One hypothesis suggest that our environment is too sterile.
Anat Binur, PhD, Co-founder and CEO of Ukko, talks to Pharmacy Times about the prevalence and impact of food allergies, such as peanut allergies, among US children.
PT Staff: In the past few decades, what factors have contributed to the growing epidemic of childhood food allergy?
Anat Binur, PhD: Yeah, it's crazy. I grew up both in Tel Aviv in and in New York (I grew up in New York and spent some my life in Israel and some of my life in the United States) and I never had a kid in my class with a food allergy or sensitivity. And now I'm almost never ever on a call, in an elevator, with my neighbors, or anywhere else without someone having it in their life, either in their own family or close friends. And you're absolutely right— it's pretty astounding and the data backs it up. I think it's something like 1 in 13 Kids in the United States today has a food allergy.
There are several hypotheses that people believe could be the case, where 1 of the most well-known is called the “hygiene hypothesis”. The idea is that we over-sterilized our environments. This lack of exposure then leads our immune system to not get accustomed or to learn and modulate itself towards allergens. That leads to some these allergic reactions we then see in kids. Another hypothesis is that we eat more processed foods, and that messes with our microbiome and sometimes makes it more susceptible to allergy. And I think the third one (there are other hypotheses as well. But these three are probably the leading ones) is that we can really delay the introduction of allergens to infants. That leads to an increase in sensitization. So, it's not just our environment that is sterile—sometimes we actively delay [introducing allergens] especially as fears gone up around allergies. That really has an impact as well. By the way, since (I think it's something like) 2015, pediatric guidelines really have recommended early introduction. You must do it carefully and there are very clear instructions to this. The idea there is to really improve and alleviate some of what we're seeing.
PT Staff: Seeing that a peanut allergy is protein-related, how does it manifest differently than a condition such as seasonal allergy?
Anat Binur, PhD: It's not just about protein and seasonal, as some respiratory allergies are also based on proteins. There are a few things that differentiate what we know as a respiratory allergy—where, at what point, the allergen interacts with your body. So, when you eat a food allergen, the interaction tends to be through the GI tract, whereas respiratory allergy tends to be obviously through breathing, and then hits your lungs and skin. So, the interaction and, therefore, the impact, really changes. And usually food allergies are more systemic, and you'll see things like nausea and vomiting, which you're not going to necessarily see in the respiratory allergies. And food allergies do tend to be far more severe. Peanut allergy, for example, is deadly (can be deadly).
PT Staff: What are the pros/cons of pharmacologic agents like EpiPen for children with food allergy/sensitivity?
Anat Binur, PhD: First-of-all I should say I'm not a clinician and everything I'm saying is just out there. And anyone who has allergies should always go and research and talk to an allergist and really be extremely careful. But what we need to remember about EpiPen is that it's not a cure, right? It helps you deal with a symptom. It's really for accidental exposure and it's about emergency— it's a rescue medication. In no way is that attempting to modulate your immune system. That is where, for example, food allergy immunotherapy can come in. So of course, the advantages are that this is the goal. EpiPen continues to be the gold standard as a rescue medication. Of course, the disadvantage is that you must walk around with it, it can be expensive, and it's not always accessible. You must really make sure for example, you know, that it can work and that it's not outdated and so on and so forth. It requires some care, but it helps in case of an emergency in the best way possible today.