Robert Wood, MD: Realistic Expectations for First-Generation Food Allergy Therapies

Robert Wood, MD, is overseeing the American Academy of Allergy, Asthma & Immunology (AAAAI) 2019 Annual Meeting during a very exciting period of advancements. The AAAAI President and Director of Pediatric Allergy & Immunology at Johns Hopkins University School of Medicine has only practiced and researched in a food allergy field without therapies beyond telling a patient, “Avoid that food.”

That could change in the near future, as 2 US Food and Drug Administration (FDA) marketing applications for peanut allergy immunotherapies will be considered in 2019. By the time the next decade begins, Wood and colleagues could be reviewing the first real-world results data for immunotherapies.

That’s not to say he’s expecting much of any first therapies. In an interview with MD Magazine® while at AAAAI 2019, Wood explained how research into what would be the first generation of food allergy therapies is already being supplanted by investigation into potentially improved therapies.

MD Mag: What are your thoughts on the current state of food allergen research and development?

Wood: It's an exciting time. For time eternity, we've had 1 treatment for food allergy, and that's to avoid the food you're allergic to. So it's been an unmet need for a long time, and something that was considered too risk to do up until very recently. The field has progressed pretty rapidly—the papers that were published on this were just 12 or 13 years ago, and now we're almost at the point of having FDA-approved therapies.

We would view these, though, very much as first-generation therapies. These are not curing food allergy, they carry their own risks, they're lifetime treatments, they're not things you can do for a year or 2. And one of the exciting things at this meeting is actually about looking forward to what next generation—and the next generation—of treatments are going to look like.

We actually set up our Presidential Plenary today (Friday) to have a third speaker look at the novel therapies that are in early development, some of which are in human trial now, others of which are only being used in mice.

What are some of these advancing therapies?

What we're doing right now is immunotherapy, in the general sense that we're exposing people to what they're allergic to. That carries its own set of risks. The opportunities are to block certain pathways that are in the immune system, and some of those pathways are currently being blocked with new drugs being used for asthma. So there are applications, potentially, for some of these biologics that are blocking different pathways of the immune system.

There are opportunities to modify the food proteins in a way that you could still induce tolerance but at least minimize the risk. There is a DNA vaccine under study—very, very different from what we're looking at for the next year.

We're looking out 7,8, even 10 years for any of these new-generation products to even get through all the required study. But there's a huge amount of interest, finally. There's been an interest in the scientific community, and now there's a major interest from the pharmaceutical industry, which is bringing a lot more opportunity into the field of food allergy.