Monday, April 27, 2015

Funding better "biomarkers" for food allergies

Update 5/1/15: Congratulations on surpassing the $50,000 funding goal before the April 30th deadline! Here are two wonderful summaries of the effort: Caroline Moassessi of Grateful Foodie and Henry Ehrlich at Asthma Allergies Children weigh in.

When our food allergy journey started out, one of the most challenging things to wrap my head around was allergy testing. I distinctly remember looking incredulously at our allergist and thinking, “You mean to tell me that a “positive” blood test or that giant hive from a skin prick test doesn’t necessarily mean our son has a REAL food allergy? What good is that?!”
Two common allergy tests rely on the IgE antibody as a "biomarker." The tips of the IgE antibody recognize specific food proteins, such as those found in a peanut. Blood tests measure the amount of IgE for a specific food that is found in the blood and skin prick tests look for the result of a food protein binding to IgE attached to a mast cell in the skin. The release of histamine (among other chemicals) causes the wheal or hive in a skin prick test. Image source: Atlas of Allergic Diseases

What I have learned over the course of several years is that there really are no great tests for food allergies – i.e. “biomarkers” –aside from actually consuming the food (oral food challenge supervised by a clinician). The two common current methods of testing - blood tests measuring food-specific blood IgE levels and skin prick tests that scratch the allergen into the skin surface are not a great tests because they frequently give “false positive” results. A “false positive” means that a person may test “positive,” but truly isn’t positive should they actually consume the suspected food. Frustrating. On top of this, most current testing methods that rely on IgE as a “biomarker” cannot predict how severe the allergy is. The only sure way to test for a suspected food allergy is to go to your allergist’s office and perform the supervised oral food challenge – you know, the test where you actually eat the suspected allergen and wait for a response. Having done this with my son several times now, I can’t stress enough just how stressful this stressful test is. There has to be a better “biomarker” – a test without the stress and risk of a reaction that can better predict an allergy and its severity. 

Image source: Selena Bluntzer from Amazing and Atopic

To help solve this problem, Dr. Xiu-Min Li, Professor of Pediatric Allergy and Immunology at the Icahn School of Medicine at Mount Sinai, and board-certified allergists Dr. Paul Ehrlich and Dr. Purvi Parikh designed a collaborative, practice-based study whose primary objective is to figure out better biomarkers of allergy (details of the study and how you can directly fund the study).

Why better biomarkers of allergy?

The overall goal of Dr. Li’s research is a bona fide cure for food allergies. In the past decade, Dr. Li’s lab has made great strides in understanding how formulas of Traditional Chinese Medicine (TCM) turn down (or completely off!) the allergic response. Studies using animal models are incredibly promising and now her lab aims to translate these results to people. Better biomarkers are an essential piece of this translation. Researchers honestly need a better way to quantify how and if treatments may be working without repeated oral food challenges. The beautiful aspect of this study is that it not only benefits those undergoing treatment for food allergy, but potentially anyone with a suspected or current allergy.

Potential benefits for my son (or anyone receiving the typical standard of care for allergies):

My seven year old son has multiple food allergies - i.e. he is polysensitized - since he was about a year old. In order to monitor JR’s allergic status, his allergist orders a blood test roughly once a year that measures food-specific blood IgE levels. If there is a downward trend in those numbers AND it is low enough, our allergist recommends the stressful oral food challenge. My son has reacted to foods on at least three occasions, meaning the allergy was not in fact gone. Once again this highlights that we need a better biomarker. The second benefit that I see is that even though my son is not receiving Dr. Li’s TCM treatment or enrolled in a clinical study, Dr. Li’s treatment provides my son with the greatest sense of hope for a treatment. Because he is “polysensitized,” other treatment options such as oral immunotherapy (OIT) seem daunting. He would spend years in a doctor’s office! TCM treatments promise to take care of multiple allergies at once.

A changing paradigm – YOU can help directly fund the research!

One of the coolest things that I have seen in science the past few years is the ability for people to contribute to funding research studies of their choice! The traditional funding paradigm for a University researcher heavily relies on writing and being rewarded research grants, often through the National Institutes of Health. In other words, we are all supporting research through our tax dollars, but we as an individual have little say in how that money gets allocated.

This system has worked for decades, yet one of the big problems in recent years is a bit of “a chicken or an egg” problem. As competition for grants has increased and funding has dwindled, a researcher needs to generate increasing amounts of preliminary data to “prove” likely success and actually get their proposal funded. Yet how can preliminary data be generated if they actually don’t have money to do any research (they’re applying for a grant after all!)? While private foundations or non-profit organizations are a common source of money to bridge that gap, it turns out that YOU are, too!

The biomarker study is a small step that will hopefully generate preliminary data for a larger, more in depth study. How cool is that?! Check out the research for yourself and if you support the research, you can directly make a tax-deductible contribution. I’m excited to see where this directly citizen-funded science will go! April 30th is the deadline and they are about $5000 shy of the $50,000 goal.

Contribute to the biomarker study:

Even more info:

A very good, thorough interview with Dr. Li about how the TCM treatment may work and the role this biomarker study plays in her research vision. What I absolutely love about this is that it highlights the many complex players involved in allergy/immunity. In other words, we may need multiple biomarkers assessed together for an accurate picture of true allergy! Obviously outcome is TBD.


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