Food Allergy – Victoria Hutton

Food allergies are IG-E Mediated Allergies. This means a hypersensitivity one (HS1) reaction. HS1 reactions are immediate and exaggerated, and are an abnormal response to a generally harmless protein. Once that protein enters the body, APC responds. It then signals B-cells who create IGE antibodies specific to that protein. They then interact with the protein, bind with mast cells, which then burst and release histamine. This can lead to anaphylaxis. . 

Diagnosis starts with a thorough patient history. Following that, the physician and diagnostic team would run tests such as: 

• IGE testing, blood samples are mixed with different allergens. 
  • TCan have false positives.

• Skin prick test 
  • This test has a quick response time of 1-20 minutes – but it is also not 100% conclusive. 
  • Can also give false positives. 

• Very controlled oral food challenge – three different versions. 
  • This involves very small amounts of food being eaten by the patient under the supervision of allergist, who is continually monitoring for a reaction. 
  • Double blind challenge – no one knows if the food is allergen or not
  • Single blind – allergist knows that the allergen is present, but patient does not. 
  • Open food challenge – both the patient and the allergist know 

No test is perfect. While these results can help guide towards diagnosis, there are many factors involved, and even the most thorough test might still leave questions unanswered. 

In the respect of treatments, this starts in a similar vein as diagnostics. Once a diagnosis is made, it is very important that the patient informs the people in their lives of these changes. This can help avoid contact with triggers in different situations. Other preventative measures include wear a piece of medical alert jewelry, and being exceptionally careful around what is being eaten. This includes carefully reading labels for the chance of cross-contamination, or small amounts of the allergen being used in the ingredients. 

Unfortunately, there is no cure for food allergies at this time. The most important treatment factor is education; for the patient, their families, their environment (school or work) and friends. 

It’s extremely important to recognize symptoms of a food reaction early, and to act fast in response. It’s also important to know what the treatments the patient uses are, and how to use them properly. 

Some treatments:

• Injectible epinephrine, and oral antihistamines. These treatment must be continuous to be effective.

• There are some newer treatments being developed which use immunotherapy. The outcome of this is hopefully being able to gradually increase the amount of allergen the patient ingests, in hopes of raising tolerance levels.

I thought that the content was very well considered, especially within the time frame. I felt that the content was thorough, and covered all of the required points. Having already been familiar with food allergies, I was surprised with how much I had to learn about food allergies, and the treatments and diagnostics involved. The gradual way that the content was explained really helped me understand what was involved in each step and what was going on within the body during the allergic reaction. There was obviously care put into explaining the diagnostic process, and I learned so much during that section. It was also obvious the work that went into learning, and then teaching the different treatment options. I really appreciated the “blue to the sky, orange to the thigh” comment, which is a fun way to remember the proper use of that brand of epi-pen. It was nice that other things were also explained, as sometimes epinephrine isn’t the only treatment involved. Throughout the discussion about treatment options, it seems that a lot of care was taken in that area as well, to explain the many different avenues that treatment options are travelling down! I wasn’t aware of the many different types of treatment or even cure pathways that are being developed. It was interesting to learn about the immunotherapy options, topical applications, and ways that scientists are working to introduce different antibodies into the body, to elicit a smaller response and slowly train the body into realizing that those food proteins are not as dangerous as once believed. The implications of this line of treatment are immense, and could change or even save peoples lives in the future.

I enjoyed the teaching that happened in this podcast. I felt that it was well informed, that the research had been done in a thoughtful way, but also very well delivered. The way that the script was written was obviously mindful of each of the narrators and their strengths, while offering the information in a pleasing way. The four different narrators each had a different role to play, and I was interested to see what the response was going to be when the new narrator replied to a previous comment. I think that the different roles were a very good inclusion, as it allowed for a different way to share the information. It allowed questions to be asked, which may have mirrored what that audience would be thinking, and then in response to the question, the answers could be given in new and refreshing ways. This is a nice comparison to some other podcast styles I have heard where it is simply one person monologuing and sharing a ton of information, all in the same way. The different characters in this podcast were engaging, articulate, and clear, and I appreciated what each person had to share with me. As a listener I was engaged for the entire listen, and was surprised at how quickly ten minutes slipped by. I would have been willing to listen to this podcast for much longer, listening to what my peers had to teach me on this subject.

In terms of changes that I could consider to make to the podcast, I think that I would have appreciated more from the case study with Bobby. In trying to be understanding about the time constraint, as well as the quality of information that was shared, the role that Bobby played in this education was still great! I know that he was considered throughout the explanation, however as he was not actually having any reaction, or experiencing any side effects of this allergy at all, I felt it hard to consider him in the scenarios described, and instead was thinking about other people in my life who have food allergies. I obviously do not condone cruelty to imaginary podcast characters, and think that Bobby was better off in the end for not having had a food reaction, however it was one change that could have been made. I did appreciate that instead of Bobby experiencing a reaction, it felt as though someone in his care team was learning bout his diagnosis, the pathophysiology involved, as well as possible treatments, and that that information was going to be used to increase the quality of his care in the future. I feel happy knowing  that Bobby is in very safe theoretical hands. If I were to change anything from this podcast, I still think that I would have appreciated going through the experience of Bobby ingesting his allergen (peanuts), what happens in the body to make him experience the different symptoms, how the treatment involved works to decrease the anaphylaxis, and then how Bobby moves through the healthcare system to receive his formal diagnosis. This could also include a small piece of teaching Bobby and his family about treatments, what to watch out for, and how to respond, however that teaching piece was very well covered regardless. 

There is a lot more involved in possible treatments for ongoing management of food allergy than I was aware of. I have had friends, family, and patients in my past who have suffered from a variety of allergies, but I did not know specifically what was going in in those cases. I feel now that because of this podcast, I have a deeper understanding of the physiology, or mechanism of action, involved in these types of responses. I think that should I be able to move forward in my education towards working in Cancer Care, this information on food allergies would be very applicable for different types of treatment reactions that patients can have. While the allergen in these cases is not usually ingested, but injected, I think that there is a parallel that can be drawn to the IGE reaction, sensitization, and types of treatments involved. 

Back within the realm of food allergies, I also think that it is very interesting to know about the variety of exposure therapies that are available, and how they work. The outcomes of these types of treatments and therapies is so immense. Being able to decrease the severity of a reaction could be life saving in so many situations. I also know from personal experience that being sensitive to ingredients can be so fatiguing, and really sometimes makes me question if I even want to attend an event due to risk of exposure. By decreasing risk, and decreasing the severity of a reaction, the opportunities in a persons life could change drastically! 

Something else that I learned which I think is very cool to know about are the three different types of food challenging. I was interested in considering the implications and reasons behind why they would want an open, single or double blind challenge, and how different reactions in each case need to be carefully interpreted. I had never considered how bias might play into the diagnosis of a food allergy! I think that it highlights that there are all sorts of food allergies, as well. Anaphylaxis is a very severe and life-threatening response, which is likely pretty easy to diagnose (the reaction, maybe not the food trigger involved). However for people who have less severe reactions to foods, this type of unbiased, incremental exposure might be able to help with all sorts of discomforts and reactions to foods that are not agreeing with them!