Food Allergy Treatment News: FDA Approves Xolair February 20, 2024

Exciting treatment news!

The FDA has approved the use of Xolair as the first and only medication to help prevent allergic reactions in individuals with food allergies. Xolair isn’t a new medication – it comes with a 20 year track record of safety in use with severe asthma. Trials supported by the National Institute of Allergy and Infectious Disease (NIAID) showed this medication to be effective in children over 1 year of age (approved to age 55), helping patients to tolerate small amounts of peanut, dairy (milk), cashew, and egg without experiencing an allergic reaction (as compared to placebo).

Xolair is a product born from a collaboration between Genentech (a subsidiary of Roche) and Novartis. AllergyStrong lauds this type of partnership which brings together the expertise of both companies for the benefit of the patient.

The FDA’s approval of Xolair is an important step forward for the food allergy community for many reasons. It is reassuring for both patients and physicians who appropriately view this approval as validation of Xolair’s safety and efficacy. FDA approval also helps make this preventative treatment affordable as insurers may be willing to cover it more readily, extending the reach of this life-saving product.

Xolair comes with many benefits:

• Xolair helped patients decrease their sensitivity, allowing them to tolerate small amounts of their allergen(s). Even a small decrease in sensitivity to/increase in tolerance of allergens can protect patients from severe allergic reactions.
• Studies show that 40% of people with food allergies are allergic to multiple foods. Unlike some treatments, Xolair increases tolerance to several allergens simultaneously.
• Xolair allows people to increase their tolerance without ingesting their allergen. This decreases the risk of allergic reaction and adverse effects.
• Xolair may be an excellent option for those who cannot see their healthcare provider frequently or easily. Because of its safety profile as well as the fact that patients do not ingest their allergen and will require less monitoring, use of Xolair doesn’t require as many appointments with a healthcare provider – making this an appealing treatment option for patients and families who don’t have easy access to their physician. After initial healthcare appointments to establish a regimen, patients can self-inject with Xolair if they choose.
• Xolair is approved for adults! Xolair is the first FDA-treatment to be approved for use in adults to age 55 filling a major unmet need for this group. Of the 32 million Americans living with food allergies, approximately 26 millions (about 11% of all Americans) are adults.

Keep in mind:

Xolair is not a cure for food allergies – it is protective in the case of accidental ingestion or exposure. Despite using Xolair, people with food allergies will continue to need to avoid their allergen and carry epinephrine with them in case of emergency.

FDA approval may mean this treatment could be covered by insurance which is critically important to families already financially burdened by living with food allergies. Food allergies cost families over $20 billion in the US each year – an average of over $4,100 per child annually. Knowing that lower income families spend 2.5 times more on emergency department visits and hospitalizations than higher earning counterparts, investment in prevention should be highly desirable. Because food avoidance (the current standard of care) is fraught with challenges, insurers would be smart to consider coverage on preventative therapies to ease burden on the healthcare system as well as patients.

We are excited and grateful to Genentech and Novartis for their cooperative work on this important product. Xolair represents an important development in the treatment of food allergies and the protection of individuals living with food allergies. Use of Xolair may not only save lives by preventing severe reactions, but it may also improve quality of life by reducing anxiety and increasing food options for those with food allergies and their families.

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Click here to read more about the approval of Xolair.

Yes, You Can Get a Food Allergy at Any Age October 1, 2018

Food allergies aren’t always something you’re born with.  Many believe that once they reach preschool age without a food allergic reaction, both they and their children are out of the woods.  Not so, says allergists.

 

Unfortunately, food allergies can begin at any age.  In fact, you can get a food allergy to any food at any age.  We can all agree; that’s a bummer!

 

Unfamiliar with symptoms and without epinephrine, many adults discover their allergy through a reaction.   My own father-in-law had enjoyed seafood for decades before having a severe allergic reaction (called anaphylaxis) on an airplane when he was in his forties.  Thirty thousand feet over the Atlantic Ocean, he was served shrimp – something he had eaten many times before.  No sooner had he finished his meal than his symptoms begin: swollen eyes and esophagus, itchy mouth and skin.  Thankfully, he made it to their destination with the help of an overwhelming amount of Benadryl.  But I think we can all agree, that’s no place to discover a food allergy.

It can be confusing to adults (as well as to their families and friends), when someone can tolerate a food one day and react to it the next.  As with all families adjusting to food allergies, there is a huge learning curve that accompanies diagnosis.  Adult food allergy patients need to relearn how to shop, cook, order food and – importantly – they must learn to recognize symptoms of allergic reactions including anaphylaxis.

