Food allergies are becoming more and more common. Approximately 15 million Americans suffer from allergies to popular foods such as milk, eggs, peanuts, wheat, soy and tree nuts such as walnuts, almonds and cashews. With the hope of making a long-term impact in the field, The Food Allergy Center at Massachusetts General Hospital (MGH) and MassGeneral Hospital for Children (MGHfC) has been established to diagnose and treat known and suspected cases of food allergies. Offering clinical care, patient education, patient support groups and clinical and basic research, the center is open to both children and adults.
“Our center is multidisciplinary in the sense that we have allergists, gastroenterologists, psychologists and nutritionists all involved to meet the needs of kids and adults with food allergies,” says Wayne Shreffler, MD, PhD, director of the Food Allergy Center at MGH/MGHfC. “We provide a broad array of clinical services specializing in both IgE mediated food allergies (the most common form associated with immediate reactions), and non IgE-mediated food allergies. We have a special clinic devoted to the care of patients with eosinophilic esophagitis (EE), and also have extensive research efforts that are focused on understanding and finding better treatments for those same conditions.”
Continuity of Care
The Food Allergy Center is one of the few in the United States that provides care to both kids and adults with allergies.
“The center has been created to overlap between pediatric care and adult allergy,” says Aidan Long, MD, the clinical director of Allergy at MGH. “As the prevalence of the number of patients with food allergies increases in childhood, then as those children are growing older, we can provide them a continuity of care so that they can stay within the same institution using the same approach to diagnosis and treatment as has been used to in the pediatric service.”
“In our field of allergy, when we train, we are trained in both adult and pediatric medicine,” adds Paul Hesterberg, MD, an allergist/immunologist. “The Food Allergy Center is a combined program where physicians from both sides are able to integrate our approach, so what we are doing on the pediatric side is the same on the adult side.” Gastrointestinal Conditions Patients suffering from gastrointestinal conditions such as EE, manifested by their body’s response to food allergies, can find appropriate care within the center.
“We have gastroenterologists, psychologists, allergists and nutritionists within the Center,” says Qian Yuan, MD, PhD, a pediatric gastroenterologist. “I primarily take care of children with EE and other symptoms associated with food allergies in general.”
In addition, the center provides treatments for food protein induced entercolitis, allergic colitis, atopic dermatitis and other disorders related to allergies.
Providing Relief from Anxiety
Anxiety in children suffering from allergies is a common symptom. Fortunately, Nancy Rotter, PhD, a pediatric psychologist, can provide the help those children might need.
“Children with food allergies may experience accidental exposures to the foods that they are allergic to, resulting in symptoms that are frightening to them. A child’s anxiety may be further heightened if he or she requires treatment with epinephrine and a trip to the Emergency Room,” says Rotter. “My role is to help children take charge of their anxiety while remaining cautious about contact with the foods that they are allergic to, with the goal of living full, normal lives. I also help parents cope with the normal worries that accompany developmental transitions, such as entering school, in which children are spending more time outside of their parent’s care.”
The Food Allergy Center is also unique in that it supports a broad array of research projects in the field. Jolan Walter, MD, PhD, an allergist/immunologist, is particularly interested in B-cell dysregulation and related diseases that affect children. “We believe that early B-cell defect may contribute to these children actually developing food allergies, and as the immune system matures, these allergies might come under control,” says Walter. “Some of the clinical trials will focus on the B-cell repertoire and how the B-cells mature and change as the child grows and gets older.”
“We have a few research protocols, including an oral immunotherapy trial for children 7-21 years old with peanut allergies,” says Shreffler. “The goal is to protect people against accidental reactions, but also to learn what is necessary to really induce true tolerance so that they could eventually have peanuts with no reactions.”
Similar studies for older adolescents and adults with milk allergy are also forthcoming, along with research protocols for EE attempting to identify less invasive means of following response to treatment, and perhaps immunotherapy to treat multiple allergies at the same time.
“Our patients really like this concept of a one-stop shop,” says Shuba Iyengar, MD, MPH, an allergist/immunologist. “They are able to see multiple specialists in one area, and because we are all seeing the same patient at the same center, we are able to talk to each other about the diagnosis and treatment quite easily.”