Food Allergy Clinical Trials in Switzerland

Peanut allergy was in the news again recently, due to a study out of Australia using a treatment that combined probiotics with oral immunotherapy. The study offers some promising results, as 80 percent of the enrolled children could tolerate eating peanut by the end of the clinical trial. At the same time, 45 percent experienced an allergic reaction, which according to Food Allergy Research & Education (FARE) is similar to other studies using oral immunotherapy. If you didn’t see all the media coverage, here are a few links to get you up to speed:

Nuts

When I posted an article about this Australian study on Facebook, someone asked if I knew of any similar clinical trials being conducted in Switzerland. To address this question, I contacted a pediatric allergist working in Geneva via email. He wrote to confirm that no such study is currently being conducted here.

This inquiry made me curious about other food allergy clinical trials in Switzerland, and the pediatric allergist I contacted recommended an online database that’s maintained by the US National Institutes of Health (NIH): ClinicalTrials.gov. When I searched the database, I found three relevant studies that are currently open and recruiting participants. You can click the links in the table below for more information about each individual study.


Food Allergy Clinical Trials Currently Recruiting Participants in Switzerland
Study title Sponsor Types of allergens Estimated completion date Eligible ages
Molecular Analysis of IgE Antibodies in Walnut Allergic Patients University of Zurich Walnut November
2015
1 year to 70 years
Integrated Approaches to Food Allergen and Allergy Risk Management University of Zurich Peanut, hazelnut, walnut or celeriac February
2017
5 years and older
Tree Nuts Allergies: Does a Single Nut Allergy Necessitate the Dietary Eviction of Other Tree Nuts? University Hospital, Geneva Peanut and tree nuts January
2016
12 months to 16 years

Source: Search results obtained on February 16, 2015 from ClinicalTrials.gov for Switzerland when the condition entered was “food allergy.”


Additional resources:

  • For some helpful background information on clinical trials, check out the Frequently Asked Questions prepared by FARE.
  • In the United States, Vanderbilt University maintains ResearchMatch, an online patient registry. FARE and NIH worked together and used ResearchMatch to create a special food allergy sub-registry for patients interested in volunteering for clinical trials.

 

Have you ever participated in a food allergy clinical trial? If you have any experience or advice to share, please leave a comment below. Many thanks!

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Oral Food Challenge for Baked Milk: Passed

Baked Milk Food Challenge

My son’s final doses of baked milk

“Milk in the batter! Milk in the batter! Stir it! Scrape it! Make it! Bake it!” – From In the Night Kitchen by Maurice Sendak

On Thursday evening, I read In the Night Kitchen to my sons at bedtime. It’s one of my favorite children’s books. I hadn’t planned on it, but I when came across the brown-hued cover on the bookshelf, it seemed appropriate timing considering our plans for the morning—my son’s physician-supervised oral food challenge for baked milk.

This would mark his sixth food challenge, and I feel the same way every time—nervous, worried, happy and excited. After our unsuccessful attempt at baked milk back in July 2014, when my son refused to eat all the required doses of cake, we decided to try a new approach. This time, as recommended by his pediatric allergist, I modified the recipe and baked the cake at home.

I’m elated to report that my son “passed” the challenge with a negative result—no reaction whatsoever. This is huge. I baked Zopf with milk and butter for my family on Sunday, and we all ate it together. My hope is that every child with a milk allergy can get to this point. We feel so incredibly lucky once again.


Why is baked milk okay?

When milk is extensively heated (i.e., baked), the proteins change somehow so my son’s immune system no longer considers it an allergen. From the various articles I’ve seen and our own experience, the heating standard for food challenges with baked milk is generally 180 degrees Celsius (350 degrees Fahrenheit) for 30 minutes. One recent study estimates that the majority (75 percent) of children with cow’s milk allergy can tolerate eating baked milk products, like cake and bread. Another study has found that consuming baked milk products helps to increase children’s tolerance for drinking unheated cow’s milk.

