Overcoming Food Allergies
Living with food allergies, especially when it comes to children, can be a constant source of stress for parents. From hidden ingredients to accidental exposure, every bite can seem like a risk. But what if there was a way to reduce that fear and build tolerance to allergenic foods? Discover new options for keeping your loved ones safe in this WFMY 2 Your Well-Being conversation with Evelyn Lomasney, MD, Cone Health Allergy & Asthma Center of NC.
A rash suddenly spread across the face of Amanda Viviello's eight-month-old baby. For years, Amanda and her husband meticulously avoided peanuts and any food that might contain them. However, in 2023, they found a potential solution in Cone Health's Oral Immunotherapy (OIT) program.
The OIT program works by gradually introducing small, controlled doses of the allergenic food to help the patient's body build tolerance.
"They started him on a very, very tiny dose of peanut dust... They would give him a little dose and see if he had a reaction, give him another dose, see if he had a reaction," recalls Amanda about Caleb's first appointment. "And they worked him up to sort of his threshold that very first appointment."
Thanks to this groundbreaking program, eight-year-old Caleb now safely eats eight peanuts a day and can enjoy foods that contain peanuts. This has been a "game-changer" for their family, especially considering the inevitable exposure Caleb would face at school with other kids bringing lunches containing peanuts or peanut butter.
About Oral Immunotherapy (OIT)
The Cone Health Allergy & Asthma OIT program began in 2019 and has since helped between 20 and 50 children complete the therapy.
Families continue to have follow-up appointments every 6 to 12 months. Some patients have even seen their allergy antibodies "driven down to zero," allowing them to stop daily maintenance doses and eat the food freely.
Common Food Allergens
In the United States, there are nine major food allergens:
These nine allergens account for roughly 95% of all food allergies. Currently, about 8% of children and 10% of adults in the U.S. have a food allergy. Peanut remains the most common allergy in children, while shellfish is most common in adults.
Navigating a New Diagnosis
A food allergy diagnosis can be daunting. Dr. Lomasney emphasizes that while food allergies are common and can be life-threatening, true fatalities are rare.
The key in the early days is empowerment through education. Patients and families need to:
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Have access to an EpiPen auto-injector.
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Learn how to read food labels. Thanks to recent U.S. laws, labels clearly state if a product contains major allergens.
Preventing Accidental Exposure
For families with young children, prevention is paramount. Dr. Lomasney recommends:
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Educating everyone involved in caring for your child (family, school, daycare) on their allergies.
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All caregivers having access to the child's EpiPen auto-injector and a detailed action plan outlining signs and symptoms of an allergic reaction.
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Being aware of subtle signs like hives, swelling, wheezing, vomiting, dizziness, or tiredness. Early recognition is crucial for timely action.
If accidental exposure occurs and symptoms appear, immediately follow the emergency action plan, which typically involves using the epinephrine auto-injector.
Safety Rules
Summer often brings cookouts and sleepovers, making social events a potential minefield for those with food allergies. To reduce the risk of an incident:
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Pack a medical alert bracelet and food allergy card with your child.
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Inform any party hosts, camp counselors, or coaches about your child's allergies, where their medication is, and what to do in an emergency.
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Use a buddy system. Have a friend or another adult trained on how to use the auto-injector in case of an emergency.
If you're hosting someone with food allergies, always ask about allergies beforehand. When cooking, read labels carefully and consider asking the guest or their parents for guidance, as they are often experts in navigating their specific allergies.
Finally, let your guest know you've done your best to prevent contamination and confirm where their epinephrine auto-injector is located.
Who is a Candidate for OIT?
Oral immunotherapy works by giving micro-doses of the allergen to "retrain" the immune system, building tolerance instead of an allergic reaction.
The process involves an initial four-hour appointment with increasing doses, followed by daily dosing at home, and weekly "updosing" appointments for about 18 weeks until a maintenance dose is reached (like eight peanuts a day for peanut allergy). Over time, maintenance doses can sometimes be reduced.
OIT is offered for most food allergies with great success. The program at Cone Health has been active since 2019, working with a national organization of board-certified allergists.
You are a good candidate for OIT if:
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You are highly motivated. The initial 18 weeks require significant commitment from parents and patients.
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You are worried about cross-contamination. If you're consistently eating your maintenance dose, cross-contamination becomes less of a concern.
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The whole family is comfortable with the risks. While controlled, the risk of allergic reactions is never zero. Families must be prepared to treat reactions if they occur, though 24/7 on-call support is available for OIT patients.
The biggest challenge can be the daily commitment to the maintenance dose. Skipping doses can lead to a loss of tolerance, making self-motivation crucial for long-term success.
Oral immunotherapy offers a beacon of hope for families managing food allergies, potentially transforming a life of constant vigilance into one of greater freedom and peace of mind.
Next Steps
If you’re affected by allergies or asthma, count on a Cone Health specialist to help you breathe easier and feel better. Our board-certified allergists and pulmonologists provide an accurate, expert diagnosis, and then work with you to create a care plan tailored to your condition and lifestyle.
