Introduction
What if I told you that the very thing that could kill you is your only chance of living? That ingesting the food that can cause you death will ultimately prove to be the thing that cures you from this allergy? A common ailment that affects many children and adults is an allergy or intolerance to certain types of food. While many continue to suffer under the guise of cautionary measures and avoidance, there are actual treatments available to those who seek them out, which could potentially “cure” people of their allergies. One specific type of treatment is that of oral immunotherapy, which is based on the premise that increasing exposure could ultimately cure or diminish the allergies through ingestion. However, this raises many questions about the risk and safety of those who undergo this treatment; if someone is extremely allergic to whatever type of food, would it not risk their safety or even life to expose them to even a small amount of their allergen? On the contrary, oral immunotherapy through increasing exposure is ultimately effective and safe when done in proper environments.
Anaphylactic Shock
To understand more intimately the risks involved in the lives of those with food allergies, one must look at what the sufferer has to lose. Many allergies can cause simple reactions, such as rashes or scratchy throats. Others, however, can be life threatening and require immediate medical attention. Anaphylactic shock is a reaction in the body that occurs when antibodies detect a foreign object and determine it to be harmful, and thus begin to shut down the body. The body will swell and ultimately the throat will close, making breathing and oxygen flow impossible. As determined by the Second Symposium on the Definition and Management of Anaphylaxis (2006), “anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death.”
The only treatment available for anaphylactic shock is an injection of adrenaline, most commonly utilized by an Epi-pen. Medical attention is still required after the adrenaline, or epinephrine, is administered in order to stabilize the victim and ensure that they are well enough to move on. This treatment “should be administered intramuscularly every 5 to 15 minutes as necessary,” (Sampson 2006) in order to make sure that the victim has a higher chance of survival. These kinds of reactions are what make exposure a serious concern. Many people who are allergic to foods will require ingestion of the allergen to elicit such a reaction, though there are many people, especially in the case of nut allergies, who need only to breathe in or come in contact with the allergen to go into anaphylactic shock. This reaction can also be induced by “drugs, blood products, insect venom, or exposure to pollems” (Barach 1984), not just foods.
Recently, there has been an increase in the population who suffer from more severe food allergies. While the various hypotheses concerning why this is happening range from an over-sanitized society nulling the immune system’s discretion to a simple increase in population means an increase in allergies, it does raise the point that this is a problem often overlooked by society. More people in the United States are now susceptible to anaphylactic shock than there have been in the history of anaphylactic shock; the first time this term was coined was roughly one hundred years ago (Sampson 2006).
Oral Immunotherapy
Oral desensitization as immunotherapy for creating a sort of “cure” for food allergies has been tested through several different experiments, each following specific guidelines and procedures. Typically, the procedure consists of ingesting small amounts of antigen orally every day, either through capsules or diluted mixtures, and increasing the amounts by set integrals every so many days. This allows for the T cells and immune systems in the body to become accustomed to the presence of the antigen in the blood system, decreasing the severity and amounts of allergic reactions per exposure.
As a study in Japan shows, oral immunization was successful in decreasing immunoglobulin E, the antibody responsible for attacking benign foreign objects in about 83% of the 59 subjects (Patriarca 2003). The allergens were administered through either pills or diluted mixtures that contained very small amounts of the allergen, and administered every day with increasing amounts every three days. For five months, this continued, with the results remaining positive with each trial. Other studies have also proven this method to work a vast majority of the time. There have been cases where there are mild side effects in response to the increasing exposure; 51% of the subjects in the above mentioned study suffered from some sort of side effect, which was easily controlled by antihistamines, and did not prove to be as threatening as the allergy itself. This study was also conducted by using a control group placed on a placebo. This allows for further accuracy in the results when analyzing the effects of oral immunotherapy, and ensures that there is significantly less subjectivity in the conclusions. By doing so, there is more evidence that this process does indeed work and provides examples to test against.
Another study explains the mechanisms for activating oral immunotherapy: the regularity T Cells can be actively suppressed, or “clonal anergy or deletion” (Burks, 2008). The T cells will come to suppress immune responses by acting upon each cell accordingly. By training the T cells to act in this way, the risk of harm when exposed to allergens decreases significantly, allowing the victim to create a higher tolerance for their allergens. The study also goes on to explain that soluble antigens prove to be more effective and safe than other forms of antigens, such as particulate. This is due to the fact that soluble antigens are more able to get into the cells that require the treatment and produce the correct biological responses. The route of the antigen also takes priority because it could potentially create hypersensitivity to certain foods, such as peanuts. If the antigen is not administered orally, the type of hypersensitivity that produces anaphylactic shock can be induced by mere skin or lung exposure to the dust without requiring ingestion. This is the case in many nut allergies, which makes that food group one of the more dangerous allergens. Oral immunotherapy is being proven to work in high percentages of these cases.