Sources:

2015-01-15 20.34.45

Have you participated in a baked milk food challenge? What was your experience?  Please leave a comment below.

My son will have another milk-based challenge coming up this spring. More details soon… In the meantime, I’m making sure he has baked milk in some form every day until then. I’m thrilled to be baking with milk and butter again!

Thanks for your continued support and advice! I hope you’re getting some good news about food allergies too.

Updated: If you would like the recipe I used for the baked milk challenge, please send me an email for more information. February 2, 2015.

Food Allergy and Anaphylaxis Meeting 2014: Dublin, Ireland

As a parent of a child with food allergies, I am always seeking out the latest news and research in an effort to improve my son’s overall health and quality of life. For this reason, I attended Europe’s leading conference on food allergies: the Food Allergy and Anaphylaxis Meeting (FAAM) in Dublin, hosted by the European Academy of Allergy and Clinical Immunology (EAACI). With about 600 participants from roughly 50 countries, the multidisciplinary seminars at FAAM 2014 covered various topics related to managing food allergies, as well as prevention and finding a cure.

2014-10-11 08.27.52

EAACI represents doctors, researchers and other medical professionals. It has over 7,800 individual members and also works with National Societies and patient organizations, such as the aha! Swiss Allergy Center in Bern. Most recently, I wrote about EAACI’s efforts to raise awareness of food allergies via a written declaration on allergic disease presented before the European Parliament.


FAAM 2014: A Few Highlights

The FAAM 2014 seminars spanned over three days, and nearly 200 abstracts were presented as part of the conference. In the coming weeks and months, you’ll notice that these seminars will be informing many of my future blog posts, as well as the management of our son’s allergies (e.g., requesting a consultation with a nutritionist). In the meantime, I just wanted to share a few of the key findings presented at the conference that I found especially interesting.

Public Policy

  • Mr. Jerry Buttimer TD (Ireland), a member of the Irish Parliament, said that if President Barack Obama can sign into law a bill encouraging schools in the United States to have access to epinephrine (a.k.a. adrenaline) auto-injectors, then surely a similar law could be passed across Europe. Mr. Buttimer was referring to the School Access to Emergency Epinephrine Act (H.R. 2094), which enables states to pass legislation requiring schools to carry “stock” epinephrine auto-injectors for emergency use.

Socioeconomic Costs

  • Dr. Audrey Dunn Galvin (Ireland), a registered physiologist and lecturer at the University College Cork, presented her research on the socioeconomic cost of food allergies. She discussed the high levels of stress and anxiety that parents can experience due to the constant monitoring of their child’s food allergies. In particular, she discussed how parents must balance the need to protect their child’s environment, while ensuring their positive development. In addition, she mentioned several recent studies socioeconomic costs, including a study of adults with food allergies in Sweden.

Oral Food Challenges

  • Dr. Carina Venter (United Kingdom) talked about food challenges as the best way to identify a true food allergy, and questioned the reliability of self-reported data to determine the prevalence of food allergies. Overall, she stressed the need for more and better data on food allergy prevalence, particularly to evaluate changes over time. As part of her presentation, Dr. Venter discussed her research on trends in the prevalence of peanut allergies in the UK.
  • Dr. Galvin’s research on the socioeconomic impact of food allergies found that routine oral food challenges help to improve health-related quality of life for families living with food allergies. From our own experience, I certainly find this to be true, as food challenges have either allowed us to introduce new foods into our son’s diet or have provided us with greater knowledge and awareness of his allergies, even though he didn’t “pass” the test.

Anaphylaxis

  • Dr. Margitta Worm (Germany) discussed her research examining an anaphylaxis registry for German-speaking countries, including Switzerland. Her study found that adrenaline was rarely used. More specifically, for the emergency treatment of anaphylaxis among 197 children and adolescents between 2006 and 2009, adrenaline was used in only 22 percent of the registered cases.

