Food allergy treatment considerations change as patients age and take into account both immunologic factors and social factors, among others. The results of a study evaluating the potential for prenatal protection against food allergies and a survey assessing the knowledge of school health workers were presented at the American College of Allergy, Asthma & Immunology (ACAAI) 2024 Annual Scientific Meeting.

Following these presentations, featured expert Sayantani Sindher, MD, was interviewed by Conference Reporter Associate Editor-in-Chief Mona Shah, PharmD. Dr Sindher’s clinical perspectives on these findings are presented here.

Many factors play into food allergies, including patients’ genetics, environmental exposures, diet, microbiome, medications, and chronic conditions, so it is actually quite challenging to study how one thing can decrease or increase a person’s risk of food allergies. The role of environmental, immunologic, and multiomics-related factors in the development of food allergies, atopic dermatitis, and other allergic outcomes are being actively studied in the SunBEAm birth cohort trial. Hopefully, we will have some early data from this study within the next couple of years.

Anna Cherian, MD, RD, and colleagues evaluated whether there is a protective effect against food allergies with prenatal fatty acid supplementation in black children in abstract R249 at the ACAAI meeting. The results did not show a significant difference in levels of prenatal docosahexaenoic acid (DHA), an omega fatty acid, at any time during gestation between children with food allergies and children without food allergies. However, the authors concluded that taking a supplement to increase DHA levels during pregnancy could be linked to a lower risk of food allergies in young children. I think that more data are needed, and I did not feel that the conclusions matched the results.

The diagnosis of food allergies is the murkiest in infants because many things can trigger a rash in these patients, and it is sometimes very difficult to tease out a benign rash vs a food allergy–triggered reaction. When they are older (ie, preschool or elementary school aged), this can become a little easier, and, by the time that they are teenagers, their clinical history is fairly easy to follow. The problem in this age group, however, is that these patients often do not adhere to recommendations and have more risk-taking behaviors, so that is an element of the adolescent that becomes a little more difficult to treat.

We often hear from school-aged children that they reported a reaction in a school setting and even said something like, “This is what I need,” but they were not taken seriously, the family was not called, or the family had to go to the school and say, “Please give epinephrine.” So, there can sometimes be a disconnect between the school team’s management of food allergies and what we recommend patients and families to be doing. At the ACAAI 2024 Annual Scientific Meeting, Amber Arias et al evaluated school health staff knowledge about food allergies (abstract R254). They found that there was a lot of misunderstanding about product labeling. Only 37% of school health staff knew that the quantity of an allergen does not influence product labels, and 75% incorrectly reported that “may contain” and “shared equipment” statements are mandated by law. Part of the problem is that there is no standardized government-regulated food allergen labeling process at this time, which can lead to confusion. I think that this poster really highlights how we need to provide more education to help health teams within the schools.

We tend to focus more on infants with food allergies because we see the most immune plasticity in that age group, and they have a higher chance of successfully outgrowing the food allergy altogether or just not being impacted too much by it because they have had a successful treatment strategy. Older patients are often more affected by their experiences, and oral food challenges and oral immunotherapy can be very stressful. In our trials at the Sean N. Parker Center for Allergy and Asthma Research, we have enrolled patients who range in age from infants to 55 year olds and have seen high rates of success. So, I never dissuade anyone from pursuing a treatment strategy just because they are older, and we have had a lot of adolescents and college-aged students who have had success with oral immunotherapy. I would suggest to really approach each individual for who they are and go through the pros and cons of each option and the most common barriers and burdens that come up at that age group, incorporating shared decision making to determine what treatment option makes the most sense.