Food Allergies and Treatment Options
FoodAllergies and Treatment Options
Foodintolerance and allergies among children have increased in Americawithin the past decade. The most prevalent allergies are those causedby proteins found in peanut, cow’s milk, and cereals. Based on thedocumented problemsthesefood allergies pose to the public,thisstudy has taken a course ofinvestigating the pathology and viable treatment options by analyzingfour primary studies conducted recently.Similarstudiestothis topic were also accessed, reviewed and analyzed.Specifically,various propertiesof allergens, particularly Gluten proteins found in cereals, werefound to contribute to the onset and severity of allergies. Thetreatment options included immunotherapy, use of supplements, andfood avoidance. Although effectiveness and safety of these optionshavebeendiscussed,further research is necessary not only to improve the knowledge onunderlying processes of allergic diseases but the prevention andtreatment as well.
Keywords:Food Allergy, Oral immunotherapy, IgE Levels, Cow`s milk allergy,desensitization, sustained unresponsiveness, Oral desensitization,early intervention, peanut allergy, celiac disease, avoidance diet,randomized clinical trial, gluten protein.
Foodallergies are diverse forms of immune system’s overreaction tocertain type food, resulting in medical conditions that requireemergency interventions. According to “Treatmentsfor Food Allergies” , theimmune system mistakenly identifies harmless food proteins as foreignantigens, and respond to neutralize it thereby resulting inautoimmunity. As foodrelated problems,allergies have affected billions of people globally including 15million Americans. Martorellet al.  reportedthat allergies affect about 2 to 3% in adults and 6% in children.Some food allergies are more common than others, for example, allergycaused by peanut is the most common and affects about 3% of childrenboth globally and locally . The mode of development of allergiesdiffersto various antigens since different proteins aredigestedwith the involvementof different enzymes. Specifically,in thecereals-induced allergy, gluten proteins areworkedon by pentapeptide (Gln-Gln-GlnPro-Pro) and tetrapeptide(Gln-Gln-Gln-Pro and Pro-Ser-Gln-Gln) that in turn reacts with theimmunoglobin E (IgE) to trigger an allergic response . It isbecause of these variations in allergic reactions resulting inmedical emergencies.
Manystudies focusing onspecific types of food allergies have established avoidance ofoffending food types as one of the solutions.However,such solution haseconomic, nutritional, and social implications . Although mostallergies haveeffective treatment and medication practices in place, there aredeviant cases that require further research. The reason for this isthat some allergies are difficult to avoid due to the proteincomponents and their abundance in common or staple food. For example,cereals containat about 80% gluten  while cow’s milk protein (CMP) is animportant food for children during early development . Allergycaused by these proteins in staple food necessitates furtherinvestigations for alternative solutions and advancement of alreadydocumented prevention or treatment methods.
Thegoal ofthis studyis to evaluate thecauses, development, and effective treatment options available tocontrol food allergies which includedefinitionof terms, logical concepts,and facts. Thismay help us to promote both prevention and treatment.
Duringallergy, the immune system responds by releasing antibodies(e.g. IgE) and chemicalmediatorssuch as histamine targeting specific proteins that arewrongfully identifiedas pathogens in cellularprocessesleading to allergic reactions. The allergens can be of differenttypes and result in serious nutritional problems to the patient.Kumar etal. revealthat 80 percent of the protein in cereals comprises of gliadin andprolamine, the two constituents of gluten that induce allergicreactions in the digestivesystem.
Sánchez-García,Cipriani, and Ricci  suggestedthatabout90 percent of allergy reaction cases are caused by eight types offood.These includes milk, fish, wheat, eggs, soyabeans,fruits, shellfish and nuts (e.g. groundnutsand those from trees) .Also,these foods can also trigger food intolerance the processby which digestive system reacts abnormally after consuming aparticular kind of food. According to Turnbull, Adams, and Gorard, food allergiesisanIgE-mediatedand specific response to food while intolerance is non-specific andthe symptoms can be overlapping with those of digestion failure.Since both are responses to food, food intolerance iseasily mistakenwith allergies.
