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Egg Beater: Overcoming A Food Allergy

Egg Beater: Overcoming A Food Allergy

CREATED Apr 29, 2013

CHAPEL HILL, N.C. (Ivanhoe Newswire) - For 15 million Americans with food allergies, what they eat could kill them. The problem seems to be on the rise too. The CDC reports an 18 percent increase between 1997 and 2007. Now, doctors discovered something that is helping some beat their allergies.

Hannah Gooch loves the ukulele and a food that could have killed her.

"I really like how they taste," Hannah Gooch told Ivanhoe.

Hannah was allergic to eggs, but not anymore.

"It's a huge thing. I mean it makes me kind of teary thinking about it," Necia Joy Gooch, Hannah's mom, told Ivanhoe.

She took part in an egg allergy study led by Dr. Wesley Burks, Professor and Chair in the Department of Pediatrics at North Carolina Children's Hospital.

"There's no proactive treatment and that's the reason this study was done," Wesley Burks, MD, told Ivanhoe.

Kids with the allergy ate egg protein every day.

"They'd give me a dose of egg protein in powder," Hannah said.

"We mixed it with applesauce," Necia Joy said.

About once a year, they would eat a real egg to test their tolerance.  At the end of three years, 45 percent of the kids were able to add egg to their diets.

"They just said Hannah can have egg and we were all surprised" Necia Joy explained.

Dr. Burks said the results are promising.

However, "more phase two and then more phase three studies need to be done before we can say yes, it's the right thing to do," Dr. Burks explained.

It's changed Hannah's life.  Now she can focus on her music, not her old allergy.

Dr. Burks said further studies testing the egg allergy treatment are in the works. He said if successful, it could be applied to other common food allergies, like milk and peanuts.

RESEARCH SUMMARY

BACKGROUND: Eggs are the most common food allergy in children.  Egg allergy can occur at infancy. Most children outgrow their egg allergy before they hit adolescence, but in some instances it can continue into adulthood. Egg allergy symptoms will usually occur a few minutes to a few hours after eating eggs or foods containing eggs. Symptoms can be mild to severe and include: hives, skin rashes, nasal inflammation, and vomiting or other digestive problems. Egg allergy can also cause a life-threatening reaction called anaphylaxis, although it is very rare.  (Source: www.mayoclinic.com)

CAUSES: All food allergies are caused by an immune system overreaction. The immune system mistakes certain egg proteins as harmful.  Whenever someone comes in contact with egg proteins, immune system cells recognize them and signal the immune system to release histamine and chemicals that cause allergic symptoms and signs.  Egg yolks and egg whites can both cause allergies, but allergy to egg whites is the most common.  (Source:www.mayoclinic.com)

HIDDEN SOURCES OF EGG PRODUCTS:  Even if a food is labeled egg-free it still could contain some allergy causing egg proteins.  Foods that contain eggs can include:  marshmallows, mayonnaise, meringue, sauces, frostings, processed meat (like meatballs and meatloaf), pudding, salad dressing, pastas, root beer, and some alcoholic drinks.  Nonfood products that contain egg products can include: medications, shampoos, cosmetics, and finger paints.  (Source: www.mayoclinic.com)

NEW TECHNOLOGY:  The study at the University of North Carolina School of Medicine found that by eating small amounts of egg every day for many months lowered the number of allergic reactions in 75 percent of egg-allergic children; 28 percent were able to incorporate egg into their regular diets after two years on the treatment.  The intent of the study was to develop a new treatment for egg allergy since the only option so far has been to avoid eggs altogether. The study enrolled 55 children and adolescents between the ages of five and eighteen who had egg allergies.  Participants were given small amounts of powdered egg or a placebo to mix into food, eventually building up to the equivalent of a third of an egg.  Children on the treatment did experience allergic reactions to the egg powder during the first couple of months of the study, but none had a severe reaction.  At the 10 month mark, researchers administered an "oral food challenge" to test the study participants' reactions to eating 5 grams of egg powder, which is equivalent to an entire egg.  Fifty-five percent of participants on the treatment passed the challenge without significant allergic symptoms.  None of the participants on the placebo passed the challenge.  Researchers gave another challenge after 22 total months on the treatment.  They were given 10 grams of egg powder, which is equal to nearly two eggs.  Seventy-five percent passed the challenge.  Those who passed stopped doing the treatment.  After two years, those who had discontinued the second challenge were administered a final test.  They were given 10 grams of egg powder and one cooked egg; 28 percent of the original treatment group passed and were able to integrate eggs into their lives.  Dr. Wesley Burks says, "Now, at the end of the third year of treatment it was 45 percent that were able to come off the food and incorporate egg into their diet."  Researchers believe that the study brings hope for treating egg and possibly other food allergies, but further research will be needed.  (Source:www.unchealthcare.org)

INTERVIEW

Wesley Burks, MD, Chair of the Department of Pediatrics, Physician, and Chief at North Carolina Children's Hospital, talks about a new study that could mean the end for egg allergies.

Doctor if you could, tell us a little bit about this study. Why did you choose to do a study on egg allergies?

Dr. Burks: We know that about 15 million people in the U.S. have food allergy; of that 15 million about 4 million of them are kids. The three foods that cause most allergic reactions are milk, egg, and peanuts. One of the most problematic, accidental reactions are from eggs and that is why we chose an older group of kids that were not going to outgrow their egg allergy to see if we can make it go away.

What are some of the symptoms that go along with egg allergies that make it dangerous?

