3 promising approaches to meet the challenges of food allergy management

What is food allergy and what are its specificities?

Food allergy is an adverse reaction of the immune system to certain food’s proteins. The global prevalence of food allergy is on the rise with a rate of approximately +1.2% prevalence increase per decade¹https://scholar.google.com/citations?user=ynpgtTsAAAAJ&hl=en, and it is characterized by great geographical variation, with a higher incidence in children compared to adults, 6-8% and 2-5%, respectively²https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940350/. The prevalence of food allergy also varies according to the type of food, with 90% of allergies being caused by just 8 types of food³https://www.ingentaconnect.com/content/ocean/jfa/2020/00000002/00000001/art00005?crawler=true&mimetype=application/pdf: Cow’s milk, egg, fish, shellfish, tree nuts, peanuts, wheat, and soy.

Symptoms can range from mild, such as cutaneous (~80% of patients), respiratory (~10% of patients, and gastrointestinal (~5% of patients) manifestations, to severe, including anaphylaxis (~5% of patients), a potentially fatal reaction that affects multiple body systems⁴https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045871/. Food allergy results from a complex interaction between environmental, genetic, and dietary factors that are not yet fully understood.

Food allergy imposes a substantial societal burden, due to high healthcare costs associated with the management of the disease, particularly in case of complications. Also, it has a significant impact on patients’ and caregivers’ daily lives, emphasized by the unpredictable nature of the disease, the need for constant attention to diet, the stress of having anaphylaxis shocks after accidental exposure, and the complexity of carrying and using an epinephrine pen. Furthermore, the emergence of new allergens, the risk of cross-contamination, and the presence of hidden allergens are additional factors that contribute to the complexity of allergy diagnosis, prevention, and treatment.

What are the challenges in the diagnosis and treatment of food allergy?

Issues in food allergy diagnosis

The current landscape of diagnostic tools to identify food allergies faces significant challenges.

The Skin prick test (SPT) is a first-line in vivo testing technique that directly assesses allergen responses in a controlled setting, offering immediate results but with potential invasiveness and safety risks.

Another diagnostic alternative is the serum allergen-specific IgE (SIgE) blood tests which is an in vitro diagnostic test that provides non-invasive quantitative results but may lead to false positive results and an incomplete clinical picture.

Today, the “gold standard” technique that provides a definitive diagnosis is called Oral Food Challenge (OFC), however, this technique poses severe health risks to the patient due to the potential to trigger anaphylactic reactions.

The variability in individual responses highlights the urgent need for more accurate and safer diagnostic approaches, with a focus on individualizing diagnoses for the effective management of food allergies.

Treatment strategies for managing food allergies

Current treatments for food allergies mainly address the symptoms of the disease facing a substantial limitation regarding its cure. The elimination diet, while effective, imposes emotional and social challenges, while symptomatic treatments, such as anti-histamine and epinephrine shots, provide temporary relief without addressing the underlying cause of the disease. Immunotherapy, although promising, does not represent a definitive cure for the disease.

The variability in individual responses to treatments makes prediction and management challenging. In addition, limitations such as the costs associated with biologics and variable success rates need to be addressed, highlighting the urgent need for individualized treatment approaches tailored to the specific genetic and immunological profiles of each person with food allergies.

Gaps in understanding and implementing prevention strategies

Finally, the gaps in our understanding of food allergies stand out, especially concerning the role of the microbiome and its interaction with the immune system. The complexity of this relationship remains largely unknown. In addition, there is a lack of robust evidence on preventative approaches, such as food restriction during breastfeeding and the use of probiotics. Filling these gaps through comprehensive research is crucial to advancing the understanding of food allergies and developing more effective prevention strategies.

What are alternative and promising approaches to meet the challenges of food allergy management?

Promising approaches are being developed to tackle the intricate challenges of food allergy, opening up new horizons in diagnosis, prevention, and treatment.

