Oral Immunotherapy for Food Allergic Patients

by Friends of Assaf Harofeh Medical Center
Oral Immunotherapy for Food Allergic Patients

Warmest regards from the Center for Allergy and Immunology at Yitzhak Shamir (Assaf Harofeh) Medical Center. The Corona pandemic is still raging, and Israel is in the midst of another lockdown. Fortunately however, we have benefitted from an extensive vaccination campaign, which will hopefully soon yield immunity in the broader population. Professor Arnon Elizur, the director of our Center, also serves on the board of the Israel Association of Allergy and Clinical Immunology, and co-wrote its position paper regarding vaccination for allergic patients. This guidance will facilitate safe and effective vaccination protocols for those with potential concerns. We are happy to report on several journal articles that have been published since our last update. First, in collaboration with our partners at the Bar Ilan University Faculty of Medicine in the Galilee, we have published a paper describing distinctive features of the stool microbiome population in food allergic patients. Some of these features also distinguished between different types of food allergies and were differentially associated with the presence of short chain fatty acids. We are continuing our work, examining whether stool microbiome features can also be tracked in patients as they progress through oral immunotherapy. And, we continue our bench research examining whether components of stool can mediate direct immune-related effects in cell culture. Secondly in the clinical arena, we report that subjective oral symptoms, such as tingling or itchiness, may not always reflect true allergic reactivity. Approximately 30% of the patients who complained of these symptoms during a food challenge, were able to successfully complete their challenge. This finding highlights a potential for false positive food allergy diagnoses, which can lead to unnecessary stress and hardships for patients. Our patients benefit from the experience and expertise of our clinical staff, who safely administer oral food challenges, yielding accurate diagnoses. At the same time, our research team continues to investigate alternative diagnostic approaches, with the goal of minimizing reliance on oral food challenges. We are very excited about our continued progress in these challenging times, and wish to express our gratitude to you-our donors and partners, in continuing to support our work. Best wishes for a happy and healthy 2021!

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Greetings from the Center for Allergy and Immunology at Yitzhak Shamir (Assaf Harofeh) Medical Center. Considering how challenging this past year has been, the new year in Israel has arrived none too early. We hope that this update finds you safe and in good health. We are happy to share some recent developments here at the Center, starting off the year on the right foot.

First, breaking news! After an extensive peer review process, our prospective study concerning diagnostic algorithms for walnut and pecan allergy has been accepted to the journal JACI-In Practice. This article confirms our previous work demonstrating the capability of two diagnostic tests (skin prick and basophil activation tests), used in tandem, to accurately diagnose walnut and pecan allergies. As we have previously noted, the diagnoses of treenut allergies in particular are complicated due to their significant cross-reactivity which may or may not lead to coallergies between different treenuts. We believe and anticipate that our findings will be adapted to improve clinical accuracy in treenut allergy diagnosis. In the near future, we aim to study the potential of diagnostic tests for accurate diagnosis of allergy to other closely-related treenuts.

The laboratory research aspect of our program is also moving apace. In collaboration with our partners at the Bar Ilan University Faculty of Medicine in the Galilee, we are comparing the stool microbiomes of patients with and without persistent food allergies, and also between patients with different food allergies. In particular, we are examining whether derivatives of bacteria found in the stool can induce the development of regulatory immune cells (B cells and T cells), which are important players in the establishment of immune tolerance, and resolution of food allergy.

Despite the pandemic, our clinical programs in food allergy diagnosis and desensitization have continued at full strength. Over 325 patients are currently in active oral immunotherapy treatment, with up to 6 new patients joining every week. The success rate in achieving complete or partial allergic desensitization is over 85%, highlighting the importance and efficacy of our work. Especially in light of these challenging times, it behooves us to note the contributions of all those involved in making our programs successful. The physicians, nurses, dieticians, administrative staff, and laboratory workers in the center work diligently, while patients and their families routinely must overcome physical and psychological obstacles in attaining treatment success. And of course, we graciously note the contributions of you the donors, who have seen the value in our work, and have opened your hearts to facilitate our continuing and expanding upon it. Thank you, and best wishes for health in the year ahead!

