EAACI Calls for Revamped Research Agenda for Food Allergy

Recent efforts to overhaul standards of care for both food allergies in general and anaphylaxis in particular led expert panels from the European Academy of Allergy and Clinical Immunology (EAACI) to a shocking conclusion: It is impossible to make evidence-based recommendations on either front because research to date has failed to establish some very basic facts about those rapidly growing hazards.

How, then, should researchers proceed? What plan of investigation would provide the best answers to the most important questions in the shortest period of time?

The EAACI food allergy panel examined these very questions for several months and, earlier this month, published in Allergy a general plan of attack that will likely influence study agendas in both Europe and the US for years to come.

Researchers, the taskforce believes, should start at the very beginning, by agreeing on a uniform definition of what constitutes a food allergy. Studies to date have employed significantly different definitions and thus made it difficult for allergists to compare the findings of various studies or even to determine the true prevalence of allergies.

Looking forward, the taskforce believes researchers should focus their efforts in two areas: the microscopic and the societal. The first type of study would seek to answer “mechanistic” questions about basic biological issues that have yet to be explained, issues like how allergies develop. “This will allow clearer understanding of the potential routes of exposure (eg, respiratory, oral, skin) and the foods that trigger adult food allergy, to identify IgE-mediated and non-IgE-mediated adult food allergy and to understand potential gene—environment interactions in the development of adult food allergy,” the taskforce wrote.

Some of these mechanistic studies may be able to use animals, but most will require human subjects or, at the very least, human biological materials. Still, such studies would be reasonably small and reasonably cheap. Exponentially more money would be needed, however, for the second study type: “large, longitudinal, population-based, multinational epidemiological studies that will allow the estimation of the incidence, prevalence, phenotypes, time trends and overall healthcare and social burden of adult food allergy to be reliably assessed.”

The taskforce acknowledged that the costs of one or more such efforts might seem prohibitive but argued that it would likely be the cheapest way to obtain anything like conclusive answers to any of the major questions about how to reverse, or at least mitigate, the growing epidemic of anaphylaxis and other severe allergies.

Recent efforts to retrospectively mine data from records kept by every organization from individual hospitals to national governments have provided a few valuable insights, but such limited and incompatible datasets are utterly insufficient for the next step of the task.

Smaller prospective studies, designed to answer important individual questions, might seem a cheaper alternative to goliath multinational efforts, but the taskforce believes that hundreds of smaller studies would ultimately prove more expensive (and possibly duplicative) and less universally reliable.

“Setting up such new large-scale primary studies will require extensive resources, manpower, time and costs, but this is essential if we are to generate reliable and comprehensive disease estimates, particularly in the many countries where there are no universal health coverage and limited opportunities to link digitized data across the life course.”