Why early exposure changes food allergies treatment

For decades, standard recommendations for managing food allergies have been simple, but strictly: total avoidance. Parents of children with allergic children have been on alert, reading the labels carefully, barbecue restaurant staff, and adrenaline auto-injectors everywhere. However, according to a comprehensive review on clinical and experimental allergies on March 5, this approach may do more harm than good, especially for the youngest allergic patients.

The review, led by researchers at the University of British Columbia, challenges traditional beliefs that controlling exposure to allergens in preschool children, known as oral immunotherapy (OIT), should be the primary treatment strategy, rather than the last treatment.

“This study highlights a critical shift in the way we deal with food allergies, from strict avoidance to controlled exposure in early childhood, which not only reduces the risk of severe reactions, but also helps prevent the long-term negative effects of food allergies,” according to the corresponding author Lianne Soller, Ph.D., University of British Columbia.

The traditional “waiting” method hopes that children will naturally surpass allergies and may lack a critical window of opportunity. The review notes that increasing evidence suggests that children’s immune systems are more likely to change or “plastic” to make preschoolers ideal candidates for OIT.

Although some children naturally go beyond food allergies, recent data suggest that this happens less frequently than previously thought. The comments state that natural resolution rates vary greatly due to allergens: peanuts (22-29%), tree nuts (9-14%), milk (41-92%) and eggs (47-59%). For those who don’t go beyond allergies, waiting until school age to provide treatment “meaning missed the safest window of opportunity and extending unnecessary dietary restrictions.”

Perhaps the most striking thing is security data. With concerns about the possibility of serious reactions introduced by allergens, multiple studies have shown that preschool OIT has an impressive safety record. In several large clinical trials, severe responses were very little (0-3%) and adrenaline usage was minimal (0-9%) during the accumulation phase. These results seem to be much better than similar treatments for older children and adults.

Edmond Chan, co-author and clinical professor at the University of British Columbia, has been at the forefront of advocating early intervention. His team’s research shows that the consequences of waiting to treat food allergies not only extend dietary restrictions.

“Even if the child’s allergies are not recovered, studies show that perceived food allergies have similar effects on quality of life than diagnosed food allergies,” the authors wrote. “In addition, the study found that adolescents with self-reported food allergies have lower quality of life than those reported by younger children who were a parent.”

The timing of this paradigm shift is consistent with shocking statistics about accidental exposure. One study found that 58% of children diagnosed with peanut allergy before age 4 responded during a five-year follow-up period, usually more severe than the initial response. A nationwide U.S. survey pointed out that 19% of households with food allergies reported at least once an allergy-related emergency department visit last year.

What makes preschoolers particularly suitable for OIT candidates? According to the comments, there are several factors:

First, allergic reactions, including allergic reactions, are usually less severe in preschool children. A French study of nearly 2,000 food-induced allergic reactions found that only 3% of infants under 12 months of age occurred, 20% occurred in preschool children, and more than 75% of school-aged children.

Second, early onset seems to increase long-term adherence. A follow-up study of preschoolers who have passed OIT found that five years later, 93% of people are still consuming allergens. In contrast, studies of elderly patients have shown that compliance rates are low, with up to 25% completely blocking allergen consumption after treatment.

The authors believe that this difference may be due in part to taste aversion, which usually develops between the ages of 6 and 7, and can continue into adulthood. By starting OIT at this critical period, children may be more willing to continue to consume allergens for a long time.

Economic cases of early intervention are also convincing. A study estimated that over 80 years, the cost of preschool peanut OIT in the United States was “to $1.23 to $47 billion in the United States and $1.04 to $13.6 billion in Canada.”

Another co-author and pediatric allergy chief, Dr. Timothy Vander Leek, admitted that despite the strong evidence, the problem persists. “Further work should be done to correctly define protocols that include maintenance dose, safety and tolerance, and carefully agree to the clinical endpoint,” the authors noted.

The review also highlights research gaps, including the need for more data on the psychosocial impact of OIT, especially that early interventions can reduce or prevent food allergies-related anxiety.

There are also implementation challenges. It is estimated that children have 6% food allergies, and traditional OIT approaches (requiring baseline food challenges and multiple office visits) may be resource-intensive in the healthcare system. In some areas, access to professional care and adrenaline remains limited.

Despite these obstacles, the authors concluded that “the evidence continues to accumulate OIT that is beneficial to preschool and suggests that OIT should play a key role in treating food allergies in preschool children.”

For parents of children with food allergies, this review offers hope to reduce the burden of ongoing vigilance through early active treatment rather than years of anxiety avoidance of ongoing treatment. As evidence increases, many allergic masters are already shifting their practice to embrace this approach and have the potential to change the landscape of next-generation food allergy management.