Oral Immunotherapy

  • Dr. Kirsten Beyer (Germany) described oral immunotherapy (OIT) as a promising treatment for allergies, but highlighted that it is not yet ready for clinical practice. She said that many different protocols exist for OIT, which makes it difficult to compare results and assess its effectiveness. Generally, researchers agree on three primary phases for this treatment: 1) a starting dose, 2) dose escalation and 3) a maintenance dose. During her presentation, she cited a recent study on the side effects of OIT for peanut allergy.

You can also review the tweets from other FAAM 2014 participants by searching for the event hashtag via Twitter: #FAAM2014.


EAACI Food Allergy and Anaphylaxis Guidelines

Throughout FAAM 2014, presenters referred to the EAACI Food Allergy and Anaphylaxis Guidelines, which were published earlier this year. The purpose of these guidelines is to translate knowledge of food allergies into clinical practice, and in particular, for such areas as diagnosis and management, prevention, quality of life and anaphylaxis. EAACI included a hard copy of these guidelines as part of the printed materials I received during the conference, and I will be sharing what I learn as I review them. While the full document is only available for EAACI members to download, sections of the guidelines are also via the EAACI website.

I will continue to provides updates on the research presented at FAAM 2014, and next week, I also plan on sharing a recipe from our excursion to Northern Ireland. Bon week-end, everyone! Thanks for your continued support.

BBC’s Horizon Explores Potential Causes of Allergic Diseases

New research suggests that changes to the bacteria inside our bodies may be linked to the growth in allergic diseases. Horizon, a BBC Two science program, covered this topic during a recent episode entitled, “Allergies: Modern Life and Me.” By profiling the experiences of two UK families living with various allergies and asthma, this program tests the hypothesis that bacteria living inside the gut, or a lack thereof, are affecting the development of allergies. (Click here to view the full program, if you’re interested).

Researchers think environmental factors have played a role in the growth of allergic diseases in the last few decades, and daily practices of modern life may be the culprit. High bacterial diversity in the gut has been associated with lower levels of allergic disease, according to several recent studies. For example, researchers have found connections between lower levels of allergies and things like having plants in your house, living on a farm or spending time outside, as these can increase bacterial diversity. Furthermore, the Johns Hopkins Children’s Center reported last month that an estimated one in 10 inner-city children in the United States has an egg, milk or peanut allergy (and researchers contend the actual number could be higher)—a finding that seems to lend support to the bacterial diversity theory.


A Swiss Connection

As I watched the Horizon program on allergies, I was pleased to see Switzerland mentioned, as there’s a prominent researcher here who’s leading some work examining the relationship between bacterial diversity and allergic diseases. Dr. Ben Marsland, an Associate Professor at the University of Lausanne, was interviewed about his work with “germ-free mice.”

While these mice are normal in their appearance, they are free of bacteria, fungi or viruses. Dr. Marsland and his colleagues found that when these mice were exposed to dust mites, they were more prone to an allergic reaction. (Similar results were found recently by a team of researchers led by Dr. Cathryn Nagler at the University of Chicago that exposed germ-free mice to peanut.)

I sent Dr. Marsland an email following the program, to thank him for his research and inquire about current and future work. He passed along three recent publications from his team’s research this year. The citations appear below, if you’re interested in a more detailed description of his findings:

Dr. Marsland added that his current work includes fundraising for a birth cohort study in Norway involving some basic interventions, such as introducing certain foods at an earlier age. In the future, he hopes his basic research can be translated into effective clinical practices to treat allergic diseases.


Living a Modern Life

During the program, I couldn’t help but think about our own family. How would we fare in a similar experiment like the one conducted with the two families for Horizon? How often do we spend time outside? How many plants do we have in our house? I didn’t have a c-section when either of my sons were born (a vaginal birth results in higher exposure to bacteria). Neither had antibiotics during their first year of life.

I’ve certainly wondered at times if there’s something I could have done to cause my son’s allergies, and this episode of Horizon definitely raised those concerns again. While it may not be possible to determine one specific thing as the root cause, it made me question our current practices. What are some practical ways we can increase bacterial diversity in our lives? I’m already planning to take the boys hiking more often on one of my favorite routes—through the forest and alongside an organic farm with goats, pigs, donkeys and chickens!

