Can Food Challenges Help Individualize Allergy Therapy?

Food allergy challenge trials are both taxing and risky for patients undergoing them, and potentially limited for physicians and allergist seeking the confidence to individualize patient care. But, they seem to be necessary until an improved practice is found.

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 trend of food challenge trials while at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2019 Annual Meeting in San Francisco, CA, this week. While the pair hope to uncover better means of understanding individual patient needs in food allergy care, they simultaneously weigh whether current food challenge standards could deliver those results.

MD Mag: What can be done in the near future to better individualize immunotherapies for food allergy patients?

Commins: I think one thing that comes to mind for me right away is—having a food-allergic child myself who is an athlete—how do we find a therapy that our high-performing folks can do, and do reliably without reacting?

Kim: And, kind of getting along with selecting patients, I think another theme that has come out of the meeting is around diagnostics, in some ways. There's been discussion about food challenges and all of these studies right now include food challenges, in order for us to say pre- and post-care, “Yes, you’re better.” But is that really what we're going to do in real life?

I think most people would say that probably is not. But if we don't have that, then what are we going to lean on to be able to say, “This is a patient that is safe to do it, this is a patient that is safe except with exercise, and this is a patient that just can't do it at all”?

I think that there is a lot of pressure on all of these companies in research, as well as the diagnostic companies, to really come up with something that can give not just the research centers like where we are, but even the private docs that are outside the community, a level of confidence that they're doing the right thing with these different treatments.

Commins: Yeah, one of the things that you and I talk about sometimes is, do we have to continue to do food challenges time and time again? Could we find a way to have a biomarker that helps us predict who's going to react and not, without having to do the invasive, full-day challenge?