Approach n°1: Revolutionize food allergy diagnosis through molecular allergology and advanced diagnostic tests

The expansion of the range of diagnostic tests represents a revolution in the understanding of food allergy. In the context of advanced cellular tests, the Basophil Activation Test (BAT) and mast cell approaches not only increase diagnostic accuracy but also provide deep insights into the molecular mechanisms underlying allergic reactions. By targeting specific cellular responses, these techniques offer a personalized and refined approach to the diagnosis of food allergies, representing a revolution in management strategies. In parallel, advanced genetic testing, an integral part of the ‘molecular diagnosis’ and ‘Omics’ approaches, offers a detailed analysis of the genetic and molecular profile related to food allergies.

Molecular diagnosis can play a central role in improving the accuracy of diagnosis reducing the risks for patients, especially for polysensitized patients with poor response to treatment, and with inconsistent symptoms and clinical history, and subsequently, in selecting the best therapy for allergic diseases. In the same direction, multi-omics approaches, such as genomics, proteomics, and transcriptomics, hold significant potential to enhance food allergy treatment by implementing personalized medicine approaches that consider an individual’s underlying biological makeup and history of environmental exposures.

Despite promising strides, these technologies are in continuous development. Their integration into food allergy diagnosis, though promising, is in its early stages, requiring extensive validation, technical refinement, assay standardization, and intricate result interpretation.

Approach n°2: Promote immune tolerance from infancy via preventive approaches modulating the microbiome

At the forefront of prevention, modulating the microbiome has emerged as an innovative and promising strategy to mitigate the development of food allergies. Research reveals that gut microbial composition plays a significant role in regulating the immune response, thus highlighting the importance of balancing this ecosystem from infancy. Approaches aimed at modulating the microbiome include the controlled administration of specific prebiotics and probiotics to regulate the immune response, providing a more tolerant intestinal environment.

Currently, these strategies are constantly evolving, with research focused on developing more precise and personalized formulations of prebiotics and probiotics. The individualization of these interventions, taking into account factors such as genetics, initial microbiome, and food exposure, represents a crucial step toward optimizing preventive efficacy.

Learn more about how our team can support you in your projects related to microbiome >

Approach n°3: Develop therapeutic combinations and novel immunotherapy class

As for therapies, the development of more comprehensive options is underway. The combination of conventional therapies, such as oral immunotherapy, with personalized biologics and specific probiotics reflects a holistic approach. Emerging options like Omalizumab and Dupilumab are investigated today in clinical trials alongside oral immunotherapy (OIT) as a co-therapy to facilitate simultaneous desensitization to multiple food allergens and manage side effects. This synergy of therapies offers not only a targeted immune response but also addresses the diversity in individual responses, overcoming the limitations seen in single therapies.

Another method gaining momentum is the EPIT (Epicutaneous Immunotherapy), a technique currently under investigation in clinical trials for peanut, milk, and egg allergies. This innovative approach administers allergens through a skin patch, offering a potentially safer and more efficient means of addressing food allergies. The potential for better management of food allergies offers the hope of a future where individuals can lead lives with fewer constraints from dietary restrictions.

These approaches, grounded in cutting-edge research, represent a substantial advance towards more effective and adaptable strategies in the food allergy landscape. The promising future of these innovations not only redefines the clinical approach to this condition but also offers renewed hope for those seeking a life free from the restrictions imposed by food allergies.

In summary, food allergies present complex challenges, from diagnosis to treatment. However, innovative approaches, such as new diagnostic and treatment methods and prevention strategies, offer promising prospects.

The road ahead requires continued investment in research and global collaboration. The intersection of emerging technologies and the search for personalized therapies point to a future where the understanding and management of food allergies will be enhanced.

If your company is exploring innovations in the field of food allergy or seeking to improve the care of food allergy patients, Alcimed can support you. Don’t hesitate to contact our team!

About the author,

Pedro, Consultant in Alcimed’s Healthcare team in France