Oral Immunotherapy for Food Allergic Patients

by Friends Association of Shamir (Assaf Harofeh)

Project Report | Jan 22, 2024
Food allergy management and oral immunotherapy in challenging times

By Michael Goldberg MD, PhD | Project Leader

Greetings to our friends and supporters from the Center for Allergy at Shamir Medical Center.

I'll be honest with you-this report will not be like previous ones. The events of October 7, 2023 and their aftermath continue to affect daily life in Israel, including at the Center for Allergy. Many of our patients are in families in which one or more caregivers are currently serving the IDF reserves. Additionally, several of our patients have been forced to evacuate their homes for security reasons. A 12 year old patient in outpatient allergy treatment at our center was taken hostage on October 7, and thankfully freed after 53 days.Sadly however, we found out that Liel, one of our previous patients, was murdered by Hamas terrorists at the Nova music festival on October 7.

Despite the trying times, the Center for Allergy has continued operations in food allergy diagnosis, and treatment through Oral Immunotherapy (OIT). In fact, the uncertainty of the current situation has necessitated some flexibility in the courses of OIT treatment for some of our patients, highlighting the professionalism and expertise of our clinical staff. An editorial summarizing our experiences and those of our patients during this time has been accepted for publication by the journal JACI-In Practice. As described within the editorial, we believe that the lessons we have taken from the current state of affairs in Israel may be applicable to other unstable situations.

With wishes for peace and better days

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Sep 25, 2023
Update about milk and walnut allergy treatments

By Michael Goldberg MD, PhD. | Project Leader

Greetings from the Center for Allergy at Shamir Medical Center. I am writing in the midst of the very busy holiday season here in Israel. While it is a time for getting together with family and friends, for those affected by food allergies, there is the everpresent concern of inadvertent allergenic exposures. Therefore this is a good opportunity to remind people to ask about food allergies that their guests might have and plan accordingly, allowing everyone to fully celebrate.

I wish to highlight two items in this update. Firstly is our experimental low dose oral immunotherapy (OIT) program for milk allergic patients. While OIT success rates in achieving allergic desensitization are very high for many other foods, we have found that some milk allergic patients were unable to complete our program, with some even failing shortly after enrollment. We designed an experimental low dose milk treatment protocol, starting patients on very low doses of milk protein, and gradually increasing their dosages to hopefully reduce the risk of reactions that could prevent their continuing. Since starting the protocol about a year ago, we enrolled 15 patients all of whom had previously failed our standard milk OIT program but are now progressing slowly on the low dose protocol. Interestingly, we observed reactions in the basophil cells from some of the patients, that might serve as a marker distinguishing them from other allergic patients. This marker could possibly indicate who might be at risk of failure in regular OIT. More work is needed, and will hopefully be described in a later update.

The other item concerns our walnut OIT program. In joint work with our partners at the Bar Ilan Medical School in Tzfat, we found that patients successfully completing walnut OIT had increased stool levels of several metabolites. One metabolite called 5-HIAA had been previously shown to be related to walnut consumption, and some of its immunological effects have been described. In initial experimentation in our lab, we observed that 5-HIAA might work directly on intestinal cells to promote integrity of the cell layer. The presence of this metabolite in the stools of patients after walnut OIT may indicate one of the mechanisms of repair occuring during allergic desensitization. More work is also needed in this study, but we hope to present preliminary results at upcoming scientific meetings.

As always, we thank our supporters for your assistance in continuing our work on these and other projects. I'd like to take this opportunity to extend you and yours the traditional holiday greetings: Shana Tova Umetuka, a good and sweet new year!

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May 30, 2023
Immunology research meeting

By Michael Goldberg MD, PhD | Project Leader

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