New guidelines to help kids overcome food allergies

Food allergies for children can be a nightmare — every school meal or birthday party could be a potential health risk. The stress and anxiety it causes to children and their parents can have a huge impact on a family's everyday social life and their ability to plan trips and parties.

Researchers have now created the first-ever standardized guidelines to help families build up their child's tolerance to common food allergens over time.

The therapy, called oral immunotherapy, involves giving very small amounts of an allergen, like peanuts, to children and gradually increasing the amount over time to build up their tolerance.

Until now, clinicians had little evidence-based guidance to provide to parents administering oral immunotherapy to their child. These new guidelines are designed to help clinicians standardize the way they work with patients and caregivers to help children overcome food allergies.

"This is a landmark paper in our field because it has never been done before and this process has never been standardized. We're in dear need of having some kind of guidance on how to approach oral immunotherapy," said Douglas Mack, a pediatrics expert at McMaster University in Canada and lead author of the paper.

How common are food allergies?

Around 4% of children and 1% of adults around the world have been diagnosed with a food allergy. But the prevalence is higher in Western countries, where 8% of young children and 4% of adults have food allergies.

One child's food can be another's poison — peanut allergies predominate in the United Kingdom, United States and Australia, but are uncommon in Asia, where wheat, egg and milk allergies are the most common.

Food allergy rates have been rising over the last two decades, which scientists think is due to rising sanitation and cleanliness. The thinking is that with fewer germs around, children's immune systemsturn against harmless things like peanuts or milk. Other factors include vitamin D deficiency and the timing of when kids get exposed to food allergens as babies.

Health officials in many countries have said babies should be slowly exposed to potential allergens to prevent allergies. Families with histories of food allergies are advised to work under the guidance of a pediatrician.

Oral immunotherapy has a long and successful history of helping children who already have a food allergy. It was first used in 1908 to desensitize a 13-year-old boy to an egg allergy. The starting dose was 1/10,000th of an egg each day, and after six months he could safely eat eggs.

"We have a treatment that works, that clinicians have wide agreement about in multiple domains. There are many studies examining many different approaches to continue to refine treatments to improve safety, reduce the medical intensity and create greater access," said Julia Upton, a clinical immunologist at the Hospital for Sick Children in Toronto, Canada.

Oral immunotherapy helps kids overcome food allergies

Oral immunotherapy programs can require caregivers to act like amateur medical professionals and watch out for dangerous levels of allergen exposure. It's common for children to experience side effects like abdominal pain or vomiting.

"Families need to learn about food allergies, anaphylaxis, immunotherapy, how to safely dose the food, which things to look out for, when to treat, and when to contact the medical team," Upton told DW.

According to the study authors, as many as one-third of patients were not getting any degree of preparation before starting treatment.

"If families are not prepared for oral immunotherapy, they're going to fail or it's going to become unsafe. These families must provide the therapy every single day. That's why these guidelines are so important," said Mack of McMaster University.

Building food tolerance like 'running a marathon'

The guidelines are designed for clinicians rather than directly for parents or caregivers, which is why it's important for parents to work with doctors to help kids overcome food allergies safely and effectively.

But the study also contains useful information for caregivers and parents.

"It shows that there is strong agreement with key safety advice and the expected outcomes. For example, asthma/reactive airways need to be well controlled prior and during immunotherapy, multiple safety and dosing instructions need to be followed," said Upton.

Upton sees the therapy like exercise training for a marathon — children need daily allergy training, and endurance would drop if they stopped oral immunotherapy entirely.

"For many people who have a food allergy, the threshold increase achieved by immunotherapy is dependent on some ongoing exposure. This often requires extensive counseling and so it is very helpful for families to see that they are widely agreed upon," said Upton.

Edited by: Martin Kuebler

Sources:

Mack D, et al. 2024. Preparing Patients for Oral Immunotherapy (PPOINT): International Delphi consensus for procedural preparation and consent. DOI: 10.1016/j.jaci.2024.02.019

Begin P, Chinthrajah RS, Nadeau KC. Oral immunotherapy for the treatment of food allergy. Hum Vaccin Immunother. 2014. DOI: 10.4161/hv.29233

Elghoudi A, Narchi H. Food allergy in children-the current status and the way forward. World J Clin Pediatr. 2022DOI: 10.5409/wjcp.v11.i3.253

US Dietary guidelines 2020-2025