Food allergies can bring untold worry to a family as they navigate a world full of potential dangers. Immunotherapy, however, may offer a promising solution for some, says Professor Jonathan Hourihane, Professor of Paediatrics and Child Health at University College Cork.

3818797103?profile=originalJonathan Hourihane shares his time between research and university responsibilities and his clinical work as a paediatrician. He is also on the advisory board for Aimmune Corporation and his major clinical and research interests are in food allergy and anaphylaxis. As he explains the emergence of Oral Immunotherapy (OIT) is a very exciting development in this area. The treatment involves a patient having controlled, repeated exposure to the food they're allergic to as a means of desensitising their immune system to the food allergen.

Signs are promising but as Jonatan explains, OIT doesn't work for everybody as not everybody can tolerate it. "With OIT, some people can't manage to eat the food that they've been avoiding for a long time," he says. "Some of that is psychological but some is real. Some people don't get past their threshold of reactivity with the treatment but if you do manage it, it appears safe and effective."

Research Trials

Treatment is in the research stage but there are currently two big companies carrying out peanut allergy trials in Ireland, with around 50 participants involved. The participants are exposed to increasing levels of peanut protein in order to improve their level of tolerance and thereby decreasing their risk of an allergic reaction with associated improvements in quality of life. One trial is focussed on OIT and the other is on patch immunotherapy where patients apply patches to their backs or shoulders. "The first study with the patch is finished and being written up at the moment," Jonathan explains. "The biggest study with Oral Immunotherapy is currently under review with a major journal. They're different approaches but they're both coming to completion in the USA and Europe between now and this time next year.”

Jonathan is optimistic that some form of immunotherapy may be on the way in the future. However there will be much to work out and, while it may indeed be successful, it will not be a quick fix for people. “There’s going to be multiple options and ways of doing it. One of the challenges for doctors and families will be to work out which one suits each child and at what age. It’s a case-by-case basis. You can’t tell by looking at a patient whether they’re a good candidate immunologically or not. You can’t predict if they’re going to respond in the desired way. Some people might not tolerate one form and we could switch them to another form and they tolerate it fine.”

Immunotherapy also demands a lot from participants and their families. “It’s a huge commitment. It’s not something you’re going to be buying off the shelf in your local pharmacy. It’s always going to be hospital based.”

Participants’ involvement

Even during this research phase, much is asked of participants. “The treatment requires a lot of trips to hospital - in the studies it’s 25 trips to hospital a year. There is a geographical or a postcode problem in that the nearer you are to a hospital the easier it is as you’ve got to have these safety visits. We’ve soaked up a lot of the patients around Cork and we’ve reached as far as Limerick and Kerry but it’s very difficult for those patients to manage those appointments.”

Participants in the trials have shown an impressive commitment to the process however – perhaps an indicator of just 3818797000?profile=originalhow stressful and life affecting a food allergy can be. “These studies were placebo controlled so some of these people were finally shown to be on dummy treatments and had to start at the bottom and keep going. Only two of the patients dropped out of the trial.”

“The fact that we were able to recruit so many people from a regional centre in Cork shows the commitment that people have to trying to get the best for their families. The recruitment in Cork has been as good as it’s been in big units in London and Berlin and other big centres with massive populations. In fact, we were in a head-to-head race with a major hospital in London, where the population is 7 million, and in the end they beat us by one patient.

“The Irish public understands research and the benefits of being involved in research. If you explain something properly and counsel people through it, the likelihood is you’ll finish the study and have some benefit.”

Patients and their families seem willing to do all that is necessary to improve their quality of life and that improvement is something Jonathan is particularly struck by. “These families have been very paralysed and isolated, or even paranoid, about their child’s safety. Whatever about the safety change or the change in your immunological condition, the fact that you can go out and eat meals while on holiday without having to explain yourself to someone who doesn’t speak English is massive.”

Shared knowledge

3818797168?profile=originalIn 2014 Jonathan availed of the safefood Knowledge Network Training and Mobility Funding Programme (TMFP) and was delighted with the opportunity it afforded. “It’s a great programme. I used it to visit a laboratory and clinic in Boston in 2014 and that ended up with a peer review publication on the basis of the work we put together afterwards. Members of my staff have gone to meetings and brought home that knowledge so it’s worked very well.”

As he points out, there are only two locations in Ireland in which to learn about food allergies (UCC and Our Lady’s Children’s Hospital in Dublin). Having the opportunity to travel and return with the information can be hugely beneficial. “For people who don’t have access to travel funds from commercial bodies or research, it’s a real boon to be able to think that a programme like the TMFP can provide an opportunity to get new knowledge and bring it home.”

ABOUT JONATHAN

Where are you from?
I’m from Dublin and I’ve been in Cork since 2005. I have four children, the youngest is 15, so work and my family life keep me busy!

What do you enjoy doing in your spare time?
I enjoy gardening and watching sports. My sons play a lot of cricket so I’m a cricket travelling dad too. 

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