Select Highlights of 2022 AAAAI Food Allergy Research Posters

By Sherry Coleman Collins, MS, RDN, LD

The annual meeting for the American Academy of Allergy Asthma and Infectious Disease (AAAAI) was packed with research and applicable presentations on allergies – including food allergies. While there were dozens of interesting sessions, I’m sharing just a handful of the novel and interesting late-breaking abstracts within key buckets such as prevention, diagnosis, and treatment. These abstracts are abbreviated reports of studies, often preliminary and small trials, do not include limitations, and have not been through the full peer-review process.

Food Allergy Prevention

Infant feeding guidelines now recommend introducing peanut foods to infants starting around 4-6 months of age. Research is showing that it could be beneficial to introduce other foods too – and that introducing these foods is safe and helps diversify the diet, which is another potentially protective step. In an abstract presented of a study of 3,062 American parents with children under 7 months of age, those who introduced peanut to their babies were more likely to introduce other potential allergens too. (Venter C, 2022) More research is necessary to better understand the association with feeding babies peanut may impact parental behavior and attitudes about introducing other allergens and the outcome on food allergy risk reduction.

In another study by the same group, an abstract presented showed that among the 3,062 caregivers surveyed, only 13.3% reported that they are aware of the NIAID-guidelines for introducing peanut foods starting at 4-6 months of age. Only 17.6% of all survey respondents reported feeding babies peanut foods before 7 months of age, but the rate rose to 31% among those who were aware of the guidelines. Fear of allergic reactions was the number one reason parents did not introduce peanut foods early. However, only 1.4% of those who did introduce peanut reported reactions. (Samady W, 2022)

Diagnosing Food Allergies

Overuse of panel testing - testing for multiple foods at one time, particularly without known reactions to such foods - in suspected IgE mediated allergies is not considered best practice. (AAAAI, 2021) In this scenario, a physician orders the test that then measures IgE to many different foods or substances to determine potential allergy. The problem is that blood and skin tests have high rates of false positives, which can lead to overdiagnosis and unnecessary food restriction. In the case of infants, this can lead to delays in introducing potentially allergenic foods, which may increase the risk of developing food allergies. In an abstract presented at the AAAAI meeting, Cotter et al found that they were able to reduce inappropriate physician ordering of panel tests through a multifaceted approach. (Cotter C, 2022) More research and efforts should be done to raise awareness about the potential damage of panel testing to reduce the negative impact they can have on patient outcomes.

Advancing Food Allergy Treatments

Oral immunotherapy (OIT) continues to be a primary area of research and advancement for treating food allergies. Importantly, it is not a cure, but is used in concert with avoidance to reduce the risk of severe reactions. Abstracts and presentations at the conference in this area focused on shared decision making between clinician and patient/families as a way to identify the best candidates for these treatments and to improve outcomes. In a study by Gunderman, et al, 32 peanut allergic children were followed for peanut OIT once it was approved in February 2020. Fifteen of the patients reached the maintenance dose (46.9%), with another ten completing dose escalation. However, seven (31.8%) discontinued treatment primarily due to GI adverse events. (Gunderman L, 2022) More research is needed in all of these areas.

Several abstracts were presented about other potential treatment options for those with peanut allergies. A study of the safety data from phase 3 studies of epicutaneous immunotherapy (EPIT) for peanut allergy showed that the most common adverse event associated with the treatment was local skin reaction. Anaphylaxis occurred at a rate of 3.7 per 100 subject years. (Pongracic J, 2022) Another potential avenue being explored is the use of virus like particle (VLP) peanut treatments. An abstract presented at the conference showed that in cell-based studies, VLP reduced activation of immune cells and histamine release in those with peanut allergies. This pre-clinical trial laid the foundation for a potential in-human study to come for this novel type of treatment. (Shamji M, 2022)

The area of food allergy research is truly dynamic. These represent a small subset of the exciting findings and studies by researchers currently advancing the field. I look forward to learning more about what happens in each of the areas of prevention, diagnostics and treatment for food allergies in the coming year. What area of food allergy research are you most excited to follow? Tell me in the comments below.

Bibliography

AAAAI. (2021). American Academy of Allergy, Asthma & Immunology Ten Things Physicians and Patients Should Question. Retrieved from Choosing Wisely: https://www.choosingwisely.org/societies/american-academy-of-allergy-asthma-immunology/

Cotter C, F. A. (2022). Multifaceted approach to limit ordering of IgE food testing. J Allergy Clin Immunol, AB105.

Gunderman L, B. J. (2022). Outcomes of real-world use of FDA-approved peanut oral immunotherapy. J Allergy Clin Immunol, AB34.

Pongracic J, B. A. (2022). Pooled safety data from phase 3 study of epicutaneous immunotherapy for peanut allergy in children aged 4-11 years. J Allergy Clin Immunol, AB33.

Samady W, W. C. (2022). Current peanut introduction practices amongst a large, representative sample of US households. J Allergy Clin Immunol, AB39.

Shamji M, L. J. (2022). Virus like particle (VLP) based peanut allergen immunotherapy candidate display a decreased acivation and histamine release from CRTH2+ basophils: A proof of concept study. J Allergy Clin Immunol, AB37.

Venter C, W. C. (2022). Does peanut introduction set the scene for earlier introduction of other food allergens during infancy? J Allergy Clinical Immunol, AB39.