This month’s ‘Ask the Expert’ focuses on your allergy questions. Below are the answers to the questions sent in by readers, kindly put together by pediatric allergist Gavin Schwarz, MD, whose bio is down below.
How effective are allergy shots?
Allergy shots, or subcutaneous immunotherapy (SCIT), is the most effective treatment available for treating environmental and venom allergies. Allergy shots are not a treatment option for food allergies. Most patients respond well to allergy shots, although some do not benefit. It is the only disease modifying treatment, meaning that it is the only treatment that can actually alter your allergies. Medications simply mask symptoms while you take them, but their benefit ends when therapy is discontinued. Allergy shots have the potential to offer long lasting benefit for many years beyond completion of therapy.
What do you think about the new oral treatment for allergies?
I assume the question is referring to oral immunotherapy for food allergies.
Oral immunotherapy for food allergies has shown a lot of promise for food allergic patients. It involves ingesting very small amounts of the food allergen initially, then very gradually increasing the dose to a point where one’s threshold for reacting to an ingestion is much higher. It essentially offers a “safety net” against accidental exposures. While it is a very promising approach to treating food allergies, it remains experimental. There are still many questions that need to be answered before oral immunotherapy for food allergies becomes the standard of care.
Do you recommend early exposure in children to nuts and should pregnant women eat more?
For most infants, early introduction of peanuts seems to be associated with lower risk of developing peanut allergy. However, children with risk factors for peanut allergy (i.e. egg allergy, significant eczema) may benefit from a consultation with an allergist prior to peanut introduction. In some cases, supervised or deferred introduction may be appropriate.
Regarding pregnant women, there are currently no evidence-based guidelines. We simply do not know the answer yet.
How does one know if they will outgrow an allergy? Are there any signs or symptoms to look out for?
Again, I assume the question refers to food allergies.
The only way one can know if a food allergy has been outgrown is to ingest the food without developing symptoms. This should only be done under the guidance and supervision of an allergist. Skin tests and blood tests are used as a guide to help determine if a supervised challenge to a food allergen is appropriate, but allergy testing alone cannot answer the question.
Is there something in the works for someone with peanut allergies?
There are several exciting therapies in development for food allergies, particularly peanut. Oral immunotherapy has shown very promising results. Another exciting treatment currently in clinical trials is the “peanut patch.” The idea behind the patch is to alter a patient’s allergic response to peanut through continuous skin exposure.
Is there such a thing as gluten allergy when someone doesn’t have celiac disease?
The term “gluten allergy” is tossed around loosely these days. Celiac disease is an immune mediated gluten intolerance, but it is not an allergy. It is also very different from a wheat allergy, which may be associated with severe symptoms of anaphylaxis. The term “gluten allergy” is a misnomer often used to describe gastrointestinal complaints seemingly associated with gluten ingestion in people who do not have celiac disease. The symptoms may improve with gluten restriction. Patients with this issue are not allergic to gluten and are not at risk for developing potentially life-threatening allergic reactions to gluten.
Remember to discuss this and any other medical advice you read online with your doctor, as it may differ based on your individual case and specifics.
Gavin Schwarz, MD is board-certified in Pediatrics and Allergy and Immunology. He has hospital appointments at Connecticut Children’s Medical Center and Hartford Hospital. He is a member of the American College of Allergy, Asthma & Immunology, American Academy of Allergy, Asthma & Immunology, and New England Society of Allergy. He is an Assistant Clinical Professor in the Department of Pediatrics at the University of Connecticut Health Center.
His practice website can be found here.