Swiss hike

Hiking with the boys on one of my favorite local trails last fall

For further reading on this topic, check out “Horizon on Allergies,” an excellent post from Michelle’s Blog, written by UK food allergy and intolerance blogger, Michelle Berriedale-Johnson.

Did you watch this episode of Horizon? What did you think? If you have any thoughts or questions to share, please leave a comment below.

Updated: January 24, 2014

Is there a Shortage of Adrenaline Auto-Injectors in Switzerland?

EpiPen and Trainer 2456x2496

No, there isn’t a shortage for the moment. However, the supply of adrenaline auto-injectors (AAIs) in Switzerland has been limited recently, due to defects found last fall in one of the two available brands here. According to an official from Swissmedic—the Swiss federal agency responsible for authorizing and supervising therapeutic products—the situation may be more accurately described as “an undersupply,” and it’s improving.

The issue of a potential shortage first came to my attention in January 2014, when I picked up a new prescription for EpiPens because our son’s were expiring. I brought them home from the pharmacy to discover they would expire in May 2014—only a 5-month shelf-life. We had to request a new prescription from our son’s allergist again this spring. I wanted to know more about why this occurred, especially since a typical shelf-life for EpiPens is about 13-14-months—a fact I learned this week via email from a representative of MEDA, the company that distributes this brand in Europe. Also, I’ve been reading about similar situations in the United States via the food allergy blog, Oh Mah Deehness!, and in the United Kingdom via Anaphylaxis Campaign.

Please note: In the United States, from my experience, AAIs are more commonly referred to as epinephrine auto-injectors.

What are AAIs?

We always carry two AAIs with us because our son has severe food allergies. If he had a life-threatening allergic reaction, known as anaphylaxis, we would need to inject him with a dose (or more) of adrenaline. Some symptoms of anaphylaxis can include skin reactions and difficulty breathing. While we’ve thankfully never had to use them, we need to make sure we’re carrying AAIs that haven’t expired.

For more detailed information about AAIs, check out “About Food Allergies: Epinephrine Auto-injectors” via Food Allergy Research & Education’s website.


What brands of AAIs are available in Switzerland?

In Switzerland, people who need AAIs have two options: EpiPen or Jext (see the table note below). Anapen has also been licensed in Switzerland, but hasn’t been available since a product recall in 2012, and it’s not known when it will be available again, based on an email response I received from aha! Swiss Allergy Centre. Here’s a quick comparison of the two available AAIs in Switzerland:

Characteristics EpiPen Jext*
Types of AAI EpiPen Jr and EpiPen Jext 150 and Jext 300
Shelf-life 18 months 24 months
Training device Yes Yes
Refill reminder system Yes (My EpiPen and My EpiPen App) Yes (Expiry Alert Service)
Distributor MEDA Pharma GmbH ALK-Abelló AG

*While the Jext 150 and Jext 300 haven’t been available during the first half of 2014 in Switzerland, a Swissmedic official emailed me on July 10 to report that new lots of the product are expected in July 2014.


What caused a batch recall of Jext AAIs?

In November 2013, there was a batch recall of Jext 150 and Jext 300 in Switzerland. It was discovered that in rare cases, a defect would prevent the adrenaline from being administered properly for certain batches of these products.

 

How did the recall affect the supply of AAIs in Switzerland?

The batch recall meant the retail sector (i.e., pharmacies) had to return their supply of Jext that could potentially have the defect. At the same time, patients with Jext were informed to keep them, since the probability of a malfunction was very low, and based on a November 2013 notice from Swissmedic, a replacement of AAIs could not be guaranteed due to a limited supply—a situation that was occurring throughout Europe.

To help alleviate the increased demand for AAI in Switzerland, Swissmedic approved the distribution of an “emergency batch” of EpiPens “with a relatively short remaining shelf-life,” according to an agency official there. It provided temporary relief and helped prevent a shortage of this medication. Patients with extremely severe and recurrent allergic reactions that had the potentially defective Jext were allowed to receive another AAI during the recall as a precaution.


