The medicine, AR101, is derived from peanut protein and could help patients build tolerance for peanuts.

“The results of this landmark trial are likely to lead to the first FDA-approved treatment for food allergy in 2019,” said Christina Ciaccio, MD, MSc, associate professor of pediatrics and medicine at UChicago Medicine and study co-author. “At UChicago Medicine Comer Children’s Hospital, we were thrilled to be part of this pivotal trial and for the opportunity to change the lives of these children and their families.”

Researchers in 10 countries across North America and Europe conducted the trial, known as the Peanut Allergy Oral Immunotherapy Study of AR101 for Desensitization trial, or PALISADE, for short. Of 496 eligible participants ages 4 to 17, 372 received the AR101 oral medication, while the remainder received a placebo drug. At the end of the trial, more than two-thirds of the group taking the active drug were able to tolerate a dose of peanut protein equivalent to about two peanut kernels.

“Almost 6 million American children are currently living with a life-threatening food allergy,” said Ciaccio. “Every three minutes, a food allergy reaction sends someone to the emergency room, contributing to the total annual cost of caring for children with food allergy of nearly $25 billion. Despite this, not a single treatment for food allergy has been approved by the FDA.” (See our story, “Children with Existing Food Allergies Should Be Screened for an Emerging, Severe Chronic Food Allergy.”)

According to the study, oral immunotherapy for peanut allergy has been recommended against in most clinical settings because past trials have been limited by small sample sizes and differing methodologies. The PALISADE trial has shown, however, that oral immunotherapy is a reasonable treatment option. Participants of the PALISADE trial were instructed to continue the standard of care for peanut allergy, which meant eliminating peanuts from their diets and carrying self-injectable epinephrine (an emergency medical treatment for accidental exposure),

“Now we have a safety net that will prevent an allergic reaction.”

Qualifying participants started with a one-day supervised increase in dosage from 0.5 mg of peanut protein up to 6 mg, an increase every two weeks from 3 mg to 240 mg and a 24-week “maintenance phase” at 300 mg. When adverse reactions occurred, the study protocol allowed for adjustments to the dosing schedule. Compared to the placebo group, participants who took AR101 had less severe allergy symptoms.

“Before this treatment, families having been living with constant anxiety that one wrong bite will send their loved one to the emergency room, or worse,” Ciaccio said. “Now, we have a safety net that we can provide to kids that will prevent an allergic reaction if they accidentally take a bite of a peanut-containing food.”

The study appeared in the New England Journal of Medicine.

A release from the society explains that surveys have indicated that at least 3 million people in the U.S. suffer from peanut allergies, with the number rising steadily over the past decade. People with known allergies are usually careful to avoid foods containing peanuts, but small amounts sometimes contaminate foods that don’t list peanuts as an ingredient. Scientists have developed several methods to detect peanut allergens in foods; however, most of these test for proteins that can be destroyed during food processing. In contrast, DNA is typically more stable than proteins. Other researchers have detected peanut nuclear DNA in foods with a sensitive technique called polymerase chain reaction (PCR). But there’s just one nucleus per cell, whereas plant cells have many chloroplasts, which also have DNA in them. Peanut chloroplast DNA has unique sequences that are not found in other plants. So, Caroline Puente-Lelievre and Anne Eischeid wondered if they could develop an even more sensitive and specific test by targeting DNA from peanut chloroplasts.

The team designed a PCR assay to detect three short DNA sequences found in peanut chloroplasts. By targeting the three regions at once, the researchers had greater confidence that the results were specific for peanut chloroplast DNA. They spiked six different foods, which varied from blueberry muffins to tomato salsa, with small amounts of the legume. The assay detected peanut in all of the foods over a broad range of spiked amounts, with a detection limit of about 1 part per million (ppm), compared with 10 to 50 ppm for previous PCR assays targeting nuclear genes.

###

The authors acknowledge funding from the U.S. Food and Drug Administration.

The study, published in June in Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI), examined 597 surveys representing 917 people. Some adults provided information both for themselves and their children with an EAI prescription.

