessarily symptomatic with exposure) was seen with the late introduction of a number of foods in this cohort of children from Finland.
4. Dietary advice is not uniformly followed, the advice given did not correlate with outgrowing egg allergy, adherence to the advice did not correlate with resolution, and accidental exposures to egg did not affect the outcome (outgrowing the allergy).
We also talked about research projects and protocols that involve food desensitization and food tolerance. Wes Burks from Duke University presented information on a number of studies. This work is ongoing at Duke, University of Arkansas, and at Mt.Sinai (New York). It is important to understand the differences between achieving a state of desensitization or tolerance.
1. Desensitization is the temporay increase of the amount of a food that would trigger an allergic reaction. This would offer protection from a life-threatening event due to an exposure.
2. Tolerance is the permanent loss of allergic reactivity due to changes in the immune system.
Desensitization and tolerance may work through similar mechanisms. Small exposures would not cause life threatening events in the desensitized child, however only the tolerant child could eat larger amounts of the culprit food without consequences.
The enthusiasm for participation in studies that may end the fear of a food reaction was intense. I was very impressed. A mother mentioned that she would donate her home if her child could participate in a program that would lead to desensitization/tolerance for peanut.
I shared the findings from an abstract of a study from the University of Michigan (abstract # 746). This was a report from a survey that represented the US population. In this survey 3-4% of those responding had a child with a life-threatening food allergy. Twenty five percent of responders knew someone with a food allergy. Of the families who had a child with a food allergy, 80% were accommodated by the school or daycare and of those, 50% of the staff had specific training in food allergy. Nearly 50% of the responders said that they were not at all inconvenienced by measures needed to protect the food allergic child, 25% were somewhat inconvenienced, and a few said it was very inconvenient for them.
We spent some time talking about this. Some of us were surprised by the findings. The charge to the group and the charge to anyone involved with children with food allergy is to advocate and to make others aware of the issues. The Southside Food Allergy Support Group offers an excellent program called
PAC- Protect Allergic Children. PAC has a detailed presentation that can be given in a number of venues. The programs are ‘Food Allergy Safety in Schools’ and ‘Creating a Safe Home for Food Allergic Families’. Information on these programs can be obtained from the Southside Food Allergy Support Group.
One topic for a future meeting most certainly will be a summary of the final Food Allergy Guidelines.
My thanks to the Southside Food Allergy Support Group for the invitation to speak (as a disclosure, I am an advisor to the group as well). Keep the kids safe!!
Respectfully submitted,
Fred Leickly
March 18, 2010
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fleickly · 
2 Comments
Tags: Food Allergy, Food Allergy Support Group · Posted in: Food Allergies, Meeting Updates
2 Responses
Dr. Leickly,
Thank you again for making the time to speak to our support group. We greatly appreciate it. I’m not sure if the link you posted to our support group is working. Our website is http://www.indyfoodallergy.org.
Thanks again!
Trisha Maled
My thanks to you and the group. I made the changes on the link to the website.
As promised I am in the process of looking at our experience with peanut sensitive children. I will keep you posted.
FEL
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