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Photos by Erin Nelson.
A weekly schedule for the oral immunotherapyprogram at the Alabama Asthma and Allergy Food Treatment Center in Homewood.
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Photos by Erin Nelson.
Milked versions of nuts are one of the ways the oralimmunotherapy program slowly introduces foods that contain allergens.
Sleepovers, company lunches, trick-or-treating, new restaurants — for people with severe food allergies, all of these experiences can be off-limits.
Having a food allergy changes the way you interact with the world, from spending time with friends to checking labels at the grocery store. The Food Allergy Treatment Center at Alabama Allergy & Asthma Center works with patients to bring their allergen tolerance down to a safe level so they can reintroduce those everyday experiences into their lives.
“It’s the most rewarding, life-changing treatment that I’ve been involved with ever in my 30-plus-year career, and it’s improving patients’ quality of life, family quality of life by providing freedom, control, peace of mind,” Medical Director Dr. Carolyn R. Comer said. “… There are families that have never eaten out at restaurants, never gone to the movies. It’s amazing when you start hearing these stories.”
Comer has been an allergist for around 35 years, first in asthma but later becoming interested in food allergy treatments after developing a shellfish allergy as an adult. When she first heard of oral immunotherapy (OIT) programs in the early 2000s, she recalls thinking about the amazing possibilities it opened up for patients.
OIT slowly builds a tolerance to an allergen with steadily increased doses of that food.
Comer helped establish the Food Allergy Treatment Center in 2016 to provide OIT programs, starting with peanuts. Since that time, the center has added treatments for tree nuts, milk, eggs, wheat, soy and sesame.
The most recent addition was a sublingual drop therapy, which puts small amounts of allergens under the tongue, added this summer. The sublingual drops don’t deliver the same level of results as regular OIT, Comer said, but the smaller doses mean it is less likely to cause a reaction and is safe for children under 4, enabling treatment to begin earlier.
Introducing allergens in a controlled dose early can help protect them from reactions later.
“Even that low, tiny dose is enough to start altering and changing the immune system’s response, so that’s what’s exciting,” Comer said.
It takes 21 to 27 weeks to reach what Comer called “sustained unresponsiveness,” where patients are able to take a maintenance dose of their allergen and are protected in case they are accidentally exposed. If they want, patients can even begin eating foods they are allergic to as part of their regular diet.
It’s not a cure, Comer said, as the allergy is still there, but the tolerance has been trained so there is very little likelihood of a reaction as long as they keep up their maintenance program.
“We know they’re safe when they take their dose,” Comer said.
The Food Allergy Treatment Center takes its safety protocols seriously to avoid the possibility of a deadly allergic reaction. The center is in a different building from the rest of the Allergy & Asthma Center to avoid contamination, and patients must stay an hour for observation each time they increase their dose.
At home, patients must take daily doses to continue building their tolerance to the allergen, and Program Director Anthony Pallotta said someone at the center has a phone with them around the clock to answer questions. Those questions can range from dealing with an emergency to how to change their dose if they’ve been stressed or ill.
“We have to be there for them just like they’re going to be there for us. It’s a team effort,” Pallotta said.
Comer said the center currently has around 67 people in active treatment programs and an additional 160 or more on ongoing maintenance programs.
Pallotta said new patients and their families are often nervous at the thought of incorporating their allergen into their daily lives.
“They have anxiety before even coming in. They’ve lived X amount of years avoiding, reading labels, really avoiding normal things in life like flying on an airplane,” Pallotta said.
But the possibilities at the end of treatment give them hope, and Comer said it’s rewarding to see the peace of mind as their allergy risk decreases.
“Oral immunotherapy offers the greater potential of becoming more ‘normal’ where they actually can incorporate that food into their diet, eat as much of it as they want,” she said. “… That is life changing.”
