Living with food allergies has a significant impact on quality of life, affecting family life and mental health, says Indian American pediatric allergist Sayantani Sindher explaining how daily stress drives her work in food allergy care.
“Food allergies affect 8 to 10% of the U.S. population, so classrooms often have multiple children navigating them,” says Sindher, a clinical associate professor of medicine and paediatrics, and the director of the Clinical Translational Research Unit at the Stanford University’s Sean N. Parker Centre for Allergy and Asthma Research.
“We worry about food allergies because accidental exposure can cause severe symptoms, even death,” she writes in a recent piece in university’s “Research Matters” series, where Stanford scientists tell about their work and its potential to advance human health.
“However, living with food allergies has a greater quality-of-life toll,” she says. “Constant vigilance around food can lead to chronic stress and anxiety. Treatment options can help mitigate these effects.”
“Our primary goal is to improve the lives of children with food allergies and their families,” writes Sindher. “In the future, we aim for better guidelines to prevent food allergies and immediate treatment options upon diagnosis.”
Early intervention is crucial, as the younger immune system is more responsive to treatment, she says talking about an ongoing clinical trial with babies under two months old with eczema or severe dry skin. Early eczema has been linked to food allergies, so we hope treating eczema and minimising skin damage early will reduce food allergies later.
Sindher’s research focuses on improving food allergy diagnosis and treatment monitoring. Skin prick testing and blood work testing are highly unreliable, she says. They can’t assess symptom severity, have a high false positive rate, and don’t monitor treatment effectiveness.
“So, we often give allergic individuals the food they’re allergic to and observe their reactions to confirm allergies or treatment response” writes Sindher. “We’re also exploring better treatment options.”
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“Initially, food allergy treatment involved avoiding allergens, but accidental exposures can occur. Oral immunotherapy, approved in 2020, involves daily small amounts of the allergen to desensitise the body. However, it’s not suitable for everyone, has a risk of reactions, can cause food aversion, and requires lifestyle modifications like adjusting exercise and meals.
In a recent trial, Sindher’s team found that the injectable medication omalizumab reduces the risk of allergic reactions. Omalizumab is now FDA-approved for children one year and older, either alone or before starting oral immunotherapy.
The injection must be given every two to four weeks to prevent the body from reverting to its allergic state. However, for children with severe food allergies, it has been life-changing, she notes. “Patients express relief when they can enjoy ice cream with friends or travel abroad without fear of their child’s allergies.”
While omalizumab works for many, not everyone, and some children are needle-phobic, new drugs and interventions aim to reduce the burden on patients, Sindher says. Sublingual immunotherapy has fewer side effects than oral immunotherapy, and a peanut patch and less-frequent injection drugs are being explored.
In another study, her lab is conducting food challenges with omalizumab-prescribed individuals at the start and six months later, collecting blood samples to identify biomarkers indicating medication effectiveness.
“We’re also conducting quality of life surveys and burden of treatment assessments to better understand how to help patients safely consume food and reduce stress in their daily lives.”
Allergy immunology is unique because it involves treating the entire family, including parents, children, and siblings, she says. “It’s like an old-timey doctor who knows everything about the family, from their vacations to their pets.”
“My research allows me to see them every two weeks, fostering a deep bond,” writes Sindher. “I bridge the gap between research and clinical practice, using patient insights to inform my work and making informed decisions for families.”