Althoughthese complications affect both children and adults, about 65 percentof children outgrow allergy with time especially when precautionarymeasures areobserved5.Turnbull,Adams, and Gorardexplain that by the time most children reach 12 years, they canconsume food previously allergic to them. However, if the conditionisnot addressedproperly, allergic reactions advances into serious disease. Forinstance, allergy due to gluten protein advances to chronic CeliacDisease (CD) while those occurring in respiratory systems can lead toasthma and lung diseases. Also, allergies that induceinflammations in blood vessels are likely to cause Coronary ArteryDisease (CAD) and stroke . In this case, both prevention andtreatment measures are important to not only reduce these reactionsbut also to eliminate the likelihood of seriousdiseases. Thisrequiresproper understanding of Allergydevelopment and the factors responsible for high prevalence in thepopulation anddifferent ethnic groups.
Normally,the immune system attacks the antigens contained within viruses,bacteria,and other disease-causing microorganisms. Some of these antigensexistin food particles,and this can cause autoimmune reactions in the case the immune systemto malfunction . For example, partial digestion of gluten due to ahigh percentage of proline and glutamine causes the productionof oligopeptidesthat requires glutamine enzymes for complete digestion. These enzymesbind with the antigens leading to inflammation and immune responseswithin the intestines . The autoimmuneresponseisoccurring,in this case,is identified as gluten-inducedallergy and usually progress to Celiac Disease (CD) if notcontrolled.
Thedevelopment of food allergy involves either IgE- mediated ornon-IgE-mediated processes.The IgE- mediated allergy usually involves the abnormalrelease of high levels of immunoglobulin E (IgE) antibodies [8,4,2].Once IgE antibodies are released, they target the mast cells proteinsbranded as threatsby releasing the histamine among other chemicals, leading to a seriesof processes that triggers an allergicreaction . Molloy etal. reportthat due to the instant protein reactions and catalytic actionsinvolving antibodies and antigens, the symptoms of IgE-mediatedfood allergy appears immediately after digestion of food.
Figure1showing the interaction of mast cell with allergens adapted fromMadden .
Thereislimited research focusing on non-IgE-mediated allergies .Consequently, the process itself is not well understood. In bothmechanisms, the immune system is presumed to be the central factor, and both types have far-reachingsymptoms both during their onset and eventually when left untreated.
Asmentioned earlier, food allergy affectsseveral parts of the body including respiratory organs,gastrointestinal tract, eyes,and skin. However, their severity and appearance dependon whether they are IgE-mediatedor non-IgE-mediated . For instance, non-IgE- mediated allergiescan take longer to manifest,unlike the IgE- mediated ones.
Thesymptoms of food allergies resulting from non-IgE-mediated mechanismsinclude vomiting, diarrhea, abdominal discomfort, and sometimesconstipation. According to Allergyand Immunology , these symptoms cantakehours or several days to surface. On the contrary, the symptoms ofIgE-mediated allergies occur 5-30 minutes after ingestions . Theyinclude hives, anaphylaxis, vomiting, and redness of the skin.According to Martorelletal. ,skin redness, vomiting, sneezing,and diarrhea are the most common symptoms affecting 90% of foodallergy patients.Insome incidences, these symptoms become severeespecially when a patient is suffering from both IgE-mediated andnon-IgE-mediated types. Children are the ones likely to develop theboth kinds of food allergy at the same time,and if treatment isdelayed,and the symptoms become chronic, and proper diagnosis is warranted.The skin redness, for example, can become increasingly itchy leadingto severeeczema .
Foodelimination that involvestemporary avoiding those foods that cause allergy. The effectivenessof this method increases when combined with blood or skin tests. Theblood test involves determining any presence of IgE antibodies inspecific foods while skin prick test involves observing anydevelopment of skin redness or rashes to various allergens throughtesting them on the skin . Finally, oral food challenge (OFC)involves testing the suspect food types under medically controlledsettingsand appears to be more effective according to Sánchez-García,Cipriani, and Ricci . Thismay increase the likelihood of reactions,and this necessitates the useof small doses of food inthe presence ofemergency medications. In most cases, food allergic reactions requireemergency interventions for they can be severe or involve delicateorgans such as lungs.