 

Just as with pediatric food allergies, symptoms range from mild to severe to include:

• Itching or tingling mouth, lips and/or tongue
• Hives, itching skin, eczema
• Swelling of the tongue, throat, lips, eyes, face, or other parts of the body
• Wheezing, nasal congestion or other trouble breathing
• Abdominal pain, diarrhea, vomiting
• Dizziness, lightheadedness, fainting

 

Symptoms of a severe reaction (called anaphylaxis) include:

• Constriction of the throat or tightening of the airway
• A swelling or lump in the throat that makes it feel hard to breath
• Shock, a severe drop in blood pressure
• Rapid pulse
• Sense of impending doom
• Dizziness, lightheadedness, loss of consciousness

*Emergency medical care is needed if experiencing any symptoms of anaphylaxis.  Even after administering an epinephrine auto-injector, seek immediate medical attention.

 

Busy adults sometimes miss symptoms of food allergies.  On occasion, adults experience vomiting without itching, swelling or hives – a symptom which imitates a virus or the flu.  After a suspected reaction, adults should meet with an allergist.  At their first appointment, patients should also discuss their other medical conditions as well as bring a list of prescription medication they take.  Specialists can help decipher between symptoms of one condition and food allergic reactions as well as give advice about any issues with administering epinephrine or taking antihistamines.

 

Too little is known about why adults develop food allergies.  Fifty-one percent (51%) of people with food allergies developed at least one as an adult.  Approximately 10.8% of adults live with food allergies in the United States (that’s about 26 million people).  The most common among them is shellfish (present in 54% of adults with food allergies), followed by milk, peanuts, tree nuts, and fin fish.  But adults suffer reactions to all kinds of food allergens.  Although you can truly get a food allergy at any age, most adult reactions occur between ages 30 and 40 and affect women more often than men.

 

There is an initial emotional burden of being diagnosed with food allergies.  This is common. Food allergies can be especially stressful as patients are adjusting to their condition and retraining their behaviors or overcoming a severe reaction.  Experiencing anxiety is normal to some degree [please read Managing Food Allergy Anxiety]; however, if the stress and anxiety of food allergies becomes overwhelming, it is recommended that patients reach out to a mental health professional and mention it to their allergist.  Both can work to give you practical and easy-to-implement strategies to reduce fears.

 

What is an Oral Food Challenge and How to Prepare February 5, 2018

Let’s start right from the beginning:

What is a food challenge?

Sometimes a skin prick test and/or a blood test does not give a doctor enough information to know if a patient is truly allergic to a particular food.  A food challenge, sometimes known as an Oral Food Challenge (OFC) or just oral challenge, is the best way for an allergist to evaluate a patient’s allergic response.

Food challenges are sometimes used to diagnose a food allergy.  While skin prick tests and blood tests are great indicators of a food allergy, they cannot help a doctor or patient understand their individual risk of a reaction.  Only the Oral Food Challenge can demonstrate a person’s true sensitivity to a given food.

Oral challenges are also helpful in determining whether a patient has outgrown a food allergy.  Doctors will suggest an oral food challenge when they believe an individual may successfully tolerate a food they previously tested allergic to.

How does it work?

For a variety of reasons, doctors may want to test a patient against his/her food allergy.  In a doctor’s office or hospital setting, food is given to that patient every 15 to 30 minutes – beginning with a very small amount and increasing with each “dose”.  The patient is observed and medically evaluated at each interval to check for symptoms of a reaction.  Feeding typically continues until a full portion of that food is consumed safely.

If the doctor sees symptoms of a reaction, he/she will stop the test.   If, on the other hand, there are NO symptoms, your doctor may rule out a food allergy and discuss ways to manage that food going forward.

Where do you go for a food challenge?  Can I do it myself at home?

OFCs are ONLY conducted in a doctor’s office or hospital setting and should only be done under a doctor’s supervision.  It is critical that the patient be checked by a doctor or nurse at each stage in the process for a reaction.  And, should such a reaction occur, the medical staff are on-site ready to respond immediately.

You SHOULD NEVER conduct an oral food challenge at home.

How safe are OFCs?

Food challenges have an excellent safety record because allergists and trained professionals follow medical standards and procedures for the test and they are prepared to handle any emergency that arises.  Thousands of OFCs have been performed worldwide safely.

Be aware, there is a risk for an allergic reaction with this test which is why it MUST be performed by a doctor in a medical setting.  The most common reactions in an oral challenge are mild skin and stomach reactions which are typically treated with antihistamines.  Allergists are prepared to use epinephrine and other medications in the unlikely event that a more severe reaction occurs.

That said, most doctors recommend an oral challenge when they believe the patient will tolerate an allergen.  They try to set their patients up for success.

How do I prepare for a food challenge?

1.  Remind yourself and/or your child that there is no “passing” or “failing” an oral challenge – there are only results.  In this way, you can keep anticipation and disappointment in check.  [But feel free to go crazy celebrating if you’re able to add another food to your diet later!]. Use words like “tolerate” and “didn’t tolerate” rather than pass/fail to reduce the pressure for you and/or your patient.

2. Have a conversation with your allergist’s office about what to bring and how to prepare it.  Allergists typically recommend how to prepare the food you are testing for.  For example, when my son tested for soy, we brought soy milk; for wheat, we brought toast; for milk and egg, we were instructed to make muffins and French Toast using a particular recipe.  Depending on your child’s age and particular tastes, the allergist may be able to alter the recommended food to make it more palatable.

