Oral Immunotherapy for Food Allergic Patients

Shalom from the Center for  Allergy at the Shamir Medical Center! It is my pleasure to provide you with an update on some of the developments over the last few months, as we continue our work on improving the treatment and management of food allergies.

Let's start where we left off. The last update was focused on our recent publication concerning diagnosis of cashew and pistachio allergies. Towards the end of the update, I noted our interest in similarly proposing diagnostic methods for hazelnut allergy.  As I have mentioned in previous updates, accurate and specific diagnosis of treenut allergies is complicated, due in part to the significant similarities between allergens of different treenuts. While these similarities often lead to dual allergies, this isn't always the case, since many patients can be allergic to a particular nut (for example, cashew) without being allergic to a closely related nut (pistachio)  We have found that the complication is even more pronounced for hazelnut allergy diagnosis. While some of the hazelnut allergens overlap considerably with other treenuts, others are quite distinct.
Given the above, I am pleased to report that we have made notable progress on the hazelnut allergy puzzle over the last several months. We have gathered data on over 75 hazelnut allergic patients who were treated at our center. This effort itself took a number of years, since true hazelnut allergy has lower incidence than do other treenut allergies. The patients, along with over 50 hazelnut nonallergic patients donated blood, allowing us to assess their cell and antibody responses to hazelnut allergens. Additionally, many of these hazelnut allergic patients underwent our oral immunotherapy (OIT) treatment  for hazelnut or for other treenuts, and donated blood after treatment as well. We are now compiling the data from these patients, and anticipate publication of two studies, one about hazelnut allergy diagnosis and one about the effect of OIT treatment on hazelnut allergy. Stay tuned here for an update in the near future, for more details.

In other food allergy-related matters over the past several months, there have been a number of items concerning food allergy that have garnered attention in the general news media. Unfortunately, there have been a number of cases in which food allergic individuals suffered anaphylactic reactions following accidental consumption of an allergenic food. There are also occasional updates in recommendations related to allergy that get reported in the general media. As our center is highly regarded for its allergy diagnosis and treatment programs, we are privileged to be able to provide outreach, with the goal of improved public awareness and understanding about food allergy. Attached below is a link to a recent radio interview (in Hebrew) about food allergy, with the director of our center, Professor Elizur.

Finally, with the arrival of the holiday season in Israel after a particularly challenging year, I would like to take the opportunity to wish our supporters the best in the year ahead. Shana Tova!

Links:

• Radio interview with Professor Elizur about food allergy

Hello from the Center for Allergy at Shamir Medical Center! Despite the challenges and uncertainties of the ongoing war in Israel, we have thankfully been able to continue our work unabated. It is therefore, my pleasure to update you on some of the recent developments in allergy research and treatment at the center.

First. after much work and effort, this February we were privileged to publish our prospective study on cashew and pistachio allergy diagnosis in the Journal of Allergy and Clinical Immunology: In Practice!  As we have mentioned in previous updates, tree nut allergies can be difficult to accurately diagnose, and patients with potential allergy to one type of tree nut are often instructed by their doctors to avoid all nuts, even without a conclusive diagnosis. This can lead to numerous difficulties for patients and their families, including constant fear of exposure, nutritional deficits, and other quality of life deficits. While it is possible to diagnose food allergies through oral food challenges, this procedure can be disturbing for the patient, and is not without risk.

We embarked on the NUT CRACKER project in 2016 in order to provide direction for accurate diagnoses of various tree nut allergies, with reduced reliance on oral food challenges. Our latest paper in this project validates our approach to diagnose cashew and pistachio allergies, which often- though not always- coincide. The approach we describe includes techniques such as the skin prick test, and a specialized blood test, known as the basophil activation test. The use of these techniques, as optimized in our center, allowed us to reduce the number of required food challenges to diagnose cashew or pistachio allergy, by over 70%. Additionally, our partners at Thermo Fisher tested patient serum for antibodies to a cashew protein, known as Ana o 3, highlighting its use as a marker for cashew allergy. After publication, we were honored that the journal editors chose our paper to be highlighted in the "Latest Research" section of its website. We hope and anticipate that our publication will be used by clinicians to better diagnose cashew and pistachio allergies. In ongoing work, we hope to develop and describe diagnostic approaches for other challenging allergies, such as hazelnut. Stay tuned to our page for further developments.

Our oral immunotherapy research programs are continuing apace during this time as well. We are still in the midst of conducting several studies aimed at improving the outcome of milk oral immunotherapy (OIT), which tends to be the most difficult for achieving successful treatment. And in the coming weeks, we expect to expand laboratory experimentation utilizing our biobank of blood and stools from patients before and after completion of OIT for walnut allergy. Digestion of walnut can generate compounds which can impact on gut immune regulation, and based on preliminary findings, we anticipate to gain a better understanding of how OIT works. More to follow in future updates.

We would like to thank you for your support of our work. Together we can help improve the lives of those affected by food allergy.