Food allergy: fight against the new epidemic

The life of food allergy sufferers – some 250 million in the world – is about to get a lot easier thanks to novel treatments and the development of innovative food products.

Olivier is a nine-year-old boy who lives in London. When he was three, he took a bite out of a button-shaped milk chocolate which contained a peanut within a candy shell.

Less than a minute later, his face swelled up and he began gasping for breath.

Olivier has had to watch what he eats ever since. He is not allowed to eat cakes at friends’ birthday parties, nor desserts that are offered at the school canteen.

He is excluded from classroom events involving food and can rarely eat out in restaurants. His is not an isolated experience.

Olivier is one of 250 million people worldwide who suffer from a food allergy,1 a condition that affects more children than adults. Worryingly, the phenomenon is growing to epidemic proportions. In the US, the prevalence of childhood food allergies increased by 50 per cent between 1997 and 2011, while peanut allergies – which can be particularly severe and persistent – more than tripled between 1997 and 2017.2

"The complications arising from food allergies extend well beyond their immediate physical effects," says Dr Stefan Catsicas is managing partner of Skyviews Life Science, a private advisory firm specialised in precision health and longevity.

"They pose significant challenges for families, including social isolation and anxiety and in some cases can morph into chronic life-threatening conditions."

There is an economic cost too. Today, the cost of caring for children with food allergies in the US totals USD25 billion per year and averages approximately USD4,200 per child annually.3

Until recently, due to a lack of approved therapies, avoiding allergens was the only way to prevent allergic reaction.

However, thanks to some novel treatments, the development of innovative food allergy products and stricter food label regulations, the life of Olivier and other food allergy sufferers could soon become a lot easier.

An evolutionary mismatch?

Dr Catsicas explains that allergic reactions occur when the body’s immune system – in particular its immunoglobulin E antibodies (IgE) - mistakenly treats certain foods as threats and overreacts by releasing a number of chemicals, which cause symptoms such as swelling of the face, a red rash or vomiting.

Their existence appears odd at first glance. Humans’ immune systems are remarkably adaptable. Their ability to detect threats has evolved and improved over millions of years.

So it seems strange that they can malfunction in this way.

Some scientists attribute allergies to an “evolutionary mismatch”, that a certain number of the body’s internal mechanism evolved in an environment that is radically different from the one in which humans live today.

This mismatch stems from the slow pace of evolution and rapid changes in human societies. In short, our digestive systems have not had time to adapt to the intensely farmed or processed foods that began appearing on supermarket shelves about a few decades ago.

Another explanation for the explosion in allergies is radical changes in our eating habits.

As globalisation took hold and the Internet spread, people suddenly gained access to a vast array of foods from different cultures -- foods which certain individuals’ immune system could not handle.

For example, one study has shown that while nuts have been common ingredient in Chinese cuisine for centuries, its expansion into Europe led to a spike in the number of Europeans experiencing nut allergies.4

New therapy and markets: no peanuts

The standard of treatment for food allergies has been poor. The default medical advice has been to avoid eating the food that causes allergy altogether.

But Dr Catsicas says advances in new treatment and therapies in recent years give reasons for optimism.

"Epicutaneous and oral immunotherapy are currently in clinical development and results so far demonstrate good tolerance and efficacy," he says.

"Biologics and anti-IgE approaches – which are designed to interfere with the IgE’s antibody function – are currently investigated for their therapeutic use and results are promising."

Separately, regulators in the US, Europe, UK and Switzerland have approved a pioneering treatment that helps reduce the severity of allergic reactions to peanuts.

Developed by Nestle-owned Aimmune Therapeutics, the treatment works by helping children aged 4 to 17 gradually decrease their sensitivity to peanuts over time.

Dr Catsicas says growth of the food allergy products market – such as dairy replacements and gluten-free alternatives – should also broaden choices and make lives easier for affected families.

The global market for such products is expected to reach USD23 billion by 2031 from USD12 billion in 2020, with lactose-free segment representing the highest revenue contributor to the market.5

Alternative milk products represent another vibrant market. Such is the scale of demand – among both the lactose intolerant and ethical consumers that Swedish Vegan milk producer Oatly secured a USD10 billion valuation when it listed in May 2021.

Better food labelling would also keep tackle the allergy crisis.

In October 2021, the UK introduced a new food labelling legislation which mandates all food sold to the public is labelled with every ingredient.

Named after a 15-year-old girl who died after suffering an allergic reaction to a sandwich containing sesame, Natasha’s Law is aimed at giving allergy sufferers the confidence in the food they buy.

The hope is that other countries, especially in developing world, implement similar regulations to protect consumers, while avoiding “overlabelling” – where too many “may contain” labels restrict potentially safe food choices. Food allergies are a growing epidemic affecting many young people.

But more innovative treatment and products and better legislation may enable us to win the fight.

[1] World Allergy Organization

[2] Jackson KD, Howie LD, Akinbami LJ. 2013. Trends in allergic conditions among children: United States, 1997–2011. NCHS data brief, no 121. Hyattsville, MD: National Center for Health Statistics. http://www.cdc.gov/nchs/products/databriefs/db121.htm, Anvari S, Chokshi N, Kamili Q. Evolution of guidelines on peanut allergy and peanut introduction in infants. JAMA Pediatr 2016; 171: 2552.

[3] Alladapt Immunotherapeutics / Stanford 2022

[4] Seema Patel, Hafiz A.R. Suleria,Ethnic and paleolithic diet: Where do they stand in inflammation alleviation? A discussion, Journal of Ethnic Foods, Volume 4, Issue 4, 2017 Worm, Margitta et al. “Use of biologics in food allergy management.” Allergologie select vol. 5 103-107. 19 Feb. 2021, doi:10.5414/ALX02141E

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