Although food allergies are a common pediatric concern, there are many adults who live with them as well. Studies have shown oral immunotherapy to be successful in desensitizing children to food allergies, but there has been little research on whether this same course of therapy could be successfully applied to adults.
Na’ama Epstein-Rigbi, MD, and colleagues retrospectively analyzed the medical records of patients aged 17 and older who completed oral immunotherapy treatment between April 2010 and December 2020. Dr. Epstein-Rigbi recently discussed the findings with Physician’s Weekly.
PW: Is there a knowledge gap regarding adults and food allergies?
Dr. Epstein-Rigbi: Food allergy is mostly viewed as a pediatric problem, and adults with food allergy are usually overlooked. In fact, there are scarce scientific works addressing the topic of adult food allergy. While it is true that some allergies resolve as the child matures, for individuals in which food allergy persists, they are usually faced with a more severe health condition. Moreover, allergic reactions tend to become more severe with age, either because of risk-taking behavior or the natural history of food allergy, or both. All these factors influenced my decision to focus on this topic.
PW: What are the most important findings from your study?
Dr. Epstein-Rigbi: We discovered several important findings.
- Adults undergoing immunotherapy for non-milk allergens (ie, peanut, sesame, egg, and tree nuts) have a good outcome. Most adult patients were able to reach either full or partial desensitization at rates similar to younger patients. This is an important finding for two reasons. First, prior to my study, there was no evidence-based research showing favorable outcome in adults undergoing oral immunotherapy. Second, these specific allergens are most associated with life-threatening reactions in adulthood, thus these finding are reassuring and provide hope for adult patients.
- Adults undergoing non-milk oral immunotherapy suffered from more severe reactions (requiring epinephrine) than the younger population, but not significantly more, rendering this treatment not only successful, but also safe and feasible.
- Milk oral immunotherapy in adults had a significantly more difficult course than the younger populations, with significantly more failures and significantly more severe adverse reactions (Figure).
PW: How can these findings be incorporated into clinical practice?
Dr. Epstein-Rigbi: These findings emphasize that adults can be treated for non-milk allergies at all ages with a good outcome and safety profile. They also emphasize the importance of treating milk allergy as early as possible and not postponing this process.
PW: What would you like future research to be focused on?
Dr. Epstein-Rigbi: Future research should focus on oral immunotherapy for milk allergy, exploring why it is more difficult to achieve desensitization in adults, better understanding the mechanisms behind immunotherapy, and finally, exploring new protocols, adjuvants, or biologics that can help achieve desensitization in milk immunotherapy.
PW: Is there anything else you would like to mention?
Dr. Epstein-Rigbi: Oral immunotherapy is still relatively rare worldwide and not incorporated into common practice therapy for food allergy. This is true for all ages, but much more profound for adults. I hope this research is another step toward reassuring physicians that oral immunotherapy is an efficient and feasible treatment with the ability to improve QOL.