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We wish our supporters well during these trying times. While there is no evidence to date that allergic disease including food allergy and asthma are negatively impacted by the virus, logistically our oral immunotherapy treatment has been challenged dramatically. Due to the closure of routine clinics in the Hospital for the month of April, several adjustments were made to our program. First, patients requiring doses from the laboratory were replenished with another month supply for home dosing until May, at which time the clinics reopened. Second, due to the social distancing requirements which limited the number of patients that could be seen in one day, our emphasis was to see first the patients that required further up-dosing to reach a level at which time actual food could be administered. We are returning to our normal routine with the anticipated lifting of restrictions.

Regarding our research programs, the International meeting scheduled in Philadelphia Pennsylvania in March, 2020 was cancelled due to Covid-19. Our data, on the combinatorial use of diagnostic tests in lieu of oral food challenges to diagnose sesame food allergy, however, was published in abstract form, and we are in the process of submitting a full-length manuscript.   

The coming together of multiple disciplines and groups of people to fight Covid-19 highlights the synergistic effects of people working together towards a common goal.  

 Similarly, our supporters provide strength to our clinical and research programs far beyond their contributions and they are sincerely appreciated. We would also like to extend an invitation to visit our Institute from near and far (yes, when we are flying again).

 Be well.

 Thank you. 

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Greetings from the Center for Food Allergy at the Shamir Medical Center (formerly Assaf Harofeh)!  We are proud to update you regarding some of the highlights of 2019.

- As of December, over 250 patients are in active oral immunotherapy treatment (OIT) programs at our center. The majority of our current patients are enrolled in OIT for milk (95 patients) and treenut (82) allergies, with others receiving treatment for peanut (49), sesame (23) and egg (5) allergies. Treatment success remains high with almost 90% of our patients achieving at least partial allergic desensitization

. -Seven articles were published in 2019 by members of our staff on various aspects of food allergy. Research topics included the specific allergens associated with different manifestations of treenut allergy, the safety and efficacy of walnut and sesame OIT programs at our center, and quality of life assessments for patients with food allergy before and after treatment.

-We continue in our efforts to devise effective methods for diagnosing food allergy, and are currently preparing a manuscript demonstrating the combined use of different blood tests to greatly curb the need for oral food challenges in diagnosing sesame allergy.

- In our collaborative project with researchers at Azrieli Medical Faculty at Bar Ilan University, we have demonstrated associations of particular gut-resident bacterial populations with persistent food allergy (that does not spontaneously resolve), along with possible mechanistic roles that microbes might play in promoting or preventing allergy.

The efforts at the Center for Food Allergy reflect our aims to join cutting-edge research with real-world impact that improves the life of allergic patients and their families. We thank you for your continued support, and invite you to follow our progress in 2020. With our best wishes for a happy Festival of Lights, or as we say in Israel, "Hag Urim Sameah!"

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Hello from the Center for Allergy at the Yitzhak Shamir (Formerly Assaf Harofeh) Medical Center. We hope you have had a pleasant summer. With the turn of the seasons, it is a good time to update you on our current progress and project direction.

In prior updates, we have discussed the difficulty in accurately diagnosing food allergy. To some extent, this is largely addressed by performing oral food challenges (OFC) with suspected allergenic foods. However OFC can be daunting for many patients to go through, not to mention the time investment required, and the complexity of the procedure. A major focus of our work therefore, has been the investigation of alternative food allergy diagnostic methods. In the last year, we have published several papers about food allergy diagnosis using combinations of various methods. While we found that many patients could be diagnosed accurately without the need for a challenge, there were still patients with negative tests results who were really allergic (false negatives). Therefore OFC have remained necessary to rule out allergy.  

We are currently looking to expand our toolbox of diagnostic methods by building on some that are already in use. Previously, we have examined the reactions of basophil cells in the blood of allergic patients to extracts of potentially allergenic food. We have also started to investigate the presence of antibodies to specific protein allergens in the sera of these patients. Going forward, we are looking to combine aspects of these methods, testing the specific protein allergens, individually or in combination, on the basophils. This work will require synthesizing the specific proteins, and optimizing for their introduction onto live cells Ultimately, the research should allow us to study direct effects of known protein allergens on histamine-producing cells such as basophils, thereby further facilitating fine-tuning of food allergy diagnosis.

Your support will further our progress toward understanding, diagnosing, and ultimately eliminating food allergy. Thank you very much and as we say in Israel  before Rosh Hashana, "Shana tova umetukah. " Have a good and sweet new year.

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Project Leader:
Michael Goldberg
Beer Yaakov, Israel
$2,437 raised of $48,000 goal
 
56 donations
$45,563 to go
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