Addressing Adult Patients, Comorbidities in Food Allergies

With multiple successful immunotherapies being investigated in children, what may successful adult food allergy care look like? That may depend on what more clinicians can learn about the adult form of allergies.

In the next segment of an interview series with MD Magazine®, Edwin Kim, MD, MS, and Scott Commins, MD, PhD, colleagues from the University of North Carolina School of Medicine, discussed the care of food-allergic adults while at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2019 Annual Meeting in San Francisco, CA. What they concluded is that there’s plenty more to learn in that space.

MD Mag: What’s the next feasible step in progressing food allergy research and care?

Commins: I think one thing in the next set of food allergies trials certainly is thinking about the fact that not just kids get food allergies. Adults get food allergies, whether it’s allergy to red meat from the alpha-gal syndrome story or seafood. And, are these therapies that we've been talking about—are they applicable to adults too?

Kim: I definitely will say that population, the adults who get food allergies, in some ways are even more interesting to me, because what's going on with them where they were tolerant and then become allergic? Why is their immune system sort of breaking, in a way? Whereas a lot of the kids with peanut allergy, our understanding is they start out that way.

So, I think it'd be really interesting to really look at that group of people—not only with treatments like you're talking about, but with understanding the immune system and understanding just plain old food allergy. Why this is happening?

Commins: It makes you think, in some ways, that the tolerance to food may be much more of an active process. I feel like, in the past, we’ve thought of it as a passive-type thing. “You're not reacting, so it's fine.” But maybe what's really happening is you're actively maintaining tolerance.

What comorbid allergies or related conditions are most pressing in patients?

Kim: I will absolutely agree with that most of our patients are not just singularly peanut allergy, or even just alpha-gal allergic. Many of them do have multiple diseases, multiple foods or just multiple allergic diseases—so maybe eczema and asthma, as well as a food allergy.

Right now, we're so focused on these very food-specific treatments—these peanut treatments or the egg as well. But if we could really develop a treatment that more broadly covered the entire immune system, it'd be wonderful. Like a one-shot cure for all of that stuff. We know that, right now at this stage, it’s not realistic. But I know there is a lot of discussion about biologics—some of these treatments that are going to calm down or suppress the immune system.

And if they can help across multiple disease diseases or multiple food allergies, that'd be fantastic.

Commins: And to me, one of the issues that I see that's different between the adult food allergy patient and maybe the child is, as you alluded to, this allergic mark trait. But often with adults, there's probably some percentage that come to us with just the food allergy and it may be a very different allergic process than we're used to dealing with.

And hopefully, we'll have therapies on the adult side. But it does make you wonder if they'll look different, or if it'll be the same type of therapy. I think one of the things that you and I both know is it's just as important on the surface to treat them as it is for us to understand and get those blood samples and skin tests and whatever it might be, to try to understand what's happening to the immune system.