Therapy Helps Children with Food Allergies Manage Severe Anxiety

Imagine a young girl with a peanut allergy, so stricken by fear of anaphylaxis that she no longer takes part in everyday activities many children take for granted. She’s stopped playing with her siblings, worried that residue from their peanut butter crackers may trigger an allergic reaction. She obsessively washes her hands to make sure there is no trace of peanut on them. She worries that every stomachache could mean she accidently ate something she was allergic to.

This story is becoming more familiar to families across the country. While most children with food allergies maintain a healthy level of caution, there is a small percentage whose anxiety is excessive and impairing. The hallmark of excessive anxiety is going to extreme, medically unnecessary lengths to avoid the allergen, such as no longer visiting extended family or refusing to eat any allergen-free food that isn’t familiar. While these coping mechanisms may relieve anxiety in the short term, they may ultimately cause more harm by negatively reinforcing the idea that the world is a dangerous place and that children are helpless to keep themselves safe.

Now, Children’s Hospital of Philadelphia (CHOP) has launched the Food Allergy Bravery (FAB) Clinic to help children with a phobia of anaphylaxis. This revolutionary clinic, housed within the Food Allergy Center, is the first in the world to bring together psychologists and food allergy experts to treat food allergic children with severe phobia of anaphylaxis.

The three Founders of the FAB Clinic published a set of best practices in the Journal of Allergy and Clinical Immunology, providing guidance to allergists and pediatricians on how to address allergy-related phobias through Cognitive Behavioral Therapy (CBT).

“CBT works by gradually encouraging anxious children to take part in ‘brave practices,’ like eating with the rest of their family, playing with siblings, and trying new foods that don’t contain allergens,” said Katherine Dahlsgaard, PhD, ABPP, Director of the FAB Clinic at CHOP. “As a child’s confidence grows, we gradually introduce them to more challenging brave practices. This could include sitting in the same room with the food they’re allergic to, or even touching the food and then washing their hands thoroughly. The aim is to help children realize, through safe, structured practices in the FAB Clinic, that the world is much safer than they think and that they are capable of keeping themselves safe within it.”

The FAB clinic enthusiastically employs the help of family members, coaching parents or caregivers to repeat brave practices at home.

“We want these children and their families to know they’re safe and capable,” said Dr. Dahlsgaard. “Our ultimate goal is to equip families with practical skills and confidence via focused treatment sessions, so that their child can safely navigate a world that can’t always be allergen-free.”

Two-thirds of pediatricians not following full guidelines on peanut allergy prevention, report finds

As many as two-thirds of pediatricians in America do not follow the newest guidelines about how to introduce peanuts to children for allergy prevention, according to a new report.

The report, published in the Journal of the American Medical Association (JAMA) found that 93% of pediatricians are aware of the new guidelines, which were released in 2017 by the National Institute of Allergy and Infectious Diseases.

But less than 30% of pediatricians are following the guidelines in full, according to the report.

The guidelines issued in 2017 call for assessment of peanut-allergy risk and introduction of peanut- containing foods in the diet of infants at 4-6 months of age, in efforts to prevent peanut allergy. This is a reversal from 20 years ago, when the American Academy of Pediatrics recommended that peanut should be avoided until the child is 3 years old.

The survey data included responses from 1,781 pediatricians found that common barriers to guideline implementation included lack of clinic time, conducting in-office supervised feeding of peanut-containing food, performing peanut allergy testing, concerns about newness of the guidelines, and parental fear of allergic reactions. 

Researchers discover critical new allergy pathway

Mouse study discovery points to potential new drug targets for treating asthma, hay fever, and other inflammatory disorders

JOHNS HOPKINS UNIVERSITY BLOOMBERG SCHOOL OF PUBLIC HEALTH

Researchers at Johns Hopkins Bloomberg School of Public Health have identified the sequence of molecular events by which tiny, tick-like creatures called house dust mites trigger asthma and allergic rhinitis.

The researchers, whose study was published online June 22 in Nature Immunology, found that allergy-triggering molecules from dust mites can interact with an immune protein called SAA1, which is better known as a sentinel against bacteria and other infectious agents. The researchers showed step-by-step how this interaction between mite-molecules and SAA1 triggers an allergic-type immune response in mice.

The findings reveal what may be a significant new pathway by which allergic and inflammatory disorders arise. They also suggest that blocking the pathway could potentially work as a preventive or treatment strategy against asthma and other allergic reactions.

“We think that the signaling interactions that occur immediately downstream of the mite-proteins’ activation of SAA1 may be good targets for future drugs,” says study senior author Marsha Wills-Karp, PhD, the Anna M. Baetjer Professor of Environmental Health and Chair of the Department of Environmental Health and Engineering at the Bloomberg School.

Asthma affects between 8 to 15 percent of people in the U.S., and is typically triggered by dust mites, tree and grass pollens, and other allergens. Researchers suspect that this inappropriate immune triggering happens when the immune system mistakes allergens–which are otherwise harmless–for pieces of bacteria or other infectious agents. However, the molecular mechanisms underlying this misidentification haven’t been well understood.