What’s the situation now?

EpiPens with a more typical shelf-life are now being made available to patients in Switzerland, according to an agency official from Swissmedic. This matches our family’s experience, as the two AAIs we picked up in May 2014 had an expiration date of June 2015. Furthermore, new lots of Jext should be coming on the market yet this month, as indicated by an Swissmedic official. All of this is good news for people living with food allergies, who depend on this medication if they ever experience a severe allergic reaction.


What kind of AAI have you or your family members been prescribed? How, if at all, have you been affected by the Jext recall? Please share a comment below, when you have the chance. Thanks in advance for your help.

Updated: July 10, 2014

Third Birthday and Upcoming Food Challenges

Dairy-free birthday cake

Our youngest son turned 3 years old this week. As we celebrate his birthday, there’s a lot to be thankful for in terms of his food allergies. We’ve had some good news this year. Here’s a quick summary:

Now I can use eggs in my son’s birthday cakes. For his party, I opted for a traditional yellow layer cake with a rhubarb swirl and chocolate frosting. The Kitchn has an easy recipe for this traditional birthday cake, which I adapted by using dairy-free margarine and rice milk.

yellow cake 2485x3175

We will be scheduling a food challenge for eggs in the upcoming months. If our son passes this test, he’ll be able to eat scrambled eggs, french toast, frittata and all those other egg-based dishes I’ve been anxiously waiting to make again. To prepare for this challenge, I’m making sure he eats some form of baked egg every day—like dried pasta, homemade cake or bread—to hopefully build up his tolerance and increase the likelihood of him passing the test.

We also have a new testing plan for his milk allergy, developed in partnership with his pediatric allergist. This involves a series of food challenges, starting with baked milk. If there’s a negative result (i.e., no reaction occurs), then we move down the list to the next test, and so on, until he completely outgrows his allergy. If there’s a positive result (i.e., a reaction occurs), then we’ll repeat the test after a certain period of time and hope he eventually passes it.

For each of these food challenges, here’s what he’ll eat:

  1. Baked milk: Cake baked with powdered milk. Looking at the data, there’s a good chance my son will pass this test. For example, a study published in the Journal of Allergy and Clinical Immunology (2011) reported that approximately 75 percent of children with a cow’s milk allergy can tolerate eating foods with baked milk.
  2. Baked yogurt: Cake baked with dairy-based yogurt.
  3. Baked cheese: Pizza baked with cheese on top.
  4. Cold milk: Cold milk or possibly petit suisse again—to be determined.

From what I’ve read, our son has a good chance of outgrowing his milk allergy. I recently came across the milk allergy guidelines from the British Society for Allergy and Clinical Immunology (BSACI), which indicate that the majority of children will resolve their cow’s milk allergy and recommends individuals “be reassessed at 6-12 monthly intervals from 12 months of age to assess for suitability of reintroduction” (p. 643).

Instead of our selected approach, we could have chosen to skip all these additional tests and go straight to the cold milk test for a second time, as our son could outgrow his milk allergy on his own, without any intervention. This was the other option we considered, and it could also work.

Even though my son could outgrow his milk allergy on his own, I’m just too impatient to wait. Plus, the study cited above found that for children, consuming baked milk products can accelerate the resolution of their allergy. Knowing this, our pediatric allergist suggested this incremental approach, and my husband and I agreed with the recommendation. I would much rather actively do something and test these different forms of milk, than wait another year, have the same result and find we can’t make any changes to our son’s diet.

Being able to add powdered milk to baked goods would be such a major improvement, and it may be something we can start doing soon, should my son pass this first test. If so, our family would no longer be living completely dairy-free in Switzerland, so once again, I may have to change the name of this blog (which I would be overjoyed to do!).

