Diana Oh

IR-2/11AP
4/3/18
Turn in Number: 10
Title: Can I Eat That?- Finding the Food Allergy Solution

Purpose

With immunoglobulin-E mediated food allergies affecting an increasing number of

people, a solution to allergies is imperative, as more people are projected to be affected in the
near future. Because cures and prevention methods are currently limited by research, scientists
are considering a third option: a treatment. Oral immunotherapy is an upcoming treatment for
allergies, that consists of feeding a patient the food they are allergic to in order to build higher
levels of desentization. This research evaluates the efficiency and ethics of the treatment in order
to assess oral immunotherapy’s potential as a clinical treatment.

Research Question and Hypothesis

What is the potential that oral immunotherapy is an effective treatment for IgE-mediated
food allergies?

Based on studies in which oral immunotherapy was used to treat IgE-mediated food
allergies, the oral immunotherapy succeeded in allowing patients to consume greater amounts of
antigen. Therefore, it may be an effective measure in preventing allergic reactions.

Is oral immunotherapy an ethical and effective treatment for IgE- mediated food allergies
that can be implemented in clinical practice?

Oral immunotherapy has been used solely in clinical studies, and has been effective in
building desentization. Although no procedure has been standardized, all procedures prioritize
safety; thus, the treatment is ethical. Therefore, oral immunotherapy does have the potential to be
used in clinical practice.

Procedures
● Conducted background research on the biological mechanics of allergies, and current
clinical treatments
● Collected peer-reviewed articles using databases and the UMBC library on oral
immunotherapy for IgE food allergies
● Reviewed and analyzed scientific studies pertaining to oral immunotherapy research
● Contacted Ms. Kim Mudd, senior nurse at Johns Hopkins, who agreed to be an advisor
● Conducted a phone interview with Ms. Mudd
● Contacted allergist, Dr. Silber, from the Allergy and Asthma Center of Central Maryland,
and conducted a phone interview
 ● Closely analyze and review clinical studies that used oral immunotherapy for IgE
mediated peanut allergies
● Design a project intended for the public in order to promote awareness of allergies in the
community

Background Visual 1
Six million children under eighteen years old have immunoglobulin-E mediated food
allergies. The graph above depicts the increase in allergy incidence in all age groups under 18
over the last twenty year. Thus, allergies have become an increasing concern for the American
population. Experts discovered that the prevalence of allergic diseases has increased for the last
50 years and is subject to continue to rise. Although the factors influencing allergy development
are unknown, increased modernization appears to correlate with the increasing frequency of food
allergies. With more industrialization, more people suffer from this condition, and a need for a
solution is urgent. Due to its chronic nature, commonality, and unpredictable symptoms, allergies
pose as a threat to many lives. The Centers of Disease Control tracked the average number of
hospitalizations per year due to allergies, which has more than tripled from 1996 to 2006. The
increase in hospitalizations indicate that there are more people with allergies and people are more
aware of the allergy symptoms and risks they pose on human health.

Background Visual 2
Allergic reactions stem from an immunoglobulin-E response when the immune system
detects a normally non-harmful substance. This substance is known as the antigen and, in food
allergies, this is the food protein. The antigen binds to B-cells, a type of white blood cell, which
triggers the production of immunoglobulin-E antibodies, also known as IgE, for that specific
antigen. The IgE acts as a messenger in the immune system and activates different
immunological pathways, leading to different bodily responses. The most severe pathway is
anaphylaxis, a life-threatening reaction. Anaphylaxis consists of an antigen and
immunoglobulin-E bound to a mast cell, releasing more immunological mediators throughout the
body. The diagram above briefly described and depicts the pathway in which the body responds
to an allergen.

Background Visual 3
As of now, the only known solutions for allergies are avoidance and emergency
medication, such as antihistamines and epinephrine but, with this method, accidents are still
common. Although society has become more aware of allergies, accidents still happen
throughout a patient’s life. Therefore, finding a treatment is imperative, opposed to relying on
emergency medications, such as antihistamines or epinephrine. However, it is also important to
note that prevention is important, as it would prevent the increasing incidence for future years,
and a cure would solve all problems. Thus, a prevention or a cure are optimal solutions, but
research has yet to reach this point. Therefore, the last option must be considered and pursued: a
treatment.

Background Visual 4
Oral immunotherapy (OIT) builds higher levels of desentization. Desensitization is the
difference in the dosage of the consumed allergen that is required to trigger an allergic reaction;
therefore, a patient to eat a greater amount of the antigen before reacting. OIT consists of orally
feeding the patient an allergen through the food source, and gradually increasing the dosage. If
the dose is not tolerated, the patient remains on the same dose for longer periods of time, or if the
patients experiences more than a mild reaction, the dose is decrease to a dose that was tolerated
preciously. Only when the current does is tolerated does the patient receive a higher one; this is
known as updosing. Generally, OIT is used to build desentization to a specific antigen. This
diagram depicts the standard method for oral immunotherapy treatment and the gradual increase
antigen consumption.