In their study, Wills-Karp and her colleagues zeroed in on SAA1, an immune protein that is found, among other places, in the fluid that lines the airways and other mucosal surfaces. A member of the evolutionarily ancient “innate immune system” of mammals, SAA1 is thought to have evolved as a sentinel or early-responder molecule that, for example, recognizes and helps clear away certain types of bacteria and other infectious agents.

The researchers found that exposure to dust-mite proteins causes an asthma-like sensitization of the airways of the control group mice. In contrast, exposure to dust-mite proteins hardly had any effect in mice in which SAA1 was neutralized by antibodies, or in mice whose genes for SAA1 were knocked out. Further experiments confirmed that SAA1, when it is present, directly binds certain dust-mite allergens called fatty-acid binding proteins, which have structural similarities with proteins found in some bacteria and parasites. This allergen-SAA1 interaction releases SAA1 into its active form, wherein it activates a receptor called FPR2 on airway-lining cells. The airway cells then produce and secrete large quantities of interleukin-33, a protein known for its ability to stimulate allergic-type immune responses.

Confirming the likely relevance to humans, the researchers found evidence of increased production of SAA1 and FPR2 in nasal airway-lining cells from patients with chronic sinusitis–which is often linked to dust-mite allergens–compared to healthy controls.

“We think that different allergens take different routes to the activation of interleukin-33 and related allergic responses, and this SAA1-FPR2 route seems to be one that is taken by some dust-mite allergens,” Wills-Karp says.

She and her colleagues now plan to investigate why some people develop allergic disorders in which this pathway is hyperactive, while most don’t. They also plan to explore the possibility of blocking this pathway, perhaps at the SAA1-FPR2 interaction, as a way of treating asthma and other allergic disorders.

The researchers suspect that the newly described SAA1-FPR2 allergic pathway may be relevant not only in asthma and hay fever-type disorders but also in atopic dermatitis (eczema) and food allergies–possibly even in chronic inflammatory disorders such as rheumatoid arthritis and atherosclerosis.

First peanut allergy drug for children approved by FDA

The U.S. Food and Drug Administration approved Palforzia [Peanut (Arachis hypogaea) Allergen Powder-dnfp] to mitigate allergic reactions, including anaphylaxis, that may occur with accidental exposure to peanuts. Treatment with Palforzia may be initiated in individuals ages 4 through 17 years with a confirmed diagnosis of peanut allergy and may be continued in individuals 4 years of age and older. Those who take Palforzia must continue to avoid peanuts in their diets.

“Peanut allergy affects approximately 1 million children in the U.S. and only 1 out of 5 of these children will outgrow their allergy. Because there is no cure, allergic individuals must strictly avoid exposure to prevent severe and potentially life-threatening reactions,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. “Even with strict avoidance, inadvertent exposures can and do occur. When used in conjunction with peanut avoidance, Palforzia provides an FDA-approved treatment option to help reduce the risk of these allergic reactions in children with peanut allergy.”

Palforzia is a powder that is manufactured from peanuts and packaged in pull-apart color-coded capsules for Dose Escalation and Up-Dosing, and in a sachet for maintenance treatment. The powder is emptied from the capsules or sachet and mixed with a small amount of semisolid food – such as applesauce, yogurt, or pudding – that the patient then consumes.

More information about this is available in FDA Press Release

Mark Cuban Invests in Food Allergy Prevention Company ‘Ready, Set, Food’ – After Shark Tank Appearance

A new dietary supplement aimed at food allergy suppression has received an investment as a result of a Shark Tank TV show appearance.

The product, called Ready, Set, Food!, pitched its concept on a segment of the ABC series. Investor Mark Cuban, who among other things owns the Dallas Mavericks of the NBA, invested $350,000 into the startup.

“Food allergies are a growing problem across the world. I’m excited to partner with Ready, Set, Food! to start to reverse this growing epidemic and make families lives better,” said Cuban.

The supplement was developed by a team of physicians. The group included Dr. Gary Rachelefsky, the past president of the American Academy of Allergy, Asthma, and Immunology, and Dr. Jonathan Spergel, MD, Chief of Allergy at Children’s Hospital of Philadelphia.

The supplement system is based on just three ingredients: organic cow’s milk, cooked organic egg white and organic peanuts. The supplement starts with a trace and then slightly larger amount of cow’s milk in the ‘Days 1&2’ and ‘Days 3&4’ sachets, then adds the egg white. The system then adds the peanuts, culminating in a ‘maintenance’ formula starting at day 11 of the intervention.
The company claims there are three clinical trials supporting the effectiveness of the supplement system at suppressing the development of common food allergies. The developers say the supplement is not meant for infants who have been diagnosed with a food allergy.

UK Proposes National Allergy Register

A coroner investigating 18 year old Owen Carey’s death called for a national register of “severe food anaphylactic reactions”, after the 18-year-old died after eating buttermilk in a grilled chicken burger. Assistant coroner Briony Ballard said that the allergy rate was, in part, due to a “failure to collect together any learning from these tragedies.”

