TulsaAllergyNews

Allergies are one of the common conditions that can have an adverse effect on your health, and it is essential to understand all the options available to treat them. One of the most promising treatments for allergies is desensitization therapy. This therapy for allergens was first performed in 1911 when Dr. Noon & Freeman injected themselves with grass pollen to prevent hayfever and it worked. (interesting that many early medical discoveries resulted from “self-experimentation”–no thank-you but I’ll pass) This therapy has many new applications that involve exposing the patient to small doses of allergens until your body becomes immune to them. And not only allergens, but we now “desensitize” to foods, medications, and even bee stings. In this blog post, we’ll discuss the use of desensitization for almonds and allergy immunotherapy, its benefits and risks, and how it can help you manage your allergies.

Desensitization for almonds:

• So why is this article below so important for the specific procedure of tree nut desensitization?
• First of all, the only product with FDA approval for desensitization challenge is peanut, with the trade name “Palforzia”. This doesn’t mean you can’t challenge/desensitize with other tree nuts (including almonds), but the FDA hasn’t approved any tree nut protocols. The reasons are many, but one criteria that needs to be achieved is acceptable levels of microbes and consistent amounts of allergenic proteins used for the procedure.
• If you read the abstract, it is possible to reduce the microbes and bacteria without decreasing the important allergenic proteins. Safety and efficacy are the gold standard and we’ll see more and more studies demonstrating the value of this procedure in the years to come.

Penumarti A, Szczepanski N, Kesselring J, Gabel E, Sheth R, Berglund J, Kim EH, Burks AW, Kulis MD. Irradiated Tree Nut Flours for Use in Oral Immunotherapy. J Allergy Clin Immunol Pract. 2021 Jan;9(1):321-327. doi: 10.1016/j.jaip.2020.11.008. Epub 2020 Nov 18. PMID: 33217614.

Background: Tree nut allergies affect an estimated 1% of the US population and is lifelong in 90% of allergic individuals. Oral immunotherapy (OIT) for food allergies is an effective method to induce desensitization in a majority of participants in trials of peanut, egg, and milk OIT. Limited trials using tree nut OIT have been reported, possibly due to the lack of standardized drug products.

Objective: Food products used in OIT are considered drugs by the Food and Drug Administration (FDA) because they are intended to modulate the individuals’ immune responses to the food allergens. As such, OIT drug products must meet FDA standards for acceptable levels of microbes and undergo testing for allergenic proteins. We aimed to determine the suitability of walnut, cashew, hazelnut, and almond flours for use in OIT trials.

Methods: We employed gamma irradiation on commercially available walnut, cashew, hazelnut, and almond flours and tested their levels of microbial contamination, total protein, and allergen content, along with stability of these parameters over time.

Results: Our results demonstrate that irradiation of tree nut flours greatly diminishes the levels of total aerobic bacteria, mold, yeast, Escherichia coli, and Salmonella, whereas there are no substantial changes in total protein or allergen content. Importantly, the microbial levels, protein, and allergen content remained stable over a 24-month period.

Conclusion: Irradiation of tree nut flours is a safe and effective method of processing to allow tree nut products to meet the FDA standards for OIT drug products.

So why would I be concerned about almond allergy? Almond allergy is one of the common food allergies, and it can cause severe reactions, including anaphylaxis. If you or your child has any almond allergy, families can be in a constant state of anxiety fretting over the next potential reaction. Just try getting a pediatric patient to eat even a small amount of almond during the procedure! They’ve been avoiding it for years. Desensitization therapy for almond allergies involves gradually exposing the patient to increasing doses of almond protein under medical supervision until the immune system becomes desensitized. This form of therapy has been shown to reduce the risk of accidental exposure to almonds and improve the quality of life for people with almond allergies.

Allergy immunotherapy:

Allergy immunotherapy is a long-term treatment that involves exposing the patient to allergens in increasing doses until the immune system becomes tolerant to them. The therapy is divided into two forms, subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). SCIT involves injections, whereas SLIT involves placing a tablet or drops under the tongue. Both forms have shown to be effective in reducing allergy symptoms and improving the quality of life for people with allergies.

Cox L. Allergy immunotherapy in reducing healthcare cost. Curr Opin Otolaryngol Head Neck Surg. 2015 Jun;23(3):247-54. doi: 10.1097/MOO.0000000000000150. PMID: 25887973.

Purpose of review: To evaluate the cost-effectiveness of allergen immunotherapy (AIT) in the treatment of allergic rhinitis and asthma. Individual studies and systematic reviews that included information on AIT economic outcomes as compared with symptomatic drug treatment (SDT) were evaluated.

Recent findings: One systematic review that included 14 studies concluded that subcutaneous and sublingual immunotherapy may be cost-effective compared with SDT from around 6 years. Another systematic review of 24 studies comparing economic outcomes of subcutaneous allergy immunotherapy and/or sublingual allergy immunotherapy with SDT found compelling evidence for cost-savings with both forms of AIT over SDT. There was no strong evidence indicating superior cost-efficacy of subcutaneous allergy immunotherapy or sublingual allergy immunotherapy over SDT in either of these systematic reviews. Individual studies have demonstrated AIT cost-savings as high as 80% compared with SDT. Significant cost-savings were reported as early as 3 months after AIT initiation. In some studies, cost-efficacy time-point was not established until after treatment discontinuation – presumably due to time required for the clinical benefits to outweigh the AIT treatment costs. Although some economic modeling studies included the costs of ‘asthma prevented’, the collective literature of AIT economics provides very little to no information about the cost benefits of the preventive aspect of AIT.

Summary: Overall, individual studies and systematic reviews provide strong evidence for the cost-effectiveness of AIT over SDT. The magnitude of cost-efficacy is likely underestimated in that few studies consider the cost-savings due to AIT’s long-term benefits or preventive effect.

So it’s always nice to have a cost reduction in the care of allergies with immunotherapy, but there are other reasons to consider desensitization to outdoor/indoor allergens.

One significant benefit of desensitization therapy is the reduction in the severity of allergic reactions, especially during the pollen season. The decreased sensitivity to allergens means that the patient can tolerate exposure better. Additionally, desensitization therapy can improve the patient’s quality of life by reducing the frequency and severity of allergic reactions and reducing the need for medications to manage symptoms.

Risks of desensitization therapy:

Desensitization therapy is not suitable for everyone with allergies and can have some side effects. The process of gradually exposing the patient to allergens can sometimes cause allergic reactions that can be severe. Additionally, desensitization therapy requires medical supervision and takes time and commitment to complete. Therefore, it is essential to discuss the potential risks and benefits with your healthcare provider before starting desensitization therapy.

Role of healthcare providers:

Your healthcare provider plays a crucial role in the management of your allergies. It is essential to work closely with your doctor to identify the causes of your allergies, discuss treatment options, and develop a plan to manage your symptoms. In my experience, most patients are just tired of treating symptoms with countless medications and never really “cure” the problem. Healthcare providers can also help identify the risks and benefits of desensitization therapy and make recommendations based on your individual needs.

Conclusion:

Desensitization therapy is a promising treatment option for allergies, including almond allergies and allergy immunotherapy. However, it is essential to work with your healthcare provider to identify the best treatment plan based on your individual needs. Discuss the potential risks and benefits of desensitization therapy and how it can help you manage your allergies. With the right treatment plan, you can improve your quality of life and reduce the frequency and severity of allergic reactions.