Pediatric Food Allergy and Atopic Dermatitis

Several notable updates on pediatric food allergy and atopic dermatitis were discussed by Julie Wang, MD, Professor of Pediatrics from the Icahn School of Medicine at Mount Sinai, at a session the ACAAI annual meeting.

For food allergy, Wang highlighted recent data showing early introduction of milk reduces risk of allergy, which adds to the growing evidence that early introduction to allergens helps to avoid issues later on. He pointed to another study focused on peanut challenge outcomes and showed that anaphylaxis was three times more frequent in teenagers than younger children. In addition, it showed that prior history of reaction to a peanut challenge did not predict the reaction threshold severity, meaning that providers should be extremely thorough in testing a full range of doses when they conduct food challenges. Quality of life for patients and caregivers is another important aspect of food allergies. Wang pointed to a systematic review examining the impact of food challenge tests on quality of life for patients and their families; the analysis found that there was a positive impact.

Caregiver health literacy is a very important component to food allergy management, as the caregiver is normally responsible for buying food and preparing food. Wang cited another recent study surveying 100 caregivers that assessed each individual’s ability to read an ice cream label. The study found that there was a high or possible likelihood of limited health literacy. Dr. Wang advised that caregiver health literacy is something to keep in the back of one’s mind when discussing food allergy plans with the patient’s family, and to bring in other tools to help the family manage food allergy.

Dr. Wang then shared an interesting case report on dupilumab, a monoclonal antibody against a subunit of IL4R that inhibits IL-4 and IL-13 signaling, that was used to treat a 30-year-old patient with severe atopic dermatitis and a history of anaphylaxis to corn and generalized urticaria during oral food challenge to pistachio. The patient was treated with dupilumab for 3 months, and oral food challenge test to pistachio (50 grams) and corn (100 grams) was negative. This case study spurred additional interest in dupilumab for food allergy treatment, and there is currently a phase 2 multi-center clinical trial underway.

“There is continued intense interest in developing food allergy therapies, both on allergen-specific immunotherapy and emerging trials with biologics,” Wang noted.