Ahead of his session at the Allergy and Free From Show, we spoke with Professor Adam Fox about how far we’ve come with food allergy management and the latest advancements in treating these allergies in babies and children.
Q: Can you tell us about yourself?
I’m a consultant Paediatric Allergist at Evelina London Children’s Hospital and Professor of Paediatric Allergy at King’s College London.
I’m also one of three Founding Professors of the Allergy Centre of Excellence, a clinic that provides the latest food allergy treatments for babies and children.
I’ve also been fortunate enough to contribute to national policy around the assessment, diagnosis and treatment of food allergy in children, through my work with the National Institute of Clinical Excellence and currently, try to continue to influence government in my role as Chair of the National Allergy Strategy Group.
Q: How has food allergy management evolved?
When I started working as a consultant in 2006, the approach to treating food allergies was very passive, in the sense that, as doctors, we focussed on diagnosing the allergy/allergies and helping patients avoid the allergens and manage reactions if/when they occurred.
From a medical perspective, it was a frustrating situation – after all, we work in this profession to make people better. It was the same for our patients as they didn’t want to live with an allergy indefinitely either.
However, there was a major turning point in 2014. Large-scale clinical studies, like the LEAP study, provided evidence that allergies could be prevented, for example with early and deliberate introduction to the food into a baby’s weaning diet.
Likewise, we found that children who are allergic to milk or egg could sometimes tolerate these foods when baked into products. Consuming it in this way helped nudge their immune system into adapting and outgrowing the allergy faster. While it wasn’t effective on those with severe allergies, it all contributed to a positive shift towards a more proactive approach to food management and changes in public health advice.
Q: So what’s been the most significant development?
The game-changer has been Oral Immunotherapy (OIT), which has been available in the UK since 2021 and involves desensitising patients by exposing them to the allergen(s) under careful medical supervision. The first treatment option that became available was for peanut allergies, but patients can now access it for a variety of other foods, including treenuts such as cashews, eggs, milk, sesame and legumes such as lentil or chickpea.
It’s no longer about just avoiding allergens—we can now actively intervene.
However, it’s added a layer of complexity to the doctor-patient relationship. It’s important to act as early as possible because the outcomes tend to be better when you start sooner, however there isn’t a one-size-fits-all answer. There are different options/programmes and families need to weigh up the risks of treatment against the risks of not treating. I do my best to avoid any sense of urgency in the decision-making, and it’s always a collaborative decision between us.
We provide more details on what OIT entails on the ACE website.
Q: What other advancements can we look forward to?
We’re seeing exciting new treatment options coming down the track in the next year or so that can be personalised/tailored to patient needs. These include sublingual immunotherapy (where the allergen is placed under the tongue) and epicutaneous patches (when it is applied to the skin using a patch) instead of eating the food to cause the desensitisation effect. We’re hopeful that these approaches will reduce some of the intrusion of the treatment in daily life. However, there are still other factors to consider; for example, it may take longer and have a more limited effect.
There are also injectable treatments that are available in the US, which offer another layer of flexibility for patients by reducing the risk of reactions to all allergens. However, again, there are other factors to consider, as these only work for as long as you are on them.
Essentially, we have more options, which means there is more opportunity to tailor something that fits best for the individual patient – some people want faster solutions, while others are happy for a slower effect if it means less risk of side effects.
Q: What’s the best of advice for parents of children with food allergies?
My single piece of advice is – try and find out all your options. Your GP is generally the best place to start with any allergy concern or query, however, there are charities like Allergy UK that can offer a lot of good information and advice. And organisations like ACE that can provide details on specific treatment options like OIT.
Every parent deserves to understand the choices available to them and make the best decision for their family.