A release from ACAAI quotes Christopher Warren, PhD(c), lead author of the study, as saying, “The majority of people surveyed (89 percent) filled the prescriptions they were given for an EAI. But almost half (45 percent) said they didn’t have their EAI with them during their most severe allergic reaction. This was despite the fact that 78 percent of the people responding had been hospitalized for their allergy at some point in their lifetime. Another 21 percent said they didn’t know how to use their EAI.”

ACAAI recommends that anyone who has been prescribed an EAI should always have it with them and that they should always carry two as the possibility exists that a severe reaction can reoccur. Moreover, epinephrine should be administered at the first sign of an anaphylactic reaction. This is particularly important for those who have had a previous anaphylactic reaction or who have both a severe allergy and asthma.

“It’s not enough to simply pick up your EAI prescription,” says Ruchi Gupta, MD, MPH, ACAAI member, and co-author of the study. “You need to know how to use your EAI and always carry it, to be prepared for an allergy emergency. It could save your life.” About half the survey participants said an EAI was accessible (within five minutes) all of the time, while 44 percent said they personally carried at least one EAI all the time. Fewer than 25 percent of those surveyed said they routinely carried multiple EAIs.

###

If you are unsure of how to use your EAI, talk to your allergist and ask them to walk you through the steps for use. To find an allergist near you who can help create a personal plan to deal with your severe allergies, use the ACAAI allergist locator.

Watch ACAAI’s YouTube video – featuring Dr. Gupta – on why it’s important not to fear epinephrine, as well as a video on how to use an EAI.

The research was presented at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting.

“Peanut allergies, along with other food allergies, are very challenging for children and families,” said Ruchi Gupta, MD, MPH, ACAAI member and lead author of the study. “While 21 percent represents a large increase in the number of kids with a likely peanut allergy, the good news is that parents now have a way to potentially prevent peanut allergy by introducing peanut products to infants early after assessing risk with their pediatrician and allergist.”

New guidelines introduced in January walk parents through the process of introducing peanut-containing foods to infants that are at high, medium and low-risk for developing peanut allergies. The guidelines are based on groundbreaking research showing that high risk infants (infants with severe eczema and/or a history of egg allergy) who are introduced to peanut-containing food early are significantly more likely to be prevented from developing a peanut allergy.

More than 53,000 U.S. households were surveyed between October 2015 and September 2016 for the study. The research suggests that rates of peanut, tree nut, shellfish, fin fish, and sesame allergies are increasing. For example, an allergy to tree nuts such as cashews and almonds increased 18 percent from 2010 when data were last collected, and allergy to shellfish increased 7 percent.

Also evident was an increase in occurrence in black children compared to white children.

“According to our data, the risk of peanut allergy was nearly double among black children relative to white children,” said food allergy researcher Christopher Warren, PhD candidate and study co-author. “Black children were also significantly more likely to have a tree nut allergy relative to white children. These findings are consistent with previous work by our group suggesting that black children in the U.S. may be at elevated food allergy risk. It’s important that anyone with a food allergy work with their allergist to understand their allergy and how best to avoid the foods that cause their allergic reaction.”

The research was presented at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting.

“Food allergies are often seen as a condition that begins in childhood, so the idea that 45 percent of adults with food allergies develop them in adulthood is surprising,” says Ruchi Gupta, MD, MPH, ACAAI member and lead author of the study. “We also saw that, as with children, the incidence of food allergies in adults is rising across all ethnic groups.”

The most common food allergy among adults is shellfish (such as lobster, crab and shrimp), affecting an estimated 3.6 percent of U.S. adults. This marks a 44 percent increase from the 2.5 percent prevalence rate published in an influential 2004 study. Similarly, these new data suggest that adult tree nut allergy prevalence has risen to 1.8 percent from a 2008 estimate of .5 percent, an increase of 260 percent.

“Our research also found that, among black, Asian and Hispanic adults, the risk of developing a food allergy to certain foods is higher than for whites, specifically for shellfish and peanuts,” says food allergy researcher Christopher Warren, PhD candidate and study co-author. “For example, Asian adults were 2.1 times more likely to report a shellfish allergy than white adults, and Hispanic adults reported a peanut allergy at 2.3 times the frequency of white adults. Because many adults believe food allergies mostly affect children, they may not think to get tested. It is important to see an allergist for testing and diagnosis if you are having a reaction to a food and suspect a food allergy.”

