Hugh Windom, MD: Treating Food Allergy with Allergen Exposure


What does the typical patient have to treat aside from their allergy, and what are their treatment goals?

Food challenge therapy isn’t looking for primary endpoints. There’s no comparative trials to assure its non-inferiority, and there’s no effort made to reach a goal. In fact, it’s an answer to what’s currently considered an incurable disease—and it’s designed to ease the patient’s life.

In an interview with MD Magazine® while at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2019 Annual Meeting in San Francisco, CA, Hugh Windom, MD, detailed the common comorbidities or difficulties a food allergy patient faces during food challenge care. The University of South Florida professor of Medicine and practicing allergist/immunologist explained how what patients are really seeking with desensitization.

MD Mag: How do comorbid allergens or conditions present in patients with food allergies?

Windom: Each case is individual, because it's an allergic disease among a sea of allergies a patient may have. You may have a patient who strictly have peanut allergy or egg allergy, and does not have asthma, allergic rhinitis, hay fever, atopic dermatitis or eczema. But then you have patients who have all those things and a food allergy.

And they may not have just 1 food allergy. They may have egg and milk. So, we're treating 1 food at a time, or we're treating multiple foods at 1 time. We can desensitize them either way. If the other diseases are unstable—if they're a severe asthmatic, severe eczema patient—we're going to wait until that's stabilized first, because we're challenging their system by giving them foods.

It's what we do in allergies—we desensitize people to ragweed, dust, cat, and dog. We've been doing that for 100 years. We're now finally bringing it into the arena of foods, and it's just been so welcome. We're changing lives. People are thrilled beyond words that their child can now be safely around egg, milk, or peanuts.

Is there a limit to sustained unresponsiveness in treated food allergy patients?

That's really an academic question. If we're putting your child on milk, and he's up to 2-4 ounces of milk per day, he doesn't want to stop milk. He doesn't care if he has sustained unresponsiveness, he just wants to keep having milk in his diet. He might cut back to twice per week, but he'll have dairy in all kinds of food: pizza, bread, everything.

Even with peanuts, you can have Snickers bars, peanut butter and jelly. It's not a goal to see if it's gone. This is not a disease. That's an academic question to justify the drugs they're trying to make, but from a food standpoint, we're trying to make people safe in eating their food and being able to continue to eat it.

They don't want to stop. Maybe with nuts, they would care to not eat walnuts every day of their life, but if they cut down to 3 days per week, twice per week, most of them would rather do that than stop and see if they're safe to be challenged and potentially have a reaction to it and have to start over.

That's not really a question patients ask.

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