Challenging food allergies in a safe place
Photo: Joshua Huston
Packing lunchboxes for three kids every day can be challenging for any parent. When one of those children has life-threatening food allergies, the difficulty factor increases exponentially.
“I triple-checked the lunchboxes,” said Jennifer Wenrick, a Seattle mom to twin 7-year-old daughters and a 6-year-old son.
She doesn’t want to make a mistake with Colin, who experienced a severe allergic reaction at age 2 after a couple of bites of a granola bar with nuts, breaking out in hives all over his body and profusely vomiting. After some testing, Colin was diagnosed with allergies to peanuts, tree nuts and sesame, and the Wenricks joined the ranks of the 15 million Americans with food allergies who have to scrutinize what’s in their food.
“Suddenly, grocery shopping took me twice as long because I had to read all the labels, until I could understand what brands I could lean toward,” she said. “It’s an added level of vigilance and stress and fear that goes with your everyday life.”
Six months ago, a big part of her worry was lifted when her son became one of the first patients at a new food-allergy-challenge clinic at Seattle Children’s Hospital & Research Institute.
The clinic is a collaborative effort of the Seattle Food Allergy Consortium. SeaFAC’s four member organizations bring together clinical expertise, research capabilities and community participation to support finding a cure for food allergies. Along with Children’s, the other members are UW Medicine/University of Washington, Virginia Mason Medical Center/Benaroya Research Institute, and Northwest Allergy and Asthma Center/ASTHMA Inc. Clinical Research Center.
Taking the food challenge
Navigating food allergies can be terrifying and frustrating for parents. Skin tests can result in false positives, and they can’t predict the severity of allergies. So parents are left wondering what might happen if their child eats something to which he or she has tested positive.
At the food challenge clinic, which is aimed at ages 5 through 21, patients are closely observed by medical staff while they eat increasing amounts of their suspected allergen. The staff is trained and ready to respond if a patient suffers a severe reaction, including life-threatening anaphylaxis.
Wenrick, 40, took Colin to the clinic soon after it launched in November 2014 to see if he really was allergic to peanuts. Since his diagnosis, the family had been avoiding peanuts and his other allergens. They carry an auto-injector with epinephrine that can stop a potentially deadly allergic reaction.
So in December, Colin went to the clinic, where he started by eating just a few Reese’s Pieces peanut butter candies.
Photo: Joshua Huston
They waited. Then he ate some more candy at regular intervals. Finally, after 3½ hours, Colin was cleared with no reaction.
“I don’t think I realized how much of a relief it would be until they came in and said he passed, it’s been 3½ hours, and I just started crying,” Wenrick said. “We were ecstatic.”
The SeaFAC food challenge clinic can help provide that definitive answer for families, even if it confirms an allergy.
“When we started the clinic, we said, let’s keep it simple, (testing) the higher-risk foods like peanuts and tree nuts, and eggs and milk, and then sesame,” said Dr. Frank Virant, who directs the food challenge clinic and is the Allergy Division chief at Children’s. He’s also a clinical professor of pediatrics at the UW School of Medicine, as well as a doctor with Northwest Asthma and Allergy.
“The hope is we can get a situation where we can actually prove that a food is tolerated, maybe eliminate the need for epinephrine all the time,” he said.
Photo: Joshua Huston
The clinic operates two Thursdays a month and receives patients who are referred through allergists connected to SeaFAC, Virant said. It is poised to add more foods to its challenges, and to expand access to allergists across the state, he said.
Before an oral challenge, the clinic does a consultation using a patient’s history and previous test results.
“We’re only going to do a challenge if there’s an 80 percent chance that the patient won’t react, or react severely,” Virant said. “But we are equipped to treat that.”
If a patient does react to a food, it’s possible that he or she could become part of a study on food allergies, Virant said.
Wenrick said that even if her son would have had an allergic reaction during the challenge, “that would have been almost a relief in some way, too, to just know definitively one way or the other.”
Part of SeaFAC’s mission is research. Currently there is no cure for food allergies, which continue to increase. In 2013, the Centers for Disease Control and Prevention estimated that food allergies among children increased about 50 percent between 1997 and 2011. Studies show that the number of children with peanut allergies tripled between 1997 and 2008, according to the national organization Food Allergy Research & Education.
But there is some promising research. One recent study that SeaFAC participated in tested a patch that provided a steady dose of peanut protein through a patient’s skin. The Viaskin Peanut patch study tested three dosages and found that after a year, half of the patients treated with the highest-dose patch tolerated the equivalent of about four peanuts — 10 times what they could tolerate before the patch.
Virant said that SeaFAC plans to do a similar skin-patch study with milk protein starting in June.
“The real challenge is, how do we cure some of these food allergies?” Virant said. “We just don’t know why peanuts, tree nuts and shellfish, why do they not go away … That’s the holy grail.”
Food allergies by the numbers
15 million: Americans with food allergies
1 in 13: Number of children in the U.S. who have food allergies. That’s two in every average-sized classroom.
8: Number of foods that account for 90 percent of food allergy reactions. They are milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish.
$25 billion: Annual economic cost of children’s food allergies.
Every 3 minutes: How often someone goes to the emergency room for a food allergy reaction.
Source: FARE (Food Allergy Research & Education). For more resources, visit foodallergy.org
Margaret Santjer is a writer, editor and the parent of a child with food allergies.