Top Food Allergy Studies of 2021

By: Sherry Coleman Collins, MS, RDN, LD
 
As with most years, 2021 was a very full year of food allergy research and news. Building upon previous years of study, researchers continue to make strides in understanding why and how food allergies happen, how they could be prevented, and ways to reverse them. In this article, we look at some of the top stories for 2021 in the areas of prevention, management, and treatment for food allergies.
Preventing Food Allergies
One of the hottest areas of food allergy research these days is in prevention of food allergies. Current recommendations from the Dietary Guidelines for Americans for infant feeding recommend that all infants eat potential allergens before 12 months of age and between 4-6 months for those at high-risk for developing food allergies. The Learning Early About Peanut allergies study (LEAP) showed that the risk of peanut allergy could be reduced by as much as 86% in high-risk infants. However, less is known for how to prevent other types of food allergies and some children may still go on to develop food allergies despite early introduction. Other potential prevention measures, including changes in the maternal diet and manipulating the gut microbiome are areas of potential for preventive interventions.
 
We reached out to food allergy dietitian and researcher, Carina Venter, PhD, RD, about her study, The Maternal Diet Index in Pregnancy is Associated with Offspring Allergic Diseases: The Healthy Start Study. Dr. Venter says this study “shows that there could be hope for prevention of food allergy in children as part of maternal diet manipulation.” The study presented a maternal diet index which can be used to provide weighted measures for healthy components of a diet (e.g. fruits, vegetables, yogurt) as compared to those that are less healthy (e.g. fried, sugary, low fiber) and used data from 1410 mother-child pairs who were participating in the Healthy Start study at University Colorado Denver. Data on diet was collected using the maternal diet index at four points throughout the pregnancy. Dr. Venter goes on to say:

“This is the first paper that shows that a healthy diet, comprising of regular intake of vegetables and yogurt and reduced intake of fried, sugary and low fiber foods is significantly associated with reduced asthma, wheeze, atopic dermatitis and allergic rhinitis up to 4 years and food allergy up to 2 years."

Venter also said that to prove that dietary changes were the cause for prevention, randomized controlled trials should be conducted, and a limitation of this study is that data was self-reported by participants. There are other factors that could have possibly influenced the study outcomes that she did not have data for including antacid, probiotic, and infections during pregnancy and early infancy. More research is needed to understand how best to optimize all interventions to reduce food allergies.
 
For more on introducing peanut foods early to help prevent a potential peanut allergy, visit PreventPeanutAllergies.org.
Managing Food Allergies (in schools)
Throughout the pandemic, schools have faced huge challenges with staff and product shortages, as well as changes in feeding protocols and locations. Keeping students with food allergies safe from accidental ingestion must also be a priority and schools need reliable and evidence-based information to do so as they also maintain the flexibility necessary to overcome the current challenges.
 
Food allergy management is something that those living with food allergies and their caregivers think about every day and so do those charged with keeping them fed. The federally funded school nutrition program is required to provide reasonable accommodations for those with food allergies and everyone who works in school meals is dedicated to student safety. Yet there remain myths and misperceptions that can make food allergy management cumbersome and less effective.  

In May, Waserman and colleagues published Prevention and Management of Allergic Reactions to Food in Child Care Centers and Schools: Practice Guidelines. This document provided a detailed guide for schools, administrators, parents, and others charged with keeping students with food allergies safer in schools. The authors provided eight major recommendations based on available evidence or best practice, along with instructions for special circumstances and considerations. The recommendations were broken down into three principal areas: food allergy training, allergy action plans, and site-wide protocols; epinephrine related issues; and site-wide food prohibitions and allergen-restricted zones.

The authors emphasized the need for training of staff, maintaining food allergy action plans (provided by caregivers), and site-wide protocol for management for those with known and unknown allergies.

The guidelines offer judicious advice on the use of epinephrine for food allergy reactions and encourage schools to have non-student specific epinephrine on site. Lastly, the authors advised against site-wide bans on specific foods, as well as allergen-restricted zones as a rule. For those charged with creating management plans for schools and school nutrition programs, the document is an invaluable tool to read in its entirety.
 
The National Peanut Board recently launched a unique landing page for schools that addresses many common myths and questions asked by schools about managing food allergens in schools. PeanutsInSchools.org includes videos with prominent stakeholders including a pediatric allergist, food allergy advocate and parent, and school nutrition director.
Treating Food Allergies: Considering the Whole Patient
While the holy grail in food allergy research continues to be a cure, advancements in treating food allergies by reducing the potential for serious reactions is also a heavy focus. Currently, peanut oral immunotherapy is FDA approved and widely available. Other potential treatments including epicutaneous and sublingual immunotherapy, drug therapies (e.g. biologics), and vaccines are being studied.

On the surface, it may seem that every parent would want their child treated for their food allergy. However, research and experience are showing that is not always the case.  

This year, there were a number of studies that explored patient and caregiver attitudes about food allergy treatments and found that many are not focused on a cure, but merely want increased safety. Moreover, treating food allergies includes potential side effects, such as gastrointestinal upset and potential inducement of eosinophilic esophagitis (a chronic tightening of the throat), is expensive and time intensive, and interrupts normal life because of required restrictions on physical activity. All of these factors can impact the success of food allergy treatment.
 
With all of this in mind, researchers and physicians have been encouraging a shift toward shared decision making when it comes to food allergy treatment. Shared decision making involves asking the patient and/or caregivers what is most important to them, considering their lifestyle and preferences, and evaluating their ability to fully participate in treatment options before determining the best course of treatment. This approach also heavily considers quality of life as a factor – some families managing food allergies do very well, but others carry high burdens of anxiety and fear. The January 2021 paper by Herbert, Marchisotto, and Vickery, Patients’ Perspectives and Needs on Novel Food Allergy Treatments in the United States, set the stage for the urgent need to explore these issues further and lead the charge in food allergy treatment from a shared decision-making stance. In some cases, considering the current risk-benefit of available treatments, individuals and families managing food allergies will continue to choose avoidance. It turns out that support for treatment for food allergies isn’t as straightforward as previously thought.
 
Food allergy research is a dynamic and changing area of study. Whether in the area of prevention, management or treatment, there is much to learn about this condition. The National Peanut Board continues to fund and follow promising approaches to improve the situation for those with peanut allergies and help remove barriers to consumption. Since 2001, NPB has allocated more than $35 million to food allergy outreach, education and research. Learn more.

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