A Legacy of Progress: Dr. Robert A. Wood’s Dedication to Food Allergy Research
Image 1: Dr Robert A. Wood presenting at the FARE Summit 2024
Attending Dr. Robert A. Wood’s presentation at the FARE Food Allergy Summit 2024 was an eye-opening experience, shedding light on the past, present and future landscape of food allergy treatments. Dr. Wood, a renowned expert in the field (kinda like celebrity status in the food allergy world), provided an overview of how the field has evolved and what it promises in the years to come. His can-do persona and command of all-things-allergies presentation was comforting to listen to and made me feel a sense of assurance that great doctors are on our side, working hard to find solutions. (And, did you know Dr Wood himself has a severe peanut allergy, and is also allergic to peas, lentils and cashews?...who knew?)
The Future of Food Allergy Treatment: "The Best is Yet to Come"
Dr. Wood started his presentation with a look in the rearview mirror. He walked through and celebrated all of the progress that has been accomplished in food allergy research in the past two decades. He emphasized that, while current advancements are promising, it reflects the necessary journey of medical innovation, from research and trials to FDA approval of new treatments. He noted that food allergy therapies often take about ten years to become a reality, given the extensive testing required to ensure both effectiveness and safety. So, he has his sights set on what’s to come in 2030 and beyond, but he did applaud the progress that has been achieved to date.
Dr Wood shared that one of the biggest goals in the future of food allergy treatments is making everyday life easier for people with food allergies. Imagine, he suggested, if there were a way for those who need to avoid foods like wheat, milk, and egg—staples in many diets—to be protected in a way that is both robust and reliable (yes, yes please!). Dr. Wood pointed out that for the millions affected by food allergies, a therapy that could offer more comprehensive protection would indeed be life-changing.
Evaluating Food Allergy Treatments: Key Questions
When it comes to evaluating food allergy treatments, Dr. Wood outlined several essential questions that both patients and doctors need to consider, and the questions he and his team consider with all the work they do:
What Do Patients and Families Want?: Understandably, families and patients want safe and effective treatments that offer meaningful protection. They want therapies that reduce the constant anxiety of accidental exposure to allergens and allow for a more relaxed lifestyle.
What Do Doctors Want?: From the medical perspective, doctors are looking for treatments that balance efficacy and safety. Therapies should provide a level of protection that is substantial enough to make a real difference in a patient's life, with manageable side effects and a good safety profile.
What Do the Treatments Really Offer?: Dr. Wood encouraged attendees to consider aspects like the degree and duration of protection, food-specific versus more generalized protection, and the long-term acceptability of a treatment. All these factors are critical to understanding the potential benefits and limitations of current and future therapies.
Dr. Wood's focus on these questions reflects the comprehensive evaluation needed to ensure that new treatments meet the needs of the food allergy community. As you can see, this research has no easy path forward – hence the length of time it takes for effective therapies to become a reality.
Current Treatments -- The Case of Oral Immunotherapy (OIT)
Oral Immunotherapy, or OIT, desensitization has been a prominent treatment option for food allergies, aiming to increase tolerance to allergens through gradual exposure. While it has provided benefits for many, OIT is not without challenges (more about our families challenges here). Dr. Wood noted that for some families, after about five years of OIT treatment, research has found that the burden may outweigh the benefits – it is a huge commitment for families to uphold day after day, year after year. Reactions to the treatment are common, adding stress and requiring additional vigilance that can be exhausting over time. The mental and physical load of OIT does affect quality of life.
This reality illustrates the complexities of OIT: while it can offer some level of protection, it demands a significant commitment from both patients and their families. This burden is something that researchers hope to ease with future innovations, aiming for treatments that not only work but also integrate seamlessly into daily life.
Xolair: A Biologic Treatment with Great Potential—And Challenges
Dr. Wood spent a portion of the presentation discussing Xolair (omalizumab), a biologic drug recently approved for treating food allergies. While Xolair has been transformative for many with allergic asthma, chronic hives, and other allergic conditions for decades now, it’s only recently been approved for food allergy treatment. I was surprised to hear Dr. Wood express his disappointment that it took over 20 years from the initial discoveries of Xolair’s potential to its approval for food allergies, given the large body of evidence supporting its safety and efficacy. His dedication to research to bring solutions to the food allergic community was more than apparent, and emphasized the importance of accelerating treatment availability for the food allergy community.
Biologics like Xolair are changing the world of allergy treatment by targeting specific immune responses. However, Xolair only works while the patient is actively using it, meaning long-term treatment is necessary to maintain its protective effects. Additionally, around 1 in 500 patients might experience a reaction to the dose, requiring the first few doses to be administered by a doctor with a two-hour observation period afterward. Other details I learned about Xolair here.
For those considering Xolair, Dr. Wood suggested evaluating one’s overall health and needs. For individuals managing multiple allergic conditions, Xolair might provide broader relief, as it could also potentially alleviate symptoms of asthma, hay fever, and chronic hives, eliminating the need for other medications. Nonetheless, Dr. Wood was candid about the disadvantages: Xolair is expensive, has dosing restrictions, and requires long-term commitment.
"What Did It Take for Me to Eat Dinner Last Night?"
Dr. Wood posed this thought-provoking question to the audience, encouraging them to reflect on the daily effort required to manage food allergies. From reading labels and cross-checking ingredients to navigating social situations, the burden of food allergies extends far beyond the simple act of eating. For many, the fear of an accidental exposure looms constantly, making mealtime a potentially risky event rather than a simple part of life.
Innovations like Xolair and other biologics could help change this experience, offering those with food allergies a more relaxed approach to eating and living. However, access to these treatments remains an issue for many. Dr. Wood noted that while there’s no contraindication for patients to be prescribed both Xolair and Dupixent (another biologic for treating eosinophilic esophagitis EoE, eczema, asthma, etc.), insurance companies are often unwilling to cover both due to cost. This limitation, driven by financial considerations rather than patient need, is a frustrating barrier for those who could benefit from both treatments. (This was especially disappointing to hear, as our family is affected by this aspect.)
A Hopeful Future for Food Allergy Treatments
Image 2: Dr. Wood’s focus on the 2030s
Dr. Wood’s presentation highlighted the challenges of current food allergy treatments but also underscored the optimism surrounding future innovations. With ongoing research and a clear understanding of patient needs, the food allergy community is positioned to benefit from more effective and less burdensome treatments. The hope is that, by the 2030s, these therapies will allow individuals with food allergies to eat, travel, and socialize with a newfound sense of freedom. I know 2030 seems far off, but I figure our family has managed the challenges of living with food allergies this long – if 2030 promises breakthroughs in treatment, we’re here for it. (see image 2)
In the meantime, the food allergy community can look forward to gradual improvements that address both the physical and emotional toll of managing food allergies. As Dr. Wood said, "The best is yet to come," and with each step forward, we’re getting closer to a future where managing food allergies is simpler and safer for everyone.