3. You will need to stop taking antihistamines as well as some other medications for at least one week prior to your appointment.  Discuss this with your doctor’s office for further instructions.  ALWAYS take emergency medication (such as a rescue inhaler or epinephrine) should you need it leading up to the oral challenge. Oral challenges can be postponed if need be.

4. Prepare for the day.  Oral Food Challenges often take several hours.  Think about what will amuse you and/or your child for that period of time.  Consider coloring books, small lego sets, matchbox cars, books, a portable DVD player or iPad for kids.  And bring something engaging and calming for you: books, laptops, portable crafts (like knitting, colored pencils, etc) can help ease any anxiety as you begin.  And, yes, that means you might arrive with a giant “tote bag of fun,” looking like you’re ready to move into the doctor’s office like I did.

5. Write down questions about the possible results of the test as you go along,  You should have a chance to discuss the results after the challenge has finished.  Some questions you may wish to ask if you can add a new food:

• What do the results tell us about my allergy?
• Are there any limits to the quantity/variations of this new food we can add?
• Can we add this food in its baked AND unbaked forms?
• Does this change the way I read food labels for safety?
• What symptoms should I look for over the next few hours and days?
• Does this alter my Emergency Action Plan?  Can you fill out a new plan so that I can copy this information for the school nurse, after care, babysitter, etc?

6.  Know that it’s very common to be nervous about these appointments.  If you experience a little anxiety, you’re probably in the majority.  Remind yourself that your doctor would only recommend an oral food challenge if they felt it was possible to tolerate that food.  And, keep in mind healthcare professional are monitoring you and will intervene at the first symptoms.

Auvi-Q vs. EpiPen: Which Is Best For You? October 4, 2013

As most of you are aware, there are many different types of epinephrine auto-injectors available these days.  Up until recently, EpiPens ruled the marketplace.  But recently, a new product, Auvi-Q, has been getting a lot of buzz.

 

So, if you’re asked which one you’d like to be prescribed, as I recently was by our allergist, which will you choose?

 

Here are the pros and cons to both as I see it:

  

EpiPens:

• Because they dominated the market for so long, EpiPens are recognizable.  In an emergency, that might mean someone who does not have food allergies may know to look for one and may be familiar with what to do with it.
• They are larger (especially because you’re carrying two of them), ensuring that they are easy to find in a purse or sports bag when seconds count.
• EpiPens have been in use for a long time, making them tried and tested.  However, there have been some functionality issues that were addressed earlier this year (2018)
• Because they are large and you must carry two, EpiPens are hard for men to carry.
• In a panic, you have to either remember your injection instructions or read them on the outside of the pen itself – something that someone who is frazzled may have trouble concentrating on.

 

Auvi-Q:

• There’s no doubt about it, Auvi-Q is sleek and small.  This is likely appealing to teenagers who may be tempted to leave their epinephrine at home.
• The needle retracts after injection, eliminating the possibility of accidental pricks, scratches or lacerations.
• It instructs you!  So, even if you’ve never touched an auto-injector before, chances are you could properly administer epinephrine using the Auvi-Q.
• It fits in your pocket.  I think this will be very helpful to both adolescents and men.  Women carry bags, so no matter the size of the auto-injector, it likely fits.  But men… well, the “Murse” doesn’t look like it’s really catching on.  Dads can stick the Auvi-Q in their pocket while they’re out on the town with the kids.  My own husband is planning to leave it in his pocket when he coaches my son’s baseball team this weekend.
• Auvi-Qs are about the size of a deck of cards. Remember: you need to carry two.
• Again, this makes it convenient for a pocket, but less so for locating it in a large purse.

 

So, what do I decide to do?  Well, I chose both!  I want my babysitters and other visitors to my house to have the emergency instinct to go for what they know:  the EpiPens.  But, I love the convenience of carrying the Auvi-Q for my husband, in particular, ensuring that my son’s emergency meds are always on-hand.

 

Both Auvi-Q and EpiPens have a solid place in the marketplace.  Both administer epinephrine which saves lives!

 

Which one did you choose?

Epinephrine: How Do You Carry It? March 18, 2013

As parents of kids with food allergies, we are all familiar with EpiPens, spring-loaded epinephrine injectors used in cases of anaphylaxis.   While sometimes considered bulky, they are currently the staple delivery of emergency medicine for severe allergic reactions.

But twin brothers, Evan and Eric Edwards, themselves allergic to food have come up with a new device aimed at making carrying epinephrine more convenient.  After frequently forgetting their EpiPens, the brothers have invented an epinephrine delivery system the size of a smartphone. Called the Auvi-Q, the auto-injector is not only smaller and arguably more portable than the EpiPen but it also boasts automated voice instructions for those who may be too panicked to read written directions.

Do you find this more convenient to carry?  Which device would you use?