Robert Wood, MD: The Past, Present, and Future of AAAAI

Most patients who have a peanut allergy also suffer from another food allergy as well. And many patients with food allergy also suffer from another allergic or immunologic disease. So much of what’s covered at the American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting is overlapping—bridged from one another either by pathology, treatment, or research.

That connectivity, depending on context, can be a positive or negative. In an interview with MD Magazine® at the 2019 meeting in San Francisco, CA, AAAAI President Robert Wood, MD, explained how the these advances in understanding disease overlap could progress so that the next generation of allergists are focusing on more specific patient populations—and possibly even a cure for food allergies.

MD Mag: How does it feel to be waiting on FDA decision for the first potential food allergy therapies?

Wood: We’re very enthusiastic, very optimistic. It's an exciting time. It's going to get more exciting over the next few years, but we're sort of crossing some thresholds now that will change the face of food allergy—not just as these first treatments are developed and approved, but there will be many, many new therapies that emerge. I told the young people this morning what I met with that, in their career, they may be using the word “cure” around the world of food allergy.

How will other specialties and fields be involved in future AAAAI meetings?

There's a huge overlap between the different allergic diseases, overlap between treatments, and one of the really interesting things is that I don't say for any patient of my 2000 or so patients that only has food allergy.

So food allergy tends to travel with asthma, eczema, allergic rhinitis, and one of the neat things about thinking of treatments would be whether there could be approaches that might do something above and beyond their food allergy. And if we did have a drug that managed the food allergy and also relieved them of their asthma, allergic rhinitis, and/or eczema, that would be a really exciting breakthrough. And that's where some of the biologics may sort of fulfill some of that.

And the other thing that I don't see ever is a patient with only peanut allergy. Most of our patients have multiple food allergies, and one of the decisions that they and their families will make as to whether they decide to be treated for their peanut allergy is whether really it’s going to make a very big difference if you still have milk, egg, and wheat allergy—because the milk, egg, and wheat allergy are actually what limit their life. The peanut allergy does not. So we're also looking at approaches to treat multiple food allergies, either with that similar immunotherapy approaches using multiple foods, but potentially using some of the biologics that are not specific to a food—not just designed to treat peanut allergy, but may block a pathway that is common—not just your milk, egg, peanut, and wheat allergy, but to your asthma, allergic rhinitis. And that's where things start to get really exciting.

What is the most pressing issue in allergy, asthma, or immunology today?

That would be a tough call. If you asked 100 people here, you’d get 100 different answers. There are things that are available to do today, like give our patients better treatment approaches when they have an allergic reaction. That's something I can take back to the clinic this afternoon and make that person's life safer. My topic this afternoon and the plenary is about diagnostics, we have a huge barrier to making accurate diagnosis of food allergy. And the tests that we use are really, dramatically flawed. There's a lot of bad information you get from doing food allergy testing, and we need to overcome that. And that is a big initiative as well.

And part of that diagnosis piece will actually be very helpful in guiding patients as to who might be best candidates for treatment, because there may be some who have a less risky form of the disease. There may be some who have a better prognosis who outgrow their allergy. And we can do a better job of phenotyping patients to really identify those that that would be at highest risk of reactions from the small exposures.

So, if the treatments that are coming forward are really designed to prevent reactions from small, accidental exposures, we would like the treatment to focus on those patients. There are lots of patients out there who don't have that risk. They're not that allergic—even to peanut. So a part of the development of diagnostic testing would ideally be able to identify that group of patients that would benefit most from being treated.