Theprimary objectives in treatment revolvearound the eliminationof theallergens, improving the immune system, and strengthening thepatients through nutrition . More importantly, food allergymanifestsitself more as an individual problem to the patient must be highlymotivated and involves the necessary lifestyle changes, strictlyfollowing the diet plans, and seeking medical assistance regularly.
Thestudy by Peters etal. reported that avoiding coffee among the patients allergic to Cofa 2 and Cof a3elements of coffee beans reduced the allergic reaction significantly.Similarly,avoidingcow’s milkamong the young children help they outgrow the allergycaused by CMP.The most common special diet plan is achievable through the rotation.In the rotation,food iseaten at intervals 3-5 days to reduce exposure and increase tolerance. Also, rotation immunotherapy iseffectiveforthe patient allergic to many kindsof foods. After several months living without the offending food, thephysician may ask the patient to try the food. The reason for thisis that some allergies are just temporary. Besides, some food typesare vital for human survival and therefore necessary to reintroducethem after a while.
Theother treatment option is through medication and supplements. In thismethod, the drugcan be administered before exposure to prevent the releaseof histamine or after exposure to suppress the symptoms . Forinstance, sodium cromolyn taken for asthma must be taken beforeexposure to allergens while Gastrocrom™can betakenafter to suppress the symptoms . In addition to drugs, there aresome digestive enzymes that are taken to facilitate completedigestion of food particles. In this case, oligopeptides and peptidesare reduced to boost digestion thereby eliminating activation ofT-cells and inflammation .Similarly,supplements such as vitamin C, quercetin,pantothenicacid and bicarbonates help stabilize the cells to prevent reactionand cope up with the allergy. According to “Treatmentsfor Food Allergies”, however, theseenzymes and bicarbonatesupplements shouldnot be used fora prolonged time to prevent becoming allergic to themselvesdevelopinghypoallergenicconditions.
Theother treatment option is immunotherapy aimed at improving the immunesystem. The methods of immunotherapy include neutralization and lowdose immunotherapy. In neutralization immunotherapy, dilution of foodextracts isadministered to neutralize the reactions while in low doseimmunotherapy, the body is stimulated to make T-suppressorlymphocytes that inhibitallergens . According to Turnbull, Adams, and Gorard, both methods have significantly lowered the cases of foodallergies among children in the past five years.
Table1.Showingthe treatment of various types of food allergy adapted from Vicker etal. (2016)
Inthe last twenty years, several studies focused on specificaspects or types of food allergies and treatment options. In thisreview, several studies areanalysed andtheir results documented to establish treatment options.
Onerecent study addressing the issue of food poisoning is “Early OralImmunotherapy in Peanut-Allergic Preschool Children Is Safe andHighly Effective” by Vickeryetal..This investigatedthe possible treatment of peanut allergy among children in the pasttwo decades. It based its objectives and methods on findings frompast studies that peanutproteins cause the most widespread allergy in America and areresponsible for almost a half of the food allergy cases both inchildren and adults.
Onetreatment option for the food allergy is immunotherapy. Vickery etal.establishedthat immunotherapy has some drawbacks that undermine itseffectiveness and safety. Such drawbacks include likelihood todevelop an allergicreaction to the medicines, relapse, and lack of feasibility inpractice.Consequently, this study’s objective was to investigate thefeasibility, effectiveness,and safety oforal immunotherapy (OIT) as one of the current treatments of FoodAllergy,and determine various improvements that can beincludedin medical practice . The enhancements targeted young childrensince the productionof food-specific IgE begins at infancy. The resultant OIT based onthe trials was early interventions oral immunotherapy (E-IOT).
Thestudy byVickery etal.has the following hypothesis statements and the objectives.
Early intervention Oral Immunotherapy (E-IOT) can be achieved as an improvement of Oral Immunotherapy (OIT) through the diagnosis of young children suffering from the peanut allergy.
