Trace amounts of peanuts that might prove deadly for a few allergic classmates have nearly eliminated the old peanut-butter-and-jelly staple from many school lunchrooms. But there is another, less overtly dangerous — yet still challenging — food allergy some kids might face.
Typical food allergies, like those to peanuts, happen when a person’s own antibodies improperly target otherwise harmless food proteins. A lot of the time, kids grow out of these allergies.
But Jonathan Spergel, an allergist and researcher with the Children’s Hospital of Philadelphia, has found that growing out of that type of allergy doesn’t necessarily mean kids are home free for life.
“About two to three years later, after adding that food into their diet, they now present with new symptoms,” said Spergel. “These [are gastrointestinal] symptoms, the trouble eating symptoms, the belly pain — so now they’ve gotten eosinophilic esophagitis to the same food they had hives to when they were younger.”
Eosinophilic esophagitis, or EoE for short, is relatively rare, affecting only one in every 2,000 kids. It’s named for a type of white blood cell that begins collecting in and inflaming the throat. Unlike traditional food allergies, there is no risk of anaphylactic shock, but it’s not something children can expect to grow out of, either.
In the latest study, which was presented this week at the American Academy of Allergy, Asthma & Immunology (AAAAI) meeting in San Diego, Spergel tracked more than 400 children with EoE stemming from an identifiable food allergen. He found 17 cases where EoE cropped up after the child had grown out of a typical food allergy following the consumption of the same formerly forbidden food.
As with all EoE cases, the most common culprits were milk, eggs, wheat, and soy.
“It’s a piece of bread; it’s pasta,” said Spergel. “It’s things you eat every day.”
Spergel noted that other researchers at the AAAAI meeting have seen similar numbers of kids with typical food allergies developing EoE following experimental programs in which they slowly build tolerance to the foods that give them trouble.
“Anywhere from about 5 to 15 percent of the patients going under oral immunotherapy — which is sort of a forced way to make patients outgrow it — get EoE,” said Spergel. “So, whether you outgrow it by natural history or you do it through oral immunotherapy, patients get EoE to that.”
Knowing the same food can be a trigger for EoE should help in the clinic, Spergel said, and is the first step in finding other treatment options, which right now are limited to avoidance and steroids.