People may not recognize they have a food allergy, and believe their reaction is a food intolerance. They might not seek the help of an allergist for diagnosis, but allergists are specially trained to administer allergy testing and diagnose the results. Allergists can tailor a plan specific to your allergies. To find an allergist near you, use the ACAAI allergist locator.

The device, which is part of a new portable allergen-detector system, would also detect any cross-contamination in foods that would otherwise be safe.

The development, by researchers from Harvard Medical School and Massachusetts General Hospital, was reported in the journal ACS Nano.

Most people with food allergies manage their condition by avoiding the specific nuts, fish, eggs or other products that cause a reaction, which can range from a mild rash to life-threatening anaphylaxis. But avoidance isn’t always possible because food can be mislabeled or cross-contaminated. Conventional methods to detect these hidden triggers either require bulky laboratory equipment, or are slow and don’t pick up on low concentrations. But the new device is more consumer-friendly.

The researchers developed a $40 portable allergen-detection system called integrated exogenous antigen testing, or iEAT. It consists of a handheld device to extract allergens from food and an electronic keychain reader for sensing allergens that wirelessly communicates the results to a smartphone. In less than 10 minutes, the prototype could detect five allergens, one each from wheat, peanuts, hazelnuts, milk and egg whites, at levels even lower than the gold standard laboratory evaluation.

Testing on samples of menu items from restaurants showed some allergens in unexpected dishes and beverages — for example, gluten in salad and an egg protein in beer. Although the prototype was designed to sense five allergens, the researchers say the device could be expanded to test for additional compounds, including other allergens and non-food contaminants such as pesticides.

Those findings, from researchers at the University of Illinois Chicago (UIC), were published in the journal Epidemiology.

Gluten-free diets have become popular in the U.S., although less than 1 percent of Americans have been diagnosed with celiac disease – an out-of-control immune response to gluten, a protein found in wheat, rye and barley.

A gluten-free diet is recommended for people with celiac disease, but others often say they prefer eating gluten-free because it reduces inflammation. However, those claims haven’t been scientifically proven. In 2015, one-quarter of Americans reported eating gluten-free, a 67 percent increase from 2013.

Gluten-free products often contain rice flour (pictured above) as a substitute for wheat. According to a news release from UIC, rice is known to “bioaccumulate” certain toxic metals, including arsenic and mercury from fertilizers, soil, or water. Overall, though, not much is known about the health effects of diets high in race.

Maria Argos, assistant professor of epidemiology in the UIC School of Public Health, and her colleagues looked at data from the National Health and Nutrition Examination Survey searching for a link between gluten-free diet and biomarkers of toxic metals in blood and urine.

They found 73 participants who reported eating a gluten-free diet among the 7,471 who completed the survey, between 2009 and 2014. Participants ranged in age from 6 to 80 years old.

People who reported eating gluten-free had higher concentrations of arsenic in their urine, and mercury in their blood, than those who did not. The arsenic levels were almost twice as high for people eating a gluten-free diet, and mercury levels were 70 percent higher.

“These results indicate that there could be unintended consequences of eating a gluten-free diet,” Argos said. “But until we perform the studies to determine if there are corresponding health consequences that could be related to higher levels of exposure to arsenic and mercury by eating gluten-free, more research is needed before we can determine whether this diet poses a significant health risk.”

“In Europe, there are regulations for food-based arsenic exposure, and perhaps that is something we here in the United States need to consider,” Argos said. “We regulate levels of arsenic in water, but if rice flour consumption increases the risk for exposure to arsenic, it would make sense to regulate the metal in foods as well.”

Bloating is a gas buildup in your stomach or intestines, the article says, building up in your stomach and intestines. As a result, you can have abdominal pain that can range from mild and dull to sharp and intense. The bloating may be relieved by passing gas or a bowel movement.

Bloating may be related, the Mayo article says, to eating fatty foods, which can delay stomach emptying and make you feel uncomfortably full;  drinking carbonated beverages or eating gassy foods; or eating too quickly, drinking through a straw, chewing gum or sucking on candies, resulting in swallowing air.