Questions: Do you or your child have a cow’s milk allergy? What approach are you taking to try and resolve it? Please leave a comment below or send me an email at dairyfreeswitzerland@gmail.com. If you have a moment to do so, I would really appreciate it.

Many thanks, and bon week-end!

Switzerland’s National Day of Allergy 2014

March 27, 2014 – Today marks Switzerland’s 6th annual Journée Nationale de l’Allergie (National Day of Allergy), which is organized by the aha! Centre d’Allergie Suisse (Swiss Allergy Center), a nonprofit organization based in Bern. According to aha!, about 3 million people in Switzerland are living with allergies, asthma or intolerances. The key message for this event is to ensure that people are well-informed and taking preventative measures in order to significantly improve their quality of life.


Source: aha!

In Switzerland today, you can view allergy-related issues and themes broadcast on large screens at the following train stations. These images are intended to stimulate interest and encourage thousands of commuters to learn about allergies.

  • Basel*
  • Bellinzona*
  • Bern*
  • Geneva*
  • Lausanne*
  • Lucerne*
  • St . Gallen
  • Zug
  • Zurich HB Stadelhofen
  • Zurich*
  • Zurich Enge
  • Winterthur

*Informational materials will also be distributed at these stations.

Thanks to aha! for all their hard work to prepare for the National Day of Allergy. It’s great to see an annual event like this—and in locations throughout the country—to help to increase awareness of allergies and provide support for those living with allergies every day.

FYI – The aha! Centre d’Allergie Suisse is also organizing a children’s camp in Crans-Montana in October 2014 for kids ages 8-12 living with allergies, asthma, intolerances and atopic eczema. For more information, click here or contact aha! at 031 359 90 50 or info@aha.ch.

European Parliament Doesn’t Adopt Allergic Disease Declaration

Tuesday, January 21 was the last day for Members of the European Parliament (MEPs) to support a written declaration on allergic disease, and it was not adopted. For the declaration to pass, a majority of MEPs needed to sign their name to it. In all, the declaration received 177 signatures—over 200 votes short of being adopted by the European Parliament.

What does this all mean? Here’s a little background info:

  • Switzerland­: Although Switzerland is not a member of the European Union, and therefore does not elect a member of the European Parliament, one of the organizations actively supporting this declaration is based in Zurich—the European Academy of Allergy and Clinical Immunology (EAACI).
  • Written Declaration 0022/2013 and food allergies: This declaration includes all types of allergic disease, such as allergic rhinitis and food allergies. As written in the declaration, “More than 17 million Europeans suffer from food allergies or severe allergies implying a risk of acute attacks or anaphylaxis with life-threatening potential.” Eleven MEPs proposed the declaration in October 2013, which began a 3-month period to collect signatures for its adoption.
  • What the declaration asked for: The declaration focuses on the need to recognize the burden of allergic disease and address the “diagnosis gap,” as about 50 percent of people with allergies are undiagnosed, according to a recent EAACI press release. Specifically, the two-page declaration outlines the following activities:

“to encourage cooperation and coordination between Member States to promote: national allergy programmes to reduce the disease burden and health inequalities; training in allergies and multidisciplinary care plans to improve disease management; use of preventive and tolerance-inducing approaches to allergy treatment; and scientific research into direct and indirect allergy risk factors, including pollution;” (p. 2).

In my opinion, it’s disappointing that more MEPs did not support Written Declaration 0022/2013. The declaration doesn’t require major reforms, but rather what seems like an incremental approach to addressing allergic disease in the European Union. The specific activities listed for Member States to promote, such as national allergy programs or preventive and tolerance-inducing treatments, do not appear controversial.

Furthermore, written declarations as a policy tool have relatively limited influence. Approved declarations only apply to those MEPs who have signed on. In other words, even if a majority of MEPs approve the declaration, it still doesn’t represent the official position or serve as a legally binding document for the entire European Parliament.

