Learn about our advocacy efforts on improving food allergen labelling and our attendance at an important conference with experts and key stakeholders from around the world. Plus, check out our Science Corner article on a potential alternative for peanut oral immunotherapy, and take a listen to our audio recording featuring Dr. Harold Kim on needle-free epinephrine options for treating anaphylaxis.
Advocacy: Advocating for improved food allergen labelling
As part of our long-term advocacy initiatives on ensuring greater access to accurate ingredient information, we took part in the 47th Session of the Codex Committee on Food Labelling in Gatineau, Quebec last month.
Codex develops internationally recognized standards, codes of practice, guidelines, and other recommendations relating to food, food production, and food safety. This meeting brought together delegates from over 50 countries and international government and non-governmental organizations, including representatives from the World Health Organization (WHO) and Food and Agriculture Organization (FAO).
Discussions included allergen food labelling standards, use of technology and ecommerce in food labelling, and precautionary allergen labelling (“may contain” statements). As a delegate, we met with global food safety experts from around the world, and participated in the consultation process to provide the consumer perspective on these important issues.
We are your voice at these sessions. As the only Canadian food allergy patient association in attendance, we acted on your behalf and provided recommendations on how to improve current food allergen labelling standards, including precautionary allergy labelling (“may contain” statements) to help those with food allergy make more informed choices.
Science corner: Boiled peanuts – a promising alternative for peanut oral immunotherapy?
The processing method of peanuts and what it may mean for peanut oral immunotherapy is summarized in this article from Danielle Della-Libera and Joshua F.E. Koenig, Ph.D. – Researchers at the Schroeder Allergy and Immunology Research Institute at McMaster University.
Read below to find out about peanut allergenicity and potential implications for treatment.
Researchers have long observed that while the prevalence of peanut allergy is on the rise in North America, it is comparatively low in other regions like China and Southeast Asia. The differences may be due in part to processing methods: dry roasted peanuts are typically eaten in North America, while fried, steamed, or boiled peanuts are more often consumed in the other regions.
A recent study investigated the use of boiled peanuts as a potentially safer alternative to the current use of dry roasted peanuts for oral immunotherapy (OIT). OIT involves consuming small doses of the food allergen and slowly increasing this dose overtime. While on treatment, patients can experience mild or moderate adverse allergic reactions such as itchy mouth, abdominal discomfort, nausea or vomiting. Patients on OIT also have a greater risk of severe adverse reactions, such as anaphylaxis. There is interest in improving the treatment to help avoid such events, and this study provides some interesting possibilities.
In this study, patients underwent three sequential phases of OIT and consumed:
- 12-hour boiled peanuts for 12 weeks,
- 2-hour boiled peanuts for 20 weeks, and
- Dry roasted peanuts for 20 weeks.
Results showed that 80% of participants were desensitized by the end of the 15-month study.
The researchers then compared their results to those from other published OIT studies, and made two significant observations:
- The use of boiled peanuts showed greater efficacy, with a higher proportion of patients continuing to consume peanuts 12 months following the study.
- Results suggested that patients subjected to boiled peanut OIT experienced fewer severe adverse reactions relative to studies involving dry roasted peanuts.
How do differences in peanut processing affect clinical reactivity?
Immunoglobulin E (IgE) antibodies cause allergic reactions by binding peanut proteins and triggering immune cells to react. Given this, researchers first tested how IgE binds to dry roasted versus boiled peanuts in patients with peanut allergy. They found that IgE showed greater binding to dry roasted peanuts, suggesting that differences in clinical reactivity between countries could be attributed in part to these processing methods.
It turns out that the dry roasting of peanuts results in the addition of sugars called “advanced glycosylation end products”, or AGEs, onto the peanut protein. AGEs are detected by dendritic cells (a specific type of immune cell) which sense AGEs as “danger signals” and initiate an immune response against the peanut protein. In contrast, the boiling of peanuts does not add AGEs to the peanut protein.
While IgE from patients with peanut allergy is less capable of binding boiled peanut proteins, this does not mean that boiled peanuts are “invisible” to the immune system. Both boiled and roasted peanuts can be detected by other immune cells, called T cells, which are the master coordinators of allergic immune responses against foods. Since AGEs are not present on boiled peanuts, the researchers hypothesized that using boiled peanuts during OIT would cause less severe allergic reactions while maintaining T cell desensitization.
What are the implications of this research?
Studies have shown that allergy returns in more than 80% of patients who stop ingesting peanut daily; therefore, the therapy must be continued indefinitely for most people. Further, allergic reactions that require a hospital visit are reported even in those who are desensitized through OIT. What remains to be seen is how boiled peanut OIT directly compares to current OIT methods in terms of allergy recurrence and safety. While these researchers have found potential benefits to using boiled peanuts, comparisons across studies are difficult to make due to differences in administration, dosages, and regimens.
Preliminary evidence from this study suggests that boiled peanut OIT may be a viable alternative to dry roasted peanut OIT. However, additional research including a direct comparison of the two is needed to provide conclusive evidence that this is the case.
Do you have a question about this article for the researchers? If so, send it to us at info@foodallergycanada.ca and we may feature it in an upcoming newsletter.
Research: Needle-free epinephrine for treating anaphylaxis
There is evolving news on the research and development of needle-free options for the treatment of anaphylaxis. It is a timely topic, and one that we cover in our new Listen and Learn audio series. Listen to our inaugural episode with Dr. Harold Kim to learn more about the potential alternatives to epinephrine auto-injectors.
Tags: Listen and Learn, needle-free epinephrine