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Food Allergy Learning Zone


Read time: 100 mins
Last updated:1st Dec 2022
Published:18th Jul 2022

Gain valuable expert insight into current developments in food allergy, and hear answers to pertinent questions from expert voices at the forefront of the field.

View expert clips highlighting the key takeaways and unanswered questions

  • Hear the perspectives of experts in food allergy
  • Watch ACAAI 2022 Congress highlights
  • Watch EAACI 2022 Congress highlights

ACAAI 2022 congress highlights

The Advancing Allergy & Immunology Care (ACAAI) Congress took place 10–14 November in Louisville, Kentucky, US. During ACAAI 2022, presentations on rare allergies, new treatment targets and recent clinical trials were given providing the latest perspectives on allergy diagnosis and treatments.

We interviewed Professor Douglas Mack (McMaster University, Canada) and Dr Jay Lieberman (University of Tennessee, USA) to hear their perspectives on the key takeaways from ACAAI 2022. Watch their highlights of the congress below.

Highlights from ACAAI 2022

Data from the LIBERTY-CSU CUPID phase 3 randomised controlled trial (RCT) investigating the efficacy of dupilumab in people with chronic spontaneous urticaria (CSU) was presented1. Participants in the study still experienced symptoms despite H1 histamine treatment, and so received dupilumab.

Dupilumab showed significant improvements in symptoms in H1 antihistamine-resistant CSU irrespective of baseline immunoglobulin E (IgE) level

At Week 24, the Itch Severity Score (least square (LS) mean difference: -4.2; P=0.0005) and Urticaria Activity Score (LS mean difference: -8.5; P=0.0003) were reduced in the dupilumab group compared to placebo.

Dr Colleen Shannon presented a retrospective chart review of infants with anaphylaxis which found most cases were triggered by food, in particular egg (26.6%), peanut (25.4%), milk (13.5%) and cashew (10.1%)2. Of the 146 infants, 86.4% received epinephrine, of which 51 (30.1%) received prior to arriving at hospital and 16 (9.5%) needing more than one dose. Dr Shannon emphasised the importance of diagnosing and treating infants with the same urgency as children and adults. Watch the video below to hear Professor Mack’s perspective on food screening of allergens in the paediatric cohort.

In addition, a longitudinal cohort study of 129 infants with food reactions looked at using multi-omic analyses for improving the understanding of the immunological origins of food reactions in this population3.

Using saliva collected at 6 months and performing multi-omic analyses of cytokines, microRNAs and, the microbiome, Dr Beheshti and colleagues found that 31% of variance between groups could be attributed to four multi-omic features (IL-8/IL-6, miR-151a-5p, STAT6, Cyanobacteria) .

Therefore, multi-omic analyses may improve understanding of the key immunological factors involved in food reactions. EPITOPE, a phase 3 RCT investigating epicutaneous immunotherapy with a patch containing 250 µg peanut protein in toddlers aged 1-3 years was presented4.

The participants who received the peanut patch had a statistically significant response compared to the placebo group (difference: 33.4%; 95% CI: 22.4–44.5% [p<0.001]) and rates of treatment-related anaphylaxis and discontinuations were low

Watch the following videos to hear Dr Leiberman discuss key future treatment options for food allergies.

A representative sample of adults with food allergies were asked to complete a US survey which focused on food allergy community needs5. The results showed that only 52% of adults had ever been prescribed an epinephrine autoinjector (EAI) and 36% thought EAI could cause life-threatening side effects. The researchers highlighted the importance of providing wider EAI use, and access in these populations ought to be prioritised by health care professionals and patient advocacy organisations alike.

Studies such as this highlight the importance of shared decision making, a hot topic which Professor Mack and Professor Lieberman discussed in their interviews with us. Watch the videos to find out more.

Implementing updates from ACAAI 2022 into practice
Advances in food allergy treatments

Furthermore, case studies of rare or previously unheard-of allergies were discussed in presentations. 

  1. Peanut allergy in an exclusively breast fed infant. According to Dr David Robertson and Dr Matthew Greenhawt, when peanuts were removed from the mother’s diet, the baby’s symptoms stopped. 
  2. A case of a woman developing hives on her back after alcohol consumption was reported by researchers from the Walter Reed National Military Medical Center. This is the second reported case of ethanol allergy causing systemic dermatitis. 
  3. Dr Jonathon Posthumus discussed a co-allergy of pork meat and cats, thought to be a cross-reactive sensitivity to serum albumin present in pigs and cats.