“A written declaration is a text of a maximum of 200 words relating exclusively on a matter falling within the competence of the European Union. They do not, however, bind Parliament, that is, they cannot be considered as an act of the Parliament representing its position, but only those of its authors and signatories.” –European Parliament/Plenary website, see Written Declarations

While the European Parliament didn’t adopt this declaration, the campaign for this effort helped raise awareness of allergic disease, including food allergies. For example, EAACI organized three days of skin prick tests in the European Parliament. In all, 350 people were tested, and 47 percent had positive test results.

Video source: EAACI Headquarters

Earlier today, EAACI and the European Federation of Allergy and Airways Diseases Patients’ Associations (EFA) in Brussels released a joint press release. It contained the following statement from EAACI’s President:

“Allergic diseases should be included in initiatives concerning chronic diseases at national and European level. The European Commission has the capacity to coordinate efforts to respond to the challenges of chronic diseases. Now is the time to act!” -Professor Nikos Papadopoulos, EAACI President

If you have any questions or information to provide about Written Declaration 0022/2013, please leave a comment below. In the meantime, I’ll continue to share public policy updates related to food allergies for Switzerland and beyond as they come up. Bon week-end!

Pediatric Allergies: Switzerland, Australia and the United States

I’m always eager to find new research and data on food allergies, and especially when it involves kids. This week, I came across new information about pediatric food allergies for three countries—Switzerland, Australia and the United States.

When you scroll down, you’ll see I’ve included some links to videos, including a Discovery Channel documentary on food allergies in America that came out over the weekend. These videos generally have a positive message about food allergies, but they also show interviews with people who have experienced anaphylaxis firsthand, for example. The families and their stories send a powerful message about the severity of food allergies and the daily stress that can come with managing them.


Switzerland

I’ve shared data on the prevalence of food allergies in Switzerland before, but have only recently come across an estimate specifically for children. When I emailed the aha! Swiss Allergy Centre about it, a member of their Specialist Team responded that approximately 5-8 percent of all children in Switzerland are expected to have some type of food allergy. These data come from an article published in 2005: Miles S, Fordham R, Mills ENC, Mugford M. A framework for measuring costs to society of IgE-mediated food allergy. Allergy 2005; 60: 996–1003.

From my quick scan of the article, it seems the authors base their estimate on a review of three studies from 1987, 1998 and 2002. According to the email I received from the aha! Swiss Allergy Centre, these data serve as an estimate of the proportion of children with food allergies for Europe. The Centre refers to European data because similar studies specifically for Switzerland do not exist. More data will be forthcoming as the EuroPrevall project, which includes Switzerland as a partner nation, continues to examine the prevalence, cost and basis for food allergies in Europe.


Australia

The Australian version of the television program “60 Minutes” recently did a segment on food allergies. I didn’t realize this, but Australia has one of the highest rates of food allergies among children in the world. Of children born in Australia, 1 in 10 has a food allergy. In addition, from 1993 to 2005 the number of visits to emergency rooms and hospitals for patients suffering from anaphylaxis doubled, as described during an interview with Dr. Kari Nadeau of the Stanford School of Medicine.

The video below has a brief interview with the reporter that interviewed Dr. Nadeau and a brave girl from California who was the first to successfully complete a clinical trial for patients with multiple food allergies. To view the full 13-minute segment online, click here. It has some heartbreaking stories that have really stuck with me.


United States

In the United States, it’s estimated that 1 in 13 children (or nearly 8 percent) have a food allergy, according to Food Allergy Research & Education (FARE).

The Discovery Channel, through a grant from FARE and Mylan Specialty L.P., released a documentary over the weekend entitled, “An Emerging Epidemic: Food Allergies in America.” Narrated by Steve Carell, the documentary presents interviews with adults and children with food allergies, as well as parents of food-allergic children. Dr. Nadeau is also interviewed in this documentary about her clinical trial. Overall, it has a very positive and hopeful tone—much more so, in my opinion, than the “60 Minutes” segment from Australia.

What are the numbers like from your country? If you have more current data to share on food allergies in Switzerland or beyond, please let me know. I’ll continue to provides updates on new research and data, as it becomes available. Thanks!

