Able to pinpoint who has food allergies, experts at the Mass General Food Allergy Center are also working on new ways to prevent life-threatening reactions.

For children and adults with food allergies, even a tiny bite can cause swollen airways, hives and digestive problems, or in severe cases, a life-threatening reaction called anaphylaxis. Food allergies have become about 50 percent more common over the past decade, estimates Wayne Shreffler, MD, PhD, director of Mass General’s Food Allergy Center (FAC).

One summer day nine years ago, Susan Fitzpatrick’s infant son, Connor, woke from his nap screaming. His face, hands and body were swollen beyond recognition. They raced to the hospital for treatment and testing. It turns out that he was allergic to peanuts, milk, eggs and soy. “It felt like danger was everywhere,” recalls Susan.

“It felt like danger was everywhere,” Susan Fitzpatrick recalls.

Seamless Care for Food Allergies

“Fortunately, these are largely preventable and treatable,” says Dr. Shreffler, who is also chief of Pediatric Allergy and Immunology at MassGeneral Hospital for Children and co-author with FAC colleague Qian Yuan, MD, PhD, of “Understanding Your Food Allergies and Intolerances.”

About 5-6 percent of all children have at least one food allergy. Most common are allergies to milk, egg, soy and wheat (which are frequently outgrown in children), and peanuts, tree nuts, fish and shellfish (which tend to be lifelong).

Lisa Stieb, RN with Connor, now in the fourth grade, and his mother, Susan.
Lisa Stieb, RN, with Connor Fitzpatrick, now in the fourth grade, and his mother, Susan Fitzpatrick.

Mass General’s Food Allergy Center is one of few in the country to offer seamless care from childhood through adulthood. The center is also renowned for its active clinical and research program for another food allergy-related disease called eosinophilic esophagitis (EoE), a chronic disease affecting the esophagus. Because people are affected in different ways by these food-related diseases, staff expertise includes allergists, gastroenterologists, nurses, nutritionists and a psychologist.

Hidden Dangers

Navigating a world where allergens can be hidden in foods at school, in restaurants, at birthday parties and on grocery shelves is initially frightening for many. Though many people with food allergies won’t ever have an anaphylactic reaction, everyone diagnosed must always carry an epinephrine autoinjector, a device that contains an injection of epinephrine, just in case.

Lisa Stieb, RN­, a pediatric allergy and pulmonology nurse at the center, knows all about the challenges of parenting a child with allergies. Her two sons, now ages 23 and 18, have multiple food allergies. “You know there’s going to be a reaction sometime, like a firefighter knows some day there will be a fire, but you don’t know when,” she explains. “You have to be prepared.”

Both of Sarah Wolfgang’s children, Lola and Miles, ages 6 and 4 respectively, have food allergies and have been seeing Dr. Shreffler since 2010. “We’re a lot less scared now,” Sarah says, attributing that to Dr. Shreffler’s kind and encouraging approach. She recalls him patiently responding to her numerous communications about hives on Miles. “It’s very easy to become fixated on food,” she says.

Taking the Food Challenge

Often food allergies are diagnosed based on a skin prick test or a blood test, but both tests are prone to “false positives.”

Sarah and Susan originally brought their children to Dr. Shreffler for a second opinion. Often food allergies are diagnosed based on a skin prick test or a blood test, but both tests are prone to “false positives.” Over-diagnosis leads to unnecessary food restrictions and under-diagnosis can be life-threatening. In many cases, the only way to really know is to give the suspect food itself in increasing doses over four hours in a carefully controlled environment. Called a “food challenge,” this is the gold standard of diagnosis, says Dr. Shreffler.

In the FAC, a food challenge is often done to see if a child has outgrown a food allergy. Susan’s son Connor can now eat milk products and all but three tree nuts. Milk means ice cream, yogurt, cheese and pizza. “Passing a food challenge is like waiting to hear if your kid gets into college,” Susan says.

There’s a high demand for food challenges. Mass General’s Food Allergy Center performs about dozen each week and is working to expand its capacity. New research efforts are also underway to develop new tests and better apply existing tests in order to reduce the need for food challenges and the risks associated with them.

Looking for Options

With the only treatment currently being to eliminate the offending food from the diet, FAC researchers are actively investigating treatment options. Dr. Shreffler is researching oral immunotherapy, for example, to gradually reintroduce the food and develop tolerance.  Unfortunately, they have found that tolerance doesn’t always last and are trying to find out why.

Dr. Shreffler, parents Sarah Wolfgang and Susan Fitzpatrick, Connor and Lisa Stieb, RN.
Dr. Shreffler, parents Sarah Wolfgang and Susan Fitzpatrick, Connor and Lisa Stieb, RN.

Another important study underway is the Peanut Allergen Threshold Study to figure out who is most highly allergic, how to better identify those individuals and the level of peanut allergen in foods that is safe for them. “If we knew who is most apt to have a severe reaction, then we could focus more preventative or even research attention toward them,” Dr. Shreffler says.

An Avenue for New Therapies

The center is actively expanding. Dr. Shreffler has recruited new faculty with expertise in the microbiome, the microrganisms that co-exist in our bodies. Changes in the microbiome are suspected to contribute to the rise in food allergies.

Changes in the microbiome are suspected to contribute to the rise in food allergies.

“The key to allergies is out there,” Susan believes. She and Sarah lead a dedicated group of parents who support each other and fundraise for the Food Allergy Center.

“With Dr. Shreffler’s help, the dangers are increasingly manageable for our family,” Sarah says,“but we also hope that through research, there will be new options for treatment and better diagnosis.”

To learn more about supporting Mass General’s Food Allergy Center, please contact us.