Oral Immunotherapy for Food Allergic Patients

Greetings to friends and supporters of the Center for Allergy at Shamir (Assaf Harofeh).
Some time has passed since our last update, and indeed we have been quite busy in the
interim. This report should fill you in regarding some of our recent and ongoing activities
First as described in our last update, we have begun work on our project to study the gut
microbiome (micro-organism populations) of patients who are undergoing treatment for
walnut allergy at our center. While most of the recruited patients are still in the early stages
of treatment, we have collected initial stool samples from them, and are planning to test
these and subsequent samples in cell culture, for immune-associated activity. Our
collaborators in Tzfat, Israel will determine the specific microbiome compositions of the
patient samples. Overall, we anticipate that this research will highlight some of the
mechanisms of oral immunotherapy (OIT), promoting an understanding of how it works in
retraining the body to tolerate allergy-inducing foods.
Secondly the director of our center, Professor Elizur has received funding from the Israel
Ministry of Health to study the potential for human milk oligosaccharides (HMO) to facilitate
successful milk OIT treatment in exceptionally sensitive allergic patients. We hypothesize
that milk allergic patients who initially did not succeed in OIT could benefit from treatment
with milk containing HMO sugars that are naturally present in human breast milk. These
sugars have been shown to serve as a prebiotic, promoting growth of normal gut micro-
organisms, which help to maintain the integrity and function of the human gut.  Considering
the potential severity of milk allergy and the complications in its treatment by OIT, improved
treatment options could be life-changing for affected patients.
Finally, continuing the theme of life-changing, I would like to share with you the story of TK,
a summer student in our lab. TK came to Israel on a post high school program, and as
someone living with food allergies herself, she was very interested in experiencing our work
first hand. As part of her work, TK learned about the different allergy tests we perform, and
assisted us in analyzing their data for our research on deriving improved allergy diagnostic
algorithms. While here, TK decided to undergo testing herself. Remarkably, the specialized
blood test we perform on basophils and the skin prick test provided strong evidence that TK
was no longer allergic to milk or eggs, foods that she had avoided since childhood. She
performed oral food challenges at our clinical center which confirmed that she was no
longer allergic to either food!! Upon returning home, TK reports that she has "eaten an
omelette, mac and cheese, Ice coffee, pizza, toast with both cream cheese and butter,
yogurt and can’t wait to try everything else!" We wish TK all the best as she begins her
university studies in biochemistry (with many more culinary options available to her). And
we are glad that we were able to provide an environment highlighting how the scientific
research and clinical aspects of our work make a difference in the quality of life of allergic
patients.
Lots more is afoot at the Center for Allergy and Immunology, and your support can make a
difference in accomplishing some of our goals. Thank you, and I look forward to sharing
more developments with you in the next report.

Greetings from the Center for Allergy at Yitzhak Shamir (Assaf Harofeh) Medical Center. As I write this update, we are in the midst of the holiday season, here in Israel. In just a few days, we will begin the holiday of Sukkot which traditionally involves get-togethers of family and friends outside in specially-built huts (as an aside-the weather is often beautiful this time of year!) While looking forward to the holiday, we are mindful of our patients and their families for whom occasions like Sukkot can add stress, with the need for extra vigilance in avoiding potential life-threatening allergen exposures while visiting others.  Our work continues in improving treatment for food allergies, so that patients can fully enjoy the holiday season.

Two research items to report in this update, related to oral immunotherapy (OIT) treatment of food allergy: Firstly, as we have described in previous updates, many of our patients suffer from multiple food allergies. Upon embarking on OIT for these patients, a decision needs to made regarding the order of allergy treatment. Certain co-allergies such as walnut and pecan, are strongly associated. And in fact, we previously found that for patients allergic to both, walnut OIT was able to also successfully treat pecan allergy. We have recently started to examine other forms of treenut co-allergy with less strong correlation (for example walnut and cashew allergies), with a goal of determining an order of preference for OIT treatment. We have designed laboratory tests related to patient serum binding to allergenic foods, which we anticipate can address this question. Preliminary results indicate that while OIT treatment preferential order, may vary between patients, our lab testing may be utseful in directing the decision of treament order. We hope that in a future report we can flesh this out further.

Secondly, we are pleased to announce that together with our collaborators at the Bar-Ilan University Azrieli Faculty of Medicine, we have been awarded a grant from the Israel Science Foundation! The grant is to study the gut microbiomes (micro-organism populations) of patients undergoing walnut OIT, through the course of their treatment. Of particular focus will be to examine the roles that the dynamic microbiomes play in modifying the immune responses related to food allergy. We anticipate that this study may reveal potential modalities for improving OIT treatment. We are excited to embark on this study, and recognize that our successful proposal was greatly enhanced by the preliminary data we included. Generation of these data is assisted by funding provided by our supporters like you, and so we are very grateful. There are several other projects in our research pipeline that may be candidates for grant funding. Your continued support will facilitate our work to make this a reality. Thank you once again for your ongoing support and partnership!