Welcome to our February research update! Getting involved with research is an important way to impact food allergy treatments, education, and awareness.

This month, we are highlighting research news on:

• Performance of epinephrine auto-injectors in real-world conditions
• Updated guidelines for eosinophilic esophagitis (EoE)
• Food allergies, anxiety, and bullying
• Nasal food challenge for hen’s egg white
• Reintroducing food after passing an oral food challenge
• Peanut oral immunotherapy using store-bought products
• Patch treatment for peanut allergy
• Food protein-induced enterocolitis syndrome (FPIES) triggers

Note: The links below will take you to external websites.

Latest Food Allergy News

Anaphylaxis

Study of Epinephrine Auto-Injectors in Real-World Conditions
People who are at risk for anaphylaxis are told to always carry epinephrine. But epinephrine has a recommended storage temperature of 68° to 77° F, but brief stays of 59 to 86° F are allowed.

A recent study tested how well epinephrine auto-injectors held up in real-life conditions. Ninety patients in Poland carried their auto-injectors for 12 months, avoiding extreme heat or cold. But some saw temperatures as low as 3° F and as high as 90° F. After a year, the epinephrine remained at an average of 94.5% of its original strength, with the lowest level still at 91.6%. This suggests that auto-injectors remain effective through everyday temperature changes.

While the Food and Drug Administration (FDA) warns that extreme temperatures could reduce effectiveness, the key takeaway is that you should always carry your epinephrine and use it if needed, since having epinephrine available is critical in an allergic emergency.

Eosinophilic Esophagitis (EoE)

American College of Gastroenterology Releases Updated Guidelines for Eosinophilic Esophagitis
The American College of Gastroenterology (ACG) has updated its guidelines for diagnosing, treating, and monitoring eosinophilic esophagitis (EoE). The new guidelines are an update of the 2013 guidelines. They reflect major advancements in diagnosis and management. The updates include several key recommendations:

• The ACG recommends diagnosing EoE based on symptoms and esophageal biopsies that show at least 15 eosinophils per high-power field, after ruling out other conditions that may cause a high eosinophil count.
• The ACG recommends using an endoscopic scoring system during endoscopies.
• The ACG recommends taking multiple biopsies from different parts of the esophagus for microscopic testing.
• Treatment options include proton pump inhibitors (PPIs), swallowed steroids like budesonide, and the biologic drug dupilumab for people who don’t respond to PPIs.
• Young patients with trouble feeding may benefit from working with a dietitian or feeding therapist.

These updates aim to improve care for people EoE and guide future research. While significant progress has been made, more research is needed on long-term treatment outcomes, dietary therapy, and the safety of biologics in children.

Food Allergy

Food Allergen Avoidance and Stress
Avoiding food allergens is the most common strategy for managing a food allergy. But avoiding a food allergen can take a lot of planning and effort.

A recent study surveyed 919 parents of children with food allergies to understand how households manage allergens and the impact on family stress and anxiety. Most parents (63.8%) removed at least 1 allergen from their home. Peanuts, tree nuts, and sesame were the most common. But families that removed allergens said they had higher levels of worry, anxiety, and lower confidence in managing food allergy compared to families who did not. Children in these households were also more likely to have anxiety.

The study suggests that doctors should ask families how they manage food allergies at home and guide them on how to reduce stress. While the study highlights a connection between removing foods and mental distress, it cannot show that removing foods leads to stress. More research is needed to understand why removing allergens may increase stress and how to better support families dealing with food allergies.

Nasal Food Challenge for Hen's Egg White
A nasal allergen provocation test (NAPT) is a test a small amount of an allergen is put into the nose to test the body’s allergic response. This test is commonly used to test for nasal allergies. A recent study tested whether this type of test could help diagnose food allergies.

The researchers studied if these tests could help diagnose allergies to the egg whites of hen’s eggs. The researchers studied 57 people – 32 with an egg allergy and 25 people without an egg allergy. They put egg white allergens on the nasal passages and measured reactions using symptom reports, blood flow tests, and specific immune markers. Results showed some nasal response in allergic people. This suggests that NAPT could be a useful tool for diagnosing food allergies. But more research is needed to make it a standard method of testing and confirm that it’s accurate.

Factors that Help and Hurt Reintroducing Food After Passing an Oral Food Challenge
An oral food challenge (OFC) is the gold standard test for diagnosing food allergy and telling if someone has outgrown a food allergy. Many children and teens who pass an OFC have trouble regularly eat the food they were once allergic to, even if their doctor recommends it. A recent study looked at previous research from 9 countries to understand how often food reintroduction happens and what helps or hurts it.

Success rates varied widely, from 14% to 86%. Up to 50% didn’t keep up with reintroduction. Common barriers included fear, anxiety, symptoms after eating, and refusing food. Younger children, boys, and families receiving guidance from their health care provider were more likely to succeed. The findings highlight the need for better support and clearer guidelines to help families maintain food reintroduction after passing an OFC.