A recent New York Times article tells us that what many people call food allergies are actually simple intolerances, and that allergies are being dangerously overdiagnosed. What is a true food allergy, and what can be done to fix them besides banning peanuts from schools and avoiding foods that make us itchy?
Allergies are caused by an inappropriate immune response to common things in the environment. Usually the offending allergen is a protein that comes from plants or animals like pollen or dander. Instead of the immune system recognizing that these proteins are harmless, it instead activates a crazy inflammatory response, causing the symptoms we recognize: itchy, runny nose, sneezing, rashes, and in some extreme cases, anaphylaxis.
This immune response is activated when antibodies bind to and recognize the globby 3D shapes of offending proteins, either proteins on the surface of dangerous pathogens or harmless allergens. Because 3D protein shapes can be similar even when proteins have different functions, sometimes allergic responses can be activated in response to a wide array of proteins. My food allergies, for example, are caused by a small group of proteins that is present in fruits and vegetables that have similar 3D shapes to the tree pollens that give me seasonal allergies. A large percentage of people allergic to birch trees like me also have allergic reactions to fruits like peaches, cherries, and strawberries, vegetables like carrots and celery, and nuts like almonds. But because the 3D shape of the protein is important in activating the allergy, I don't get itchy when these foods are cooked, because high heat changes the shape of food proteins.
Even factoring in the fact of overdiagnosis, food allergies are on the rise in developed countries, with rates of serious allergy soaring just in the past few years. This change is now frequently attributed to the fact that many of us in developed countries are just too clean, leaving our immune system with nothing to do except get itself all worked up for no good reason. In places around the world where dirt and parasites are a more common part of childhood, there is very little incidence of serious allergies. This hygiene hypothesis says that if our immune system was challenged with more kinds of dirt and bacteria when we were younger, or was more distracted trying to keep us healthy, that allergies would just go away. There is of course a lot of good that comes from not growing up with unmanageable parasites and high rates of potentially deadly infectious disease, but perhaps there can be a happy medium between good health and a good immune systems.
This question is explored in a fascinating episode of RadioLab from last year all about parasites. In that episode we learn about a man with terrible allergies and asthma who gave himself a hookworm infection that basically cured him. I won't go into the gory details of how he got hookworm, you should listen to the episode not close to any mealtimes for that, but the result is fascinating. By distracting his immune system with a harmless levels of an intestinal parasite, he was able to go outside again without having a life-threatening allergic reaction.
I've wanted my own hookworms ever since, although I prefer to wait until I can have medical supervision. I thought that opportunity had arrived on Sunday when the ads for the evening news after Lost included a story of researchers right here at two of the Harvard hospitals beginning a trial of hookworm infection as a cure for food allergy! I called the researchers hoping to sign myself up as a volunteer, but I'm sadly going to have to wait a few years it seems until they expand the study beyond just looking at peanut allergy (thanks for nothing FDA!).
In the meantime, I'm hoping to take another path to being able to eat some of the fruits and vegetables that I'm allergic to--genetically modifying the plants to delete the proteins that cause my allergy. The safety of genetically modified food is a serious and ongoing concern, but what if the genetic modification was meant to make the food safer in the first place? Many of the proteins that cause allergies are not required by the plant for survival, and the genes that encode them can be deleted or knocked down through several different methods, without adding any genes from other organisms or significantly changing the plant biology. Such plants would grow normally but would be hypoallergenic, safe to eat by everyone. This is one of the projects my iGEM team is working on, part of a potential future toolkit to custom-engineer the plants in your garden. Plants grow slowly and are hard to work with in the lab, so maybe it'll also be many years before I can grow my own hypoallergenic strawberries, but I'm hopeful for an allergy-free future!
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I think I remember something similar, using a not very harmful parasite to "distract" the immune system being proposed as a "cure" for colitis.
I'm allergic to dustmites (?i think?) and pollen, but some reason I sneeze around old dusty books. My grandfather bought all of these paper backs in England when he was a Rhodes scholar, and as soon as I get near his library I just start sneezing. We tried putting some of the books out in the sunlight and then vacuuming. It helped some. "For us who are borne b y the earth, the sun and moon pass by/ And the stars return on their rounds, and again they drop out of sight"
A friend, one more than slightly susceptible to woo-woo "cures", sent me an article about the hookworm treatment/experiment, and I'd skipped it as just another weirdity.
Maybe I should be more skeptical about my skepticism...
At any rate, there are more than enough allergy sufferers around who are more than unsatisfied with what western (US in particular - I'm told Europe bans the only FDA-approved allergen desensitization treatment) medicine offers them that lots of "hookworm therapy" will be underway very soon.
This will probably deter more than encourage wider research by mainstream physicians & scientists capable of properly designing and recording experiments, alas.
This is an great post. I listened to the radiolab show and found myself laughing, dry wretching but most of all amazed at the awesomeness of hookworm.
What's interesting is that your body still mistakes these similar molecules and mounts a response whereas it doesn't happen across the population. Maybe all we need is some 'beneficial' parasite after all that can subdue our immune system to tolerate these aggravators!
There's also the issue that modern crops are not the same as pre-modern crops. Hybridization has made the genomes more complicated, so there are more proteins, so more chances that something will cause a problem. This has continued to change in recent times - like within our lifetimes. GMO may have the same issue.
Wow, I think I am going to research this further. I am severely allergic to vegetables, fruits and nuts. It happened gradually starting in my early 20's. My fruit/nut allergies cause anaphylaxis. I recently had to begin a fruit/nut/vegetable free diet because I was reacting so severly to foods out of the blue. I might even try it before the FDA approves it, just so I can eat again.