The Environment
The environment and supervision in which this treatment is administered is extremely important to its success. Under the guide of professionals who understand the medical and physical aspects of the risks being presented in these circumstances, this treatment becomes very safe and ultimately helpful to the subjects. Each allergy is taken into consideration, as well as how it is administered. Nadeau, a professor of allergies and immunology, conducted a treatment on several children who suffered from multiple severe food allergies (Thernstrom, 2013). She was able to control the environments around the children to ensure that their treatment was not contaminated with any sort of allergen that would cause anaphylaxis or a severe response, which would make the only exposure that they had to their allergens be the ones that were professionally administered to them for the treatment. By doing so, the risk factor of anaphylaxis went down significantly, creating a safe environment for the children who continued to ingest their controlled dosages of allergen. She would also treat these children for several of their allergies at once, making breakthrough discoveries concerning the effects of oral immunotherapy in such cases.
Only qualified allergists should be the ones administering these types of treatments. They are able to calculate the exact amount of allergen is required per dosage and by how much it should be increased and continue to treatment without causing an overdose and potential anaphylactic shock. This treatment can be disastrous if performed incorrectly, so it is vital to its success, not to mention the subject’s safety, that it be done in care of a certified allergy doctor.
The results of these studies and experiments have been ultimately successful. The first study examined took about five months, ending with an 83% success rate. There were several different allergies involved, such as eggs, milk, peanuts, fish, and several different types of fruit. The allergies were all treated with the same discernment, but it is possible that certain allergies would require either more time or higher dosage increases in order to actually make a successful difference. The second study was performed on mice, in order to specifically study the reaction of the cells as they were exposed to potential reactants. This way, the scientists were able to study the biological effects of allergies and are now better able to understand how to treat these kinds of disabilities. This is important to take into consideration because it means that things can happen when done correctly.
Conclusion
Resistance to food allergens can be successfully overcome through the process of oral immunotherapy. Through the case of several different studies, this treatment has worked in desensitizing the subjects from their allergies a majority of the time, with only a few side effects shown. Doctors and allergists are able to apply just enough allergen to the subject’s T cells in order to create an immunity to the reaction that occurs when these cells are overloaded with the reactant.
While it is a risky process, many of these problems can easily be overcome by ensuring that the treatment is administered in a safe and controlled environment. Allergists have the ability to control the amount of exposure that is given to each subject, securing the safety and lives of those who undergo this process. It is important that this is observed, or else there are potentially deadly consequences to the subject. Most people who take part in this treatment are met with success, and an ultimately allergy free life from then. Anaphylactic shock is no longer a danger that hovers over their head everyday in fear of a friend’s lunch or a contaminated restaurant.
Works Cited
Barach, E. M. (1984). Epinephrine for treatment of anaphylactic shock. JAMA: The Journal of the American Medical Association, 251(16), 2118-2122.
Burks, A. W., Laubach, S., & Jones, S. M. (2008). Oral Tolerance, Food Allergy, and Immunotherapy: Implications for Future Treatment. Journal of Allergy and Clinical Immunology, 121(6). Retrieved March 1, 2014, from http://www.sciencedirect.com/science/articl
Patriarca, G., Nucera, E., Roncallo, C., Pollastrini, E., Bartolozzi, F., Pasquale, T. D., et al. (2003). Oral Desensitization in Food Allergy: Clinical and Immunological Results. Alimentary Pharmacology and Therapuetics, 17(3). Retrieved February 27, 2014, from http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2036.2003.01468.x/full
Sampson, H. A., Lewis, L. M., Thomas, S., Wood, J. P., Hepner, D. L., Harlor, A. D., et al. (2006). Second Symposium on the Definition and Management of Anaphylaxis: Summary Report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium. Annals of Emergency Medicine, 47(4), 373-380.
Thernstrom, M. (2013, March 7). Can a Radical New Treatment save Children with Severe Food Allergies?. The New York Times, MM28. Retrieved February 20, 2014, from http://www.nytimes.com/2013/03/10/magazine/can-a-radical-new-treatment-save-children-with-severe-allergies.html?pagewanted=1&_r=2&
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