March 4, 2024 – Kathy N. has suffered from food allergies since childhood. It began with eggs, an allergy she shared together with her mother, and regularly progressed to walnuts, pecans and garlic. Kathy, a 61-year-old consultant from Northern Virginia, has little selection but avoidance, so she has relied on over-the-counter allergy medications. “Basically, I’ve been self-medicating my whole life,” she said. “When I go out to dinner, I take a lot of medication so I know I'll survive the meal.”
Kathy's experience is becoming increasingly common; Food allergyAllergies affect as much as 1 in 10 U.S. adults and as much as 8% of U.S. children, of whom 30 to 86% are allergic to multiple thing. But there is perhaps a glimmer of hope; The FDA just gave approval a drug called Xolair to scale back the chance of probably life-threatening allergic reactions (anaphylaxis) following accidental exposure.
Xolair is a drug with an extended track record. It has been used for over 20 years to treat asthma in children aged 6 and over, chronic cold allergies and chronic nasal congestion with polyps in adolescents and adults.
“It is also safe in pregnancy and has not been shown to be associated with cancer, which has long been a concern,” said Thomas Casale, MD, director of the Division of Allergy and Immunology on the University of South Florida in Tampa. and chief medical advisor to the nonprofit organization Food Allergy Research & Education.
However, unwanted side effects corresponding to pain on the injection site and fever are common, he said.
“If it's the right circumstances and the right patient, I wouldn't hesitate to do it,” he said.
Xolair's approval comes at a very important time.
“There is a huge unmet need,” said Dr. Robert Wood, director of the Eudowood Division of Pediatric Allergy, Immunology and Rheumatology on the Johns Hopkins Children's Center in Baltimore. “The treatment strategies we have used include avoiding food and keeping emergency medication with you in case of a reaction.”
That's not the perfect approach, he said, because “random reactions are very common.”
Risk reduction
There are nine Major food allergensFive of those (peanuts, tree nuts, milk, wheat and eggs) were recently included in a study aimed toward determining whether Xolair is an efficient and secure treatment for youngsters aged 1 12 months and older and adults aged 55 and over In 180 individuals with peanut allergies and at the very least two other food allergies, Xolair shots were in comparison with placebo shots for 16 to twenty weeks.
After the researchers were assigned to one in all the 2 groups, they conducted a dietary test to see if the participants could devour at the very least 600 milligrams of peanut protein (1/16).Th tablespoon) without moderate to severe symptoms corresponding to hives all around the body, cough or vomiting. Participants were then exposed to increasing doses of cashews, milk, eggs, walnuts, hazelnuts or wheat.
“80 to 85% had very clear protection against the risk of accidental exposure,” said Wood, who also led the study.
Almost half could tolerate a dose of about 25 peanuts. During the study, 69% of people that took
Food for thought
Many in allergy research and clinical settings imagine that Xolair will usher in a brand new era within the treatment of food allergies – welcome news for the thousands and thousands of individuals forced to be cautious around food.
Although Xolair may very well be a very important addition to the allergy toolbox, it just isn’t a panacea. The drug reduces the chance of significant allergic reactions, but doesn’t completely prevent them. About 14% of patients within the clinical trial experienced reactions after exposure to certain foods.
Additionally, patients using Xolair are advised to avoid contact with allergens if possible and to proceed to have an EpiPen readily available in case of emergency. Additionally, the primary three drug injections have to be administered within the doctor's office in order that patients may be monitored within the event of an emergency response. (About 75% of emergency reactions occur in the primary three doses, Casale said.)
There can be the query of price, which, in keeping with a spokesman for biotechnology company Genentech, ranges from an estimated $2,900 per thirty days for youngsters to $5,000 for adults, depending on the dose, the whole amount of protein antibodies (immunoglobulin, or IgE), that are present at produced during exposure). against allergens) within the blood and the way often (2 to 4 weeks) vaccinations are required.
Still, living with food allergies is already difficult and the standard way of coping with them is way from ideal.
“Following a diet and fearing a reaction every day your child goes to school causes an extraordinary amount of stress and anxiety for many families, significantly impacting their quality of life,” Wood said. “There is public knowledge about peanut allergies, but if you have a severe reaction to milk, egg or wheat, your family basically can't eat outside their home.”
“It's very scary,” said Emily Goodstein, a 40-year-old consultant in Washington, D.C., and mother of a 3-year-old who’s allergic to cashews, pistachios and eggs.
“Of course I'm very careful about what she eats, but the hardest part is when we're at a vegan or vegetarian restaurant; There’s often a lot of cashew stuff hanging around.”
The sudden death A New York-based doctor's account after a meal at a Disney World restaurant last 12 months underscores that dangers often lurk in any kind of restaurant, even when measures are taken to make sure adequate safety precautions are in place. In this case, the doctor was assured by the restaurant staff that certain dishes may very well be prepared allergy-free and he or she also used an epinephrine device (EpiPen). Still, the coroner's report showed she had been exposed to large amounts of dairy products and nuts, which led to a severe allergic response and death.
Ultimately, the choice to try Xolair might not be so simple as talking to a physician and medical health insurance. Price aside (Genentech offers patient assistance for individuals who meet certain qualifications), health disparities are as widespread in allergies as they’re in other diseases. Studies show that non-Hispanic black children have done this higher rates of Food allergies, multiple food allergies, severe reactions, and emergency room visits related to food allergies in comparison with white children.
The same differences may exist amongst black adults, although evidence is proscribed. And for underserved communities, a lot of whom live in food deserts and depend on food banks, access to secure, real food may be difficult.
Patients like Kathy N. and fogeys like Goodstein are cautiously optimistic, saying they're curious enough to keep watch over Xolair but aren't quite able to make the leap, at the very least not yet. For others, the drug may very well be a welcome safety net, allowing them and their children to live more freely and have less fear of by accident being exposed to a dangerous food allergen.