Treatment Stopped: No More Milk

I’m disappointed to report we’ve stopped administering what seemed like a promising treatment for our son’s milk allergy. No longer does he receive a small daily dose of cow’s milk mixed in his soy milk. Working with our allergist, we decided not to proceed with this new treatment. For me, the risk was too unknown, and the benefits weren’t guaranteed.

DSC09790


The First Four Days

On the Saturday following my son’s food challenge, I mixed 10 mL (2 teaspoons) of cold cow’s milk into his morning glass of soy milk. The plan was to give a daily milk dose for one month’s time, and if all went well, increase the dosage by a certain amount, as recommended by our allergist. He drank it up without noticing any difference.

Not long after, we noticed red raised hives developing around his mouth. As the days progressed, we noticed the hives increasing—not enough to warrant an antihistamine, but more than what appeared after the same dosage of milk during the food challenge.

Each day the milk dosage became more and more stressful for me, even though I knew the little guy could tolerate a large quantity of milk. You can never predict the severity of an allergic reaction, which could be life threatening. Furthermore, the onset of such a reaction can be “deceivingly mild,” as outlined in our epinephrine instructions.


Not a Routine Treatment

On what would have been day 5 of his treatment, my son had cold symptoms—“le rhume” was making its way through our household. Our allergist advised us not to give him any milk when he’s sick, so we skipped the dosage. At about this same time, I started reviewing abstracts of various studies and checking in with others to find out about their experiences with this treatment. I had heard about oral immunotherapy before, particularly from all the discussion surrounding the recent New York Times article. Were we doing oral immunotheraphy?

After checking in with my son’s allergist, I learned we were instead using a practice referred to as specific oral tolerance induction (SOTI). Similar to oral immunotherapy, SOTI involves a patient consuming increasing doses of an allergen in order to build tolerance (I’m still learning about the similarities/differences between these various therapies, a comparison of which is a topic for another blog post…).

Our son’s allergist said SOTI is used quite frequently in Vevey, Lausanne and Geneva, with great caution used to determine the dosage amounts given at home in order to prevent a systemic reaction. As such, we felt comfortable going forward with the treatment. However, I started seeing things that raised more questions for me, like the current US guidelines for clinicians, published in 2010 by an agency under the National Institutes of Health.

“There is no evidence that unintentional or intentional exposures to the food allergen alter the natural history of the FA.” –Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-sponsored Expert Panel Report, 2010 (p. 9, Sec. 3.7).

To find out more, I contacted a Geneva-based allergist via email that’s also familiar with SOTI. According to him, it’s not yet an established treatment, but it’s currently under investigation. I also spoke with our former allergist in the US. He does not administer SOTI in his practice and said it generally does not occur outside of a funded study. He also told me a recent study found a potential link between desensitization practices and eosinophilic esophagitis (it may have been this study). Finally, I reached out to some other food allergy parents via Facebook, one of whom shared information about a study I remembered from earlier this year, which indicates the success of oral immunotherapy may reverse over time.

Given our son’s reactions during the first four days of the SOTI treatment and what we’ve subsequently learned about this new treatment, along with emails back and forth with his allergist, we’ve stopped giving him milk.

Please note: I am not a medical professional. While this wasn’t the right treatment for my son at this time for a number of reasons, it may be in the future, as further research provides more data about its effectiveness. Also, our son’s allergist has been great and so very patient with me as I ask question after question…


Looking on the Bright Side

While I wish our son could have continued with this treatment, I was relieved to give up the stress and fear of his daily milk dose—even though it was low-risk with such a small amount. Plus, as I’ve written before, the food challenge gave us good news by showing that our son has a relatively high tolerance for milk. According to our allergist, this means he can now safely consume food products with the “may contain traces of milk” warning. For example, Oreo cookies in Switzerland fall under this category. More good news, right?

While it’s back to the status quo of living Dairy-Free Switzerland, hopefully in another year we’ll have some better news. I think we still have so much to be thankful for.