Despite a general greater awareness of food allergies and a greater distribution of Epi-Pens, the rate of deaths from food allergies “remains static”. Ms Ballard said she was concerned there is “no national register recording the circumstances of these deaths, which could then be analysed and learnt from by allergy specialists.”

Anaphylaxis Campaign said it “whole heartedly supports” calls for a national register, adding: “We believe lessons can and must be learnt from tragic deaths related to anaphylaxis.”  There are also talks of potential laws to improve allergy awareness and standards in restaurants.

A SPECIAL INTERVIEW EVENT: THOMAS SILVERA

TRIGGER AWARENESS Founder and Host of ‘WorldAbout’ Radio Talk Show and Podcast, Grace Farah recently sat down with Thomas Silvera, Co-Founder of the Elijah-Alavi Foundation, and discussed how losing his son to anaphylaxis has put him on a path of ensuring that no other family has to go through what he and his family experienced. “It shouldn’t take a tragedy to create change. Elijah, he did not die in vain. His echo and his words, rang through each and every one of us.”

Click below to listen to the interview;

WorldAbout Show: Thomas Silvera, Co-Founder Of The Elijah-Alavi Foundation

Teal Pumpkins Light the Way for Allergy – Friendly Halloween

This Halloween, teal pumpkins will signal safe treats for trick-or-treaters with food allergies as part of the Teal Pumpkin Project, an awareness initiative jointly supported this year by leading food allergy organizations.

Over the past five years, households from every state have participated in the Teal Pumpkin Project, which encourages people to place a teal pumpkin in front of their home to show they have non-food treats, such as toys, available for children with food allergies and medically-necessary dietary restrictions.

Virtually any food can cause a reaction. Many popular Halloween candies contain nuts, milk, egg, soy or wheat, which are among the most common allergens. Additionally, many miniature candy items do not have labels, so it is difficult to determine whether these items are safe.

Taking part in the Teal Pumpkin Project is simple: paint a pumpkin teal, or buy one at any number of national retailers, and place it on front of your home to show you have non-food treats. Participants can offer treats, such as glow sticks or small toys, as an alternative to candy.

The Teal Pumpkin Project was inspired by a local awareness activity by the Food Allergy Community of East Tennessee.

To learn more and add a participating home to Teal Pumpkin Project map, visit www.tealpumpkinproject.org.

Australia – Allergies and anaphylaxis under the microscope

The House of Representatives Standing Committee on Health, Aged Care and Sport has commenced an inquiry into allergies and anaphylaxis in Australia.

The Chair of the Committee, Mr Trent Zimmerman MP, said that allergies were seeing a rapid rise in Australia affecting more than four million Australians.

‘Some will experience a life threatening allergic reaction known as anaphylaxis. Over the last 20 years hospital admissions for anaphylaxis has increased five-fold and has a major impact for so many families, schools and child care centres,’ Mr Zimmerman said.

‘While the cause of the increase in allergies remains uncertain, what is clear is that this is a phenomenon found primarily in wealthier western nations like Australia.

‘Severe allergies can be life threatening and this will be an important opportunity for the Parliament to shine a light on how we can better support those at risk.

‘The Committee will be taking a broad look into the potential and known causes of allergies and anaphylaxis, food and drug allergy management, access and cost of services, as well as treatment and support services,’ Mr Zimmerman said.

‘We’re looking forward to hearing from the public, health professionals, and other organisations on how allergies and anaphylaxis is being handled in the wider community. The Committee will investigate whether there is anything further the Government could be doing to make life easier for people living with allergies and anaphylaxis.’

The Terms of Reference of the inquiry also investigate developments into research and prevention of allergies and anaphylaxis, unscientific diagnosis and treatments being used by some consumers, and the impact of unnecessary drug avoidance due to unconfirmed drug allergies.

Submissions from interested individuals and organisations are invited by Thursday 24 October 2019. The preferred method of receiving submissions is by electronic format lodged online using a My Parliament account.

Further information about the Committee’s inquiry, including the full terms of reference and details on how to lodge a submission is available here Click here:

Sesame allergies may affect 1.5 million Americans – five times more than previously believed

Thirty-two million Americans have food allergies and new research finds more than a million of them are allergic to sesame.

The study by Northwestern University provided the first up-to-date estimates on the current prevalence of sesame allergy among U.S. children and adults in all 50 states. It was published at the JAMA Network Open journal.

Researchers estimate about .49% of the US population reports having a sesame allergy and .23% had what’s called a “convincing,” or true food allergy, with skin, lung, heart or gastrointestinal symptoms.

The study looked at ongoing regulatory rule-making by the U.S. Food & Drug Administration, which is currently considering whether sesame should be added to the list of key food allergens for which mandatory product labeling is required.

At this time, only the labeling of the top eight allergenic foods/food groups is required: peanuts, milk, shellfish, tree nuts, egg, wheat, soy, and finfish (along with proteins derived from them). A change in policy would align with those in Australia, Europe, New Zealand and Canada, which all have sesame labeling requirements.

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