Dr. Burks: The symptoms of any food allergy are related to the skin, the respiratory tract, and the GI tract. Skin symptoms include hives or whelps and can be an itchy, red rash. Respiratory symptoms are coughing, wheezing, or swelling of the throat. The GI symptoms include vomiting; sometimes maybe severe abdominal pain or diarrhea.

How long does the symptoms last?

Dr. Burks: After a child accidentally ingested an egg, literally within seconds to minutes or at the most within 2 hours, they will begin to have symptoms. It may be just skin or it may be skin, respiratory, and GI. The symptoms typically last somewhere between 2 and 4 hours. They will not go on into the next day because the body begins to get rid of the foreign antigen. That is what that allergic reaction does; it helps get rid of the food.

It is hard to avoid eggs, because it is in everything we eat almost. What are some of the treatments, if any, for egg allergies at this point? 

Dr. Burks: Right now, the best treatment is an appropriate diagnosis to help the child and family know that they are truly allergic to egg and not allergic to other things. Then, we help them avoid it. There is no proactive treatment and that is the reason this study was done, to develop an active treatment.

Can you explain the process of the study?

Dr. Burks: These are children older than 5 years of age who had had long-standing egg allergy. We did not expect them to, based on this criteria, outgrow their egg allergy anytime during the study for the next 3 years. As we entered the blinded study, several centers were involved through the Consortium of Food Allergy Research; 40 children received treatment and 15 received placebo. The paradigm of treatment is starting out at a very low dose and building up to a daily dose, but receiving a new dose about every 2 weeks. It took about 4 or 5 months.

What did you see in the kids with the small doses? Was there any reaction at all during the process? I noticed after it said 10 months that it lowered the threshold for the allergic reaction, but did they have any symptoms on a day-to-day basis?

Dr. Burks: For the daily dosing, you basically take an egg white powder and mix it in food. Less than 10 percent of the kids had local side effects to actually taking the treatment. A few had to drop out, but that was a really small number. So, we were able to build each child up to a specific dose and then at the end of the 10 months, we did a food challenge to find out how much egg they would tolerate while they were on treatment.

How did that go?  

Dr. Burks: We saw that out of the group that was treated, of those 40, over half of them were able to tolerate the whole challenge that we did with the egg. None of those in the placebo group were able to tolerate the challenge. So, there was a significant difference in those on treatments and to those not on treatments. 

Then you used another food challenge after 22 months. Is that correct? 

Dr. Burks: The study design was that those that were already on treatment, those 40 for the first year, continued on treatment for a second year. Those that were on a placebo, we just observed until that second year. At the end of the second year we did another challenge. Now, 75 percent of them tolerated that challenge. 

What was your reaction when you saw that? 

Dr. Burks: We had expected that it would be an incremental amount, not 50 percent greater the second year that would tolerate the challenge. However, then we wanted to try to find out if that treatment can be permanent rather than just sustain the change in threshold while you are on the treatment. We took them off the treatment at the end of those 22 months.  So, 75 percent were able to tolerate the food while on treatment, but we stopped the treatment and then that number goes back down to about 27.5 percent. So, many of them lost that protection just in that month.

So it seems like it can help a lot of people, but is it ready to be widespread yet?

Dr. Burks: If you think about the normal development process of a new drug, which what is being done is in fact using a food as a drug to treat someone and walking through the FDA where there is a Phase 1, Phase 2, and Phase 3 process. This study is kind of the in the middle of a Phase 2 process.  We want to know more about the safety of which this study did and we have proven the efficacy in a blinded study. More Phase 2 and then more Phase 3 studies need to be done before we can say that it is the right thing to do.

So do you have plans for that next phase? 

Dr. Burks: So, the Consortium of Food Allergy Research has plans with egg and other allergens to go to the next step. There are also national organizations, like The Food Allergy and Research and Education (FARE), a nonprofit foundation, and others are looking at ways to try to gather the support to do that next series of Phase 2 and Phase 3 studies. So, we really could have a product that would be approved that can be used for treatment.

What would treatment be like? Would it be like a daily pill that they would take that would contain some of that egg powder? What would be the end goal for treatment if this works? 

Dr. Burks: The first goal really would be for the development of a treatment that would protect a child from an accidental reaction. The second goal would be to develop a treatment that we can actually give someone for a period of time and make that disease go away. It may be a daily powder put on food or a capsule or some other way. I think that is what remains to be determined in the rest of those phases 2 and phase 3 studies.

When can we expect those to start or have they started? 

Dr. Burks: I think some have already started, nationally and internationally, trying to develop other protocols so we can get a better idea.

What are the implications of this for other food allergies, like nuts and some of the more common ones?

Dr. Burks: If this paradigm works for egg allergies, which there are indications that it does, there is not any reason to believe that we cannot do this same type of process for milk, peanut, for other tree nuts, and for shellfish. Based on previous similar studies, that same paradigm will work for those other foods.

So this is pretty exciting stuff then?

Dr. Burks: I think the two things that we get out of the study: one is that there is promise for the development of a treatment; that this is an exciting development that really is in the middle stages of a new product being developed; and the second thing is that it really is still in the development. We are not ready to do this clinically yet. It is not something to be used in practice at this time. It does give us promise, but we are not quite there yet.

FOR MORE INFORMATION, PLEASE CONTACT:

Danielle Bates
Communications Manager
North Carolina Children's Hospital
(919) 843-9714
dbates@med.unc.edu