Modern food allergy management has evolved beyond simple avoidance to include preventative treatments that increase the threshold for reactions, such as biologics like omalizumab (an anti-IgE antibody that blocks the immune response to multiple food allergens) and immunotherapy approaches (oral, sublingual, and epicutaneous) that build tolerance to specific allergens, with treatment selection requiring shared decision-making between patients and physicians based on individual circumstances.
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Options for Preventing Food Allergy ReactionsAñadido:
That's what's really hopeful and exciting about where we are right now is that I think the food allergy community finally has options out there where they can choose what is best for them.
>> [music] [bell] >> My name is Caroline Krae and I've lived with severe anaphylactic food allergies since I was 2 years old. Later when I was 18 years old, I was diagnosed with mast cell activation syndrome.
I'm excited to be joined by Dr. Cleary.
Thank you so much for being here. Uh could you tell us a little bit about yourself?
Sure, thank you for having me, Caroline.
Um my name is Kelly Cleary. Uh my background is I did a residency in pediatrics and then a fellowship in emergency medicine. So for many years took care of kids coming into the ER with anaphylaxis. Um had some pivots in my career and did urgent care and some mental health. I'm a mom of four kids and one of them has multiple anaphylactic food allergies. So that's what brought me to my current role as medical director and VP of health and education at FARE, Food Allergy Research and Education, which is a national nonprofit really with a mission to help those with food allergies by providing education, um research, and advocacy.
That's great. Thank you so much for the work that you do and I can only imagine, um you know, the time and energy you put in to be a doctor and a mom. So thank you for that as well. Um so we hear a lot about the importance of avoiding trigger foods, but can you tell us briefly about treatments that work to lower the risk of actually having a reaction?
Yeah, so I I remember as a mom, and my son with food allergies is 14, when he was first diagnosed with food allergy, it was go home and avoid all these foods. And that's what we did for a a long period of time. And what I find is most exciting right now about food allergy and the science and medicine behind it is that patients are finally getting some options. Um and we're learning of new treatments that potentially can increase that threshold for having a reaction, meaning that you could have more of a certain food before a reaction starts. And that's typically an accidental exposure. So, some of those that we're seeing now are treatments like biologics, like omalizumab. Um there's immunotherapy that now is is reaching patients, both oral immunotherapy, sublingual, um and epicutaneous. So, lots of options. And again, that's what's really hopeful and exciting about where we are right now is that I think the food allergy community finally has options out there where they can choose what is best for them.
Absolutely. I've definitely felt that throughout my years of living with food allergies. What began as just avoidance and using an EpiPen for emergency has now transformed into a whole new conversation about what we can do to prevent and to be proactive about it. Um Sue, could you tell us who is a candidate for preventative treatments?
So, I think that that's where people have to come in with an open mind because at this point, it really is about shared decision-making between a patient and a doctor. And I I really am an advocate for every patient with food allergy to go into their doctor and ask about treatment plans. And are there things that I can be doing um that exceed just avoiding that food? Um so, really we're at that that core phase right now of shared decision-making with your physician. So, I would encourage everyone to be talking to their physicians and seeing if they are a candidate. Um and it's going to depend on, you know, where what of life you are, what you know, modifications and lifestyle modifications you have.
You know, something like, let's say a biologic, so omalizumab. That's an injection that that is given every two to four weeks. It's an anti-IgE.
It's an anti-IgE antibody, so it it inhibits IgE. And why that's important is because IgE is the antibody that is almost overactive and is kind of misdirecting its action in food allergy.
So, what omalizumab does is block that IgE.
So, for a patient that might come in that has multiple food allergies, because omalizumab is what we call agnostic to each individual food allergen. So, you you're not coming in and getting treated just for a peanut allergy or just for an egg allergy.
Because food allergy works with IgE being you know, elevated in and binding and then releasing those those that histamine, that is really what you're you're targeting. So, it's it's agnostic to whatever you're eating. So, that's that's something that will be discussed is that, "Okay, so you've got multiple food allergies, maybe you want to consider this." If you're someone coming in that has one food allergy, and let's say you're coming in and you have a peanut allergy, well, there might be different options. Omalizumab might be one option for you. Another option for you might be to avoid the food because you're doing really well and haven't had any reactions. And another option might be something like oral immunotherapy.
Where oral immunotherapy is building up a tolerance to that particular allergen.
And you're introduced to small incremental doses of that food in the presence of a doctor or physician's office until you get a little bit more tolerant. So, again, it's so individualized and that is where I'm finding a lot of hope because patients throughout our community really will have something to talk to their doctors about finally.
Absolutely. I think that there are more options now than ever before. That's been my experience, too. I feel like my world has really opened up um as research has continued and as we've gotten more successful preventative treatments.
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