Pediatric allergic diseases — food, drug, seasonal allergies — and anaphylaxis, a potentially life threatening allergic reaction, are on the rise and researchers are working furiously to understand, prevent and treat these conditions.
The Vanderbilt Division of Pediatric Allergy, Immunology and Pulmonology hosted a daylong conference Sept. 20 at Monroe Carell Jr. Children’s Hospital at Vanderbilt called Pediatric Allergy in a Nutshell: Emerging Therapies and Prevention of Allergic Disease. In hopes of more clearly identifying these pediatric patients so families can receive the help and education they need, the pediatric allergy team invited community pediatricians for a showcase in the latest and hottest topics in pediatric allergic disease.
They covered the gamut of allergic disease from food allergies (particularly peanut allergy), to drug allergies and atopic dermatitis conditions, such as eczema, along with causes, prevention and emerging therapies.
“Our goal is to educate community providers on allergic and immunologic conditions,” said Allison Norton, M.D., assistant professor of Pediatric Allergy, Immunology and Pulmonology and organizer of the event. “We hope that these conferences improve patient’s health and give pediatricians confidence in their future management of these diseases. We also hope it reminds community providers that we are partners in the health of their patients and that we are approachable and available.
“In January 2017, new NIH guidelines on early introduction of peanut in infants for the prevention of peanut allergy came out. We thought it would be important to discuss these new guidelines and address questions from the community providers regarding its implementation.”
The guidelines refer to when to introduce peanut into a child’s diet and are based on a game-changing study from 2015 called LEAP (Learning Early About Peanut study).
Recommendations are now to introduce peanut sooner with some variables in hopes of preventing peanut allergies. Infants 6 to 11 months old with severe eczema or a diagnosed egg allergy or both, should be seen by an allergist and after appropriate evaluation, have peanut introduced into the diet; infants with mild to moderate eczema should begin consuming peanut around 6 months of age; and infants with no history of eczema or other allergies, can safely consume around 6 months as well. However, this should be done with guidance from the child’s regular doctor since raw nuts are a choking hazard to patients under 4 or 5 years old.
Through the presentations, the lecturers noted the rise in incidence for each category and populations affected: about 8.4 percent of the U.S. population has asthma; about 8 percent of young children and 5 percent of adults suffer from food allergies; atopic dermatitis affects about 20 percent of children; and more than 20 percent of people worldwide report a drug allergy.
Researchers don’t fully understand why some of these diseases are on the rise, though a trending theory, presented during the lecture, is that our bodies have evolved in relation to our environment and the economic development around us, particularly in urban areas. They have been working to understand causes behind allergic disease and how to prevent and treat them.But they are still early in their work, with a bevy of articles being published since 2010.
Jonathan Hemler, M.D., had two presentations that focused on food allergies, with heavy emphasis on peanut allergy.
The biggest prevention method in an allergist’s tool kit right now is related to peanut allergy prevention (following the new NIH guidelines), but much remains unknown about preventing other allergic diseases. A lot of research focus is on finding treatment for food allergy, which include sublingual immunotherapy (SLIT), or under the tongue; oral (by mouth) immunotherapy (OIT); and epicutaneous (skin) immunotherapy (EPIT). But there are drawbacks and limitations, as well as positives to all. Allergic rhinitis, or seasonal allergies, is often treated with SLIT (under the tongue) or SCIT (allergy shots).
“There are currently no FDA-approved therapies for food allergies. The only thing we have to offer patients right now is avoidance of the allergenic food and an epinephrine auto-injector to always have on hand in case of a reaction. However, there are two therapies for peanut allergy currently in phase III trials that could be FDA-approved next year, which is very exciting,” Hemler said.