Allergies: Cured or Controlled in a Decade

Dr. Adelle Atkinson is a mother of a son with a food allergy severe enough that he carries an auto-injector in case of anaphylaxis. She’s also a Clinical Immunologist in the Division of Immunology and Allergy at SickKids. So the stated goal of the Allergy Program here at the Hospital – to prevent and ultimately cure food allergy in kids in the next ten years – is one that resonates personally.

Recent developments in the study of allergy, both inside and outside SickKids, suggest SickKids’ goal is achievable. Dr. Atkinson is particularly excited about the results of the LEAP study, announced last year. (‘LEAP’ stands for ‘Learning Early About Peanut’.) The study, led by Professor Gideon Lack at King’s College, London was designed to definitively answer the question: “Which approach – avoidance or consumption – works best to prevent peanut allergy?” 640 participants between four and 11 months of age, identified as high-risk for peanut allergy, were selected to be part of a randomized control trial. The ‘consumption’ group ate peanut protein three times a week, while the ‘avoidance’ group did not ingest peanut-containing foods. The children were followed until they were five.

Living with allergy

Dr. Atkinson calls the results a “huge discovery”: in a nutshell, early introduction reduces the risk of developing a peanut allergy a staggering 70-80%.

This dovetails with what Dr. Atkinson and her team, under Dr. Eyal Grunebaum, have been able to achieve at SickKids. The clinical setting has allowed the team to take on riskier oral food challenges. These oral challenges are done to demonstrate – hopefully – that the child is not allergic, and able to tolerate the food. The result is what Dr. Atkinson calls ‘de-labelling’, which has been transformative for families. As Dr. Atkinson says, “This can be life-changing for parents.” Dr. Atkinson’s de-labelling strategy has seen significant wins at SickKids over the last several years.

Recent developments in the study of allergy suggest SickKids’ goal is achievable.
Another achievement is in the area of education. Dr. Atkinson leads continuing education for physicians, providing educational presentations in multiple contexts. Last year, Dr. Atkinson estimates she has had the opportunity to make a dozen media appearances.

What’s next? Dr. Atkinson sees great promise in SickKids’ research. The identification of a molecule in a patient’s blood that could be a marker for anaphylaxis allows for ‘risk stratification’. In other words, whether the patient is at greater or lesser risk for anaphylaxis. “What this means,” says Dr. Atkinson, “is we’re not making people live with the greatest fear.” Part of the research is working to ‘block’ the molecule, so it doesn’t activate, or produces a milder reaction.

All of what Dr. Atkinson and her colleagues have achieved, and aim to achieve, makes a profound difference in the lives of patients and their families, particularly moms. To a mom living with the burden of two ‘allergy’-labelled kids, Dr. Atkinson was able to offer the hope that oral challenges might ‘de-label’ her kids. Through a challenge, first with milk in a baked good, then with fresh milk, it was discovered that the boy was no longer allergic. The mom was overjoyed. “ ‘You have no idea the difference this will make in our lives. I want to thank you every morning’, ” relates Dr. Atkinson, with a smile. Almost as big as the smile on the boy’s face, as he enjoyed his first-ever ice cream cone the next day. Dr. Atkinson has the picture to prove it.

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