Other possible causes, the Mayo article says, include stress or anxiety; smoking; a gastrointestinal infection, blockage or disease; irritable bowel syndrome (a condition characterized by abdominal pain or cramping and changes in bowel function); and conditions such as celiac disease or lactose intolerance in which the intestines aren’t able to digest and absorb certain components of food.

To reduce bloating, it may help to avoid or reduce the amount of gas-producing foods you eat. Many carbohydrates cause gas, and the following items are common culprits: beans; broccoli; brussels sprouts; cabbage; carbonated drinks; cauliflower; chewing gum; fruits (apples, peaches, pears); hard candy; lettuce; milk and milk products; onions; sugar alcohols found in sugar-free foods (sorbitol, mannitol, xylitol); whole-grain foods.

Belching: According to the Mayo News Network article, belching or burping is the body’s way of expelling excess air from your stomach. It’s a normal reflex caused by swallowing air. You may swallow excess air if you eat or drink too fast, talk while you eat, chew gum or suck on hard candies, drink carbonated beverages, or smoke.

And acid reflux or gastroesophageal reflux disease (GERD) can have the same effect, Mayo says: If stomach acid backs up into your esophagus, you may swallow repeatedly to clear the material. This can lead to swallowing more air and further belching.

Some people swallow air as a nervous habit, the Mayo experts say, even when they’re not eating or drinking. In other cases, chronic belching may be related to inflammation of the stomach lining (gastritis) or to an infection with Helicobacter pylori, the bacteria responsible for some stomach ulcers.

The Mayo experts recommend the following strategies to reduce belching:

Eat and drink slowly. Taking your time can help you swallow less air.

Avoid carbonated drinks and beer. They release carbon dioxide gas.

Skip the gum and hard candy. When you chew gum or suck on hard candy, you swallow more often than normal. Part of what you’re swallowing is air.

Don’t smoke. When you inhale smoke, you also inhale and swallow air.

Check your dentures. Poorly fitting dentures can cause you to swallow excess air when you eat and drink.

Treat heartburn. For occasional, mild heartburn, over-the-counter antacids or other remedies may be helpful. GERD may require prescription-strength medication or other treatments.

Making lifestyle changes may help reduce or relieve excess gas and gas pain:

Try smaller portions. Many of the foods that can cause gas are part of a healthy diet. So, try eating smaller portions of problem foods to see if your body can handle a smaller portion without creating excess gas.

Eat slowly, chew your food thoroughly and don’t gulp. If you have a hard time slowing down, put down your fork between each bite.

Avoid chewing gum, sucking on hard candies and drinking through a straw. These activities can cause you to swallow more air.

Check your dentures. Poorly fitting dentures can cause you to swallow excess air when you eat and drink.

Don’t smoke. Cigarette smoking can increase the amount of air you swallow.

Exercise. Physical activity may help move gas through the digestive tract.

If the odor from passing gas concerns you, limiting foods high in sulfur-containing compounds — such as broccoli, Brussels sprouts or other cruciferous vegetables, beer, and foods high in protein — may reduce distinctive odors. Pads, underwear and cushions containing charcoal also may help absorb unpleasant odors from passing gas.

Editor’s note: If bloating, belching and passing gas seem especially severe or persist despite making lifestyle and dietary remedies, consider seeing your doctor. You may have a more serious health condition.

The Mayo Clinic Book of Home Remedies provides answers you need to take care of common health problems on your own. This reference covers 120 of today’s common health problems in an easy-to-follow, A-to-Z format. Learn what you can do for yourself and when to seek medical attention.

For more information on health issues, visit www.mayoclinic.org.

A release from the hospital notes that food allergies affect approximately eight percent of children and up to two percent of adults. Almost 40 percent of children with food allergies have experienced at least one life-threatening reaction.

The study, published in the Journal of Allergy and Clinical Immunology: In Practice, surveyed 6,584 consumers in the U.S. and Canada on their purchasing habits of food products with various labels about possible allergen exposure due to food processing. Most participants were caregivers of a food-allergic child, while the rest had food allergy themselves.