Results

Topic Study 1- ​Narisety Study 2- ​Varshney Study 3- ​Vickery

● Physician ● Those with ● Excluded if there

diagnosis was history of were life
require reactions within threatening
● Positive skin 60 minutes of reactions,
prick test ingestion wheat/oat
● A positive ● Positive skin allergy, severe
reaction to at prick test atopic dermatitis,
least 1,000 mg of ● Excluded if there asthma, and
peanut was a history of participation in a
Eligibility
● Excluded if there anaphylaxis, food allergy
was a history of asthma, atopic study within the
severe dermatitis, same year.
anaphylaxis, allergies to oat, ● Positive skin
hypotension or or inability to prick test
neurological temporarily
compromise, discontinue
allergic reaction antihistamines
to placebo,
 atopic dermatitis,
asthma, and a
diagnosis of
eosinophilic
esophagitis

● Started with a ● Updosing ● There were two

0.1 mg dose and occured only at groups: high
escalated to 6 mg the research dosing and low
on the first day facility where dosing
● The escalation emergency ● The high dosing
always occured medications and group escalated
at the facility, staff were with 3000 mg
which was available per day.
visited every 1-2 ● Started at 0.1 mg ● The low dosing
weeks over 16 of the protein group escalated
Updoing Method weeks ● Doses were with 300 mg per
● The goal was to doubled every 30 day.
reach an increase minutes ● The 300 mg dose
of 2000 mg per ● Increasing stop is mixed with
day during an once 6 mg was 2700 mg of
updosing period reached or a placebo, so there
● For a longer reaction occurred is no
therapy, ● The next starting identification
dose would be between the two.
the highest
tolerated dose

● This study was ● There was a 2:1 ● The placebo was

conducted to ratio of patients oat flour
compare SLIT who received the ● For a low
and OIT, thus the peanut or the dosage, there
placebo for OIT placebo was placebo
is paired with ● The placebo was mixed in order to
Placebo active SLIT toasted oat flour compensate the
● The placebo OIT ● Underwent the volume
and the active same procedures
OIT were in a
1:1 ratio
● The placebo was
oat powder

● If the patient ● If 1.5 mg could ● 3 subjects

Dropout Rate developed any of not be tolerated, withdrew due to
the conditions the subject was due to severe
 that made them forced to drop reactions
ineligible ● 3 subjects ● If the patient
● 5 subjects withdrew due to developed any of
withdrew during allergic the conditions
the blinded symptoms that made them
therapy ineligible

● Took daily home ● Peanut free diets ● There was no

doses over the outside of the home dosing
course of 16 treatment
weeks, and ● Kept journals of
received dose symptoms and
increases every missed doses
1-2 weeks at the ● Given
facility epinephrine
injectors and
pagers for
emergencies
● Did not does if
Home Dosing
ill or tired
● Eat with full
stomach
● Dosing occured
if subject missed
less than 3 doses
per a day
● Returned to
observation if
more than three
doses were
missed

Conclusion
The three oral immunotherapy studies indicate that safety is the first priority of the
treatment. The studies excludes those with deadly reactions or respiration problems, ensuring
that the patients are healthy and are at low risk during treatment, so, if a reaction does occur, the
patient is not in danger. If patients were concerned about their health, they were eligible to drop
out at any point. Additionally, all updosing, the procedure that induces the most reactions, was
done in research facilities in which there are many physicians and health professions who can
help if a dangerous reactions occurs. Home dosing is relatively safe as well, since families are
given strict instructions and emergency medications. Therefore, the treatment is ethical and
promotes patient safety.
 Additionally, all three studies are vetted and well constructed. In order to measure the
effect of oral immunotherapy on the level of desentization, a placebo group was designated in all
the studies, which increases their validity. However, all the studies were conducted in order to
assess different aspects of oral immunotherapy; therefore, slightly different procedures were
used. Thus, it is difficult to assess at this point, whether this treatment is ready for clinical use.
More studies must be compared in order to more accurately conclude the efficiency of the
procedures and its potential for clinical use.

Learning Outcomes
Throughout the year, I have learned about food allergies and allergy treatment,
specifically oral immunotherapy. However, in the process, I also learn more about myself and
my style of research. The most important lessons were:
● Pace myself and schedule projects ahead of time
● Ask for help when it is needed. It is better to ask and do it right than to guess and
do it wrong.
● Always do background research. It not only builds better understanding of the
topic, but also boosts confidence when speaking with experts.

Overall, the experience was fulfilling and I have had a wonderful time presenting and
sharing my research. Through this experience, I was able to improve my public speaking skills,
along with my researching skills. I look forward to improving my presentation and sharing it
with other students as well as adults in order to promote awareness of allergies in the
community.

Name Plate

Diana Oh

River Hill High School: G/T Independent Research

Advisor: Kim Mudd

Johns Hopkins Pediatrics