A high number of patient (70 %) receiving low-dose E-IOT would get sustained unresponsiveness (SU) to % grams of peanut butter during the four weeks food challenge before the continuation of immunotherapy.
To investigate the feasibility, effectiveness, and safety of (OIT) and determined various improvements that can be included in medical practice.
To determine the changes occurring in the immune system with the administration of E-IOT.
Thestudy carried out randomized clinical trials of both Low-doseand High-dose peanuts among newly diagnosed children between 9 and 36months  toachieve the objective and test the hypothesis.In addition to age, these participants had other requirements tomeet.
First,their non-mediated hemoglobin (psIgE) level was supposed to be below0.35 kUA. In a studyof allergy, kUAis a specific food unitthat can cause allergy and theirskin prick test had to be about3mm in diameter . Due to the need for eliminating risks associatedwith the trials, children with chronic cases such as severeallergies, asthma,and atopic dermatitis wereexcludedfrom the participating. In addition to this group, there was acontrol cohort group of 150 children for comparison during thetrials, comprising of individuals from allergy patients’ databaseof John Hopkins Hospital.Asthe study group, the control group’skeyimmunological variables including psIgE values were taken andverified by the allergists in pediatrics. All guidelines andprotocols including the informed consent, local ethics, and diseasessafety manuals were utilized in this study to uphold integrity andensure safety during the trials.
Thefood challenge tests commenced after the treatment trials andrepeated after a month of peanut abstinence. This technique helpednot the onlytest for 4-SU but also the end assessment of the treatment progressand benchmarking.Consequently, patients not meeting the benchmarking were furthertested for a 4-SU again after sixmonths.
Infood allergies, there are two important immunoglobin factors,and they include IgE (allergen-specific)and psIgE (non-allergen specific). In this study, the levels of thesefactors and peanut-specificIgG4weredetermined to define various trial aspects . Once their valueswereachieved,the study focused on the averages, variances, and frequencies.Various percentages were defined and applied during the trials whilethe data achieved waspresentedgraphically. Consequently, several characteristics of the studypopulation werecomparedbetween E-OIT and the OIT using the Fisher exact test . The finaldata achieved involved the criticaluse of statistic models including strata and GraphPad Prism 6, andlinear and quadratic equations.
Thepriority of this study was to investigate the effectiveness of OITand consequently come up with an advancedextension for its application in clinical settings. Theproposed E-OIT was found effective,and about 95 percent of the subjects exhibited improvement .However, there were mild side effects such as vomiting. Also,there wasno need for the administering histamine.
Moreimportantly, both low doses and high doses of peanut OIT triggeredimmune responses. Specifically, the immunological changes thatoccurred involved a declinein pdIgE (prenatal determinant of immunoglobin E) levels while theproduction of pdLgG4(theprenatal determinant of immunoglobin G) as amplified . Theprenatal determinant immunoglobins are those that originate from themother of the child. Also, high rates of sustained unresponsiveness(SU) wereachievedwhen Low-doseand high-dose OIT wasadministeredin children with peanut butter.
Theother important finding from the study is that thelevels of psIgE determined the time to taken to complete treatmentbut with an averageof 29.1months. Similarly, the results of the treatmentcould bemonitoredby observation of psIgE (non-allergen specific) levels. Simply put,there was a significant increase in the treatment duration with anincreasein pdIge. Finally, the study reported that unlike avoidance, exposureto peanut couldsuppress IgE thereby allowing consumption of peanut.
Figure3.Showing the psIgE association with outcomes from Vickeryetal.
Peanutis one of the major causes of food allergies in America. In fact, itcauses a highpercentage of allergies when compared with other types of food. Inthis study, early- Oral immunotherapy was suggested as an improvementof the common Oral immunotherapy. Therefore, its effectiveness wastestedunder several thematic goals. E-OITwas found effective for the peanut-specific IgE levels reduced withits administration. More importantly, it was safe for use inclinical applications. However, as required to achieve a stable andsustainable treatment methods and outcomes, further research isneeded to expand knowledge on several unattended aspects of peanutallergy.
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