The release quotes senior author Ruchi Gupta, MD, MPH, pediatrician and researcher at Ann & Robert H. Lurie Children’s Hospital of Chicago and Associate Professor of Pediatrics and Medicine at Northwestern University Feinberg School of Medicine, as saying, “Our findings underscore the challenges people with food allergies face in deciding if a food product is safe to eat. Currently, precautionary allergen labeling is voluntary and the statements used lack consistency, making it more confusing for consumers. They also do not reflect how much allergen is in the product, which is something consumers need to know to assess food allergy risk.”

Consumers had many misconceptions about precautionary labeling. A third falsely believed that precautionary allergen statements are based on the amounts of allergen in the product. Almost half believed that this type of food labeling is required by law, which is not the case.

The laws in the U.S. and Canada require labeling if a major food allergen is an intended ingredient. In the U.S., these include wheat, egg, milk, peanut, fish, crustaceans, soy and tree nuts. Canadian regulation also adds sesame, mollusks and mustard. Neither country requires labeling about unintended presence of allergens in foods as a result of processing on shared equipment, although many food manufacturers include a variety of precautionary statements on labels.

Purchasing habits varied depending on the precautionary phrase used on the label. Fewer respondents (11 percent) bought food with “may contain” labeling, while many more (40 percent) bought a product with “manufactured in a facility that also processes” statement.

“There is clearly a need for regulation and standardization of precautionary allergen labeling to help consumers make safe food choices,” said Gupta.

Gluten-free diets are those that omit the protein gluten, which is found in wheat, barley, rye and a cross between wheat and rye known a triticale.

A gluten-free diet is used to combat celiac disease, a potentially serious condition that prevents absorption of some nutrients. It can cause everything from weight loss to depriving the brain, nervous system, bones, liver and other organs of vital nourishment.

Some people, the Mayo experts say, may not have full-fledged celiac disease but may have some symptoms. That is known as non-celiac gluten sensitivity. People with that condition may benefit from a gluten-free diet. But for people with celiac disease, a gluten-free diet is essential for preventing symptoms and related complications.

Although a gluten-free diet might seem restrictive, the Mayo experts say there are many foods you can eat, including: unprocessed beans, seeds and nuts; fresh eggs; fresh meats, fish and poultry (no batter or breading); fruits and vegetables; and many dairy products.

But, the experts say, you have to make sure that food isn’t processed with gluten-containing grains, additives or preservatives.

A list of safe grains provided by Mayo include amaranth; arrowroot; buckwheat; corn and corn meal; flax; gluten-free flours such as rice, soy, corn, potato, bean; hominy; millet; quinoa; rice; sorghum; soy; tapioca; and teff.

The experts also say it’s essential to avoid foods and drinks made with barley; malt; rye; triticale; and wheat. Some other wheat products include durum flour; farina; graham flour; kamut; semolina; and spelt.  Some oats are contaminated with wheat during production; doctors and dietitians advise avoiding oats unless they are labeled gluten free.

In general, the Mayo experts recommend, avoid the following foods unless they’re labeled as gluten-free or made with corn, rice, soy or other gluten-free grain: beer; breads; cakes; pies; candies; cereals; Communion waters; cookies; crackers; croutons; French fries; gravies; imitation meat or seafood; matzo; pastas; processed lunch meats; salad dressings; sauces (including soy sauces); seasoned rice mixes; seasoned snack food such as potato chips; self-basting poultry; soups and soup bases; and vegetables in sauce.

You should also be alert for other products that you eat or that could come in contact with your mouth that may contain gluten. These include food additives such as malt flavoring as well as medicines and vitamins that use gluten as a binding agent.

Cross-contamination occurs when gluten-free foods come into contact with foods that contain gluten. It can happen during the manufacturing process, for example, if the same equipment is used to make a variety of products.

Foods may also be labeled as “gluten-free.” If a product carries a gluten-free label, the Food and Drug Administration requires that the product contain less than 20 parts per million of gluten. Be aware that products labeled “wheat-free” may still contain gluten.

If you’re not sure if a food contains gluten, check with the manufacturer, or don’t buy it.

For more information on health matters, visit www.mayoclinic.org.