Editors' ChoiceFood Allergy

The Scientific Approach to Better Birthday Parties

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Science Translational Medicine  08 Aug 2012:
Vol. 4, Issue 146, pp. 146ec139
DOI: 10.1126/scitranslmed.3004701

How much does birthday cake cost? Put another way, how much does not being able to eat birthday cake “cost” for a 3-year-old who can only watch his friends eating cake because of a food allergy? A recent paper from a multicenter cooperative group led by Burks provides an opportunity to help children with food allergies safely eat their favorite foods, using a systematic approach to functional desensitization through oral allergen exposure.

This group studied a dose-escalating oral egg exposure protocol for children with egg allergy. During the period of escalating allergen exposure, 25% of allergen doses caused mild allergic symptoms at the time of the treatment, but none of these reactions were severe, and the protocol was well tolerated overall. Out of 40 patients initially randomized to the experimental arm, 30 were transiently desensitized to egg protein while on the immunotherapy protocol, and 10 achieved long-term functional tolerance and successfully transitioned to a regular diet.

The mechanisms underlying food allergy and treatment through exposure are unclear, but experimental data are growing. Recent data indicate that maternal exposure to allergens during pregnancy may, somewhat paradoxically, protect offspring from food allergy and that early postnatal exposure may not be harmful. Reconciliation of these data with known mechanisms of antigen exposure will require further research. Similarly, more research is needed to examine the impact of food allergy on child development and any psychological problems that may arise because of frustration caused by life-long dietary limitations. Using the new method for oral desensitization of children with food allergies, it may finally be possible to compare the children who are successfully treated with those who remain allergic and clarify the impact that the food allergies have on children’s quality of life. In the meantime, based on the results presented by Burks et al., parents of children with food allergies who previously had to say “no” to the cake can now say “possibly later.”

A. W. Burks et al., Oral immunotherapy for treatment of egg allergy in children. N. Engl. J. Med. 367, 233–243 (2012). [Full Text]

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