Finally, on 14 November it was reported that Dr Kathleen May, Medical College of Georgia at Augusta University, would be appointed as the new ACAAI president

Expert opinion on ACAAI 2022 

We interviewed Professor Douglas Mack (McMaster University, Canada) and Dr Jay Lieberman (University of Tennessee, USA) to hear their perspectives on ACAAI 2022. To go more in depth and hear their full perspectives, watch the videos below.

Prof. Douglas Mack

Dr Jay Lieberman

Main takeaways from the International Food Allergy Symposium at ACAAI 2022
Key future treatment options for food allergies
Advances in food allergy treatments

Meet the food allergy experts

Dr. Douglas Mack

Dr Mack is a Paediatric Allergy, Asthma and Immunology Specialist. Dr Mack is an Assistant Clinical Professor in the Department of Paediatrics at McMaster University. He is the Principal Investigator for Ontario Paediatric Allergy Research Corporation. He sits on the Board of Directors of the Canadian Society of Allergy and Clinical Immunology and is on the Executive for the section of Allergy for the Ontario Medical Association. He is an author of clinical guidelines on the prevention of allergy, epinephrine and anaphylaxis for the CSACI and is the editor of the first North American Manual on Oral Immunotherapy for food. He sits on the editorial board for the Journal of Food Allergy. Dr Mack is co-founder of Halton Paediatric Allergy Clinic where his focus is on Oral Food Immunotherapy.

Disclosures: Consultant and Speaker for ALK, Bausch Health, Aimmune, Medexus. Investigator for DBV and ALK.

Dr Jay Lieberman

Jay Lieberman, MD currently serves as an Associate Professor at the University of Tennessee Health Science Center and LeBonheur Children’s Hospital. Throughout his career, Dr Lieberman has dedicated his studies to the field of allergy and immunology. He completed his Internal Medicine Residency at Washington University and Barnes Jewish Hospital in St Louis, and later completed his allergy training at Mount Sinai Hospital in New York, where he was awarded the American Academy of Allergy Asthma & Immunology (AAAAI)/Elliot and Roslyn Jaffe Third-Year Fellowship Food Allergy Research Award. He currently works for the University of Tennessee and LeBonheur Children’s Hospital seeing patients and conducting clinical research studies in the field of allergy/immunology. Dr Lieberman also currently serves as chair for the American College of Allergy, Asthma, and Immunology food allergy committee, on the Joint Task Force Practice Parameters, as an associate editor for the Annals of Allergy Asthma and Immunology, and as an executive board member for the American Board of Allergy and Immunology.

Disclosures: Research (money to institution) from Aimmune, DBV, Novartis; advisor/consultant to, ALK, Aquestive, Bayer, Novartis; adjudication/DSMB to Abbvie, Siolta; organisational roles as a board member of the American Board of Allergy and Immunology, chair of food allergy committee ACAAI, member of the Joint Task Force for allergy practice parameters.

Improving patients’ journeys in food allergy 

As exciting new treatments and diagnostics begin to transition into clinical practice, join leading experts Alexandra Santos, Montserrat Fernández-Rivas, and Gideon Lack in this symposium presented at the EAACI Hybrid Congress 2022 in Prague.

Professor Alexandra Santos introduces the EAACI 2022 symposium in Prague.

Full Symposium

Chapter 1: Introductions

Chapter 2: Professor Alexandra Santos – Food allergy diagnosis: future strategies to improve the patients’ experiences

Chapter 3: Dr Montserrat Fernández-Rivas – Avoiding avoidance: novel strategies for food allergy management

Chapter 4: Professor Gideon Lack – Prevention of food allergy and the ‘window of opportunity’

Chapter 5: Q&A discussion with all faculty

Disclaimer: Final polling data may be different to what is presented at live session

Food allergy symposium overview 

In this timely and relevant symposium on food allergy, Professor Alexandra Santos opens with an overview of food allergy diagnosis utilising basophil activation tests (BAT) and mast-cell activation tests (MAT) to diagnose food allergies.

Dr Montserrat Fernández-Rivas describes the importance of a paradigmatic shift from avoiding certain foods to introducing them via novel oral immunotherapy treatments (OIT), and presents data on the prevalence of food allergy, risk factors and burden on patients.

Finally, Professor Gideon Lack explains how the early introduction of food allergens (peanut and baked egg) in infants has a dramatic effect of the prognosis of their food allergies later in life.

Meet the food allergy experts

Professor Alexandra SantosProfessor Alexandra Santos 

Professor Alexandra Santos is Professor of Paediatric Allergy at King’s College London and Honorary Consultant in Paediatric Allergy at the Evelina London Children’s Hospital in London, UK. The Santos Lab aims to improve the accuracy and safety of food allergy diagnosis and our understanding of the mechanisms of food allergy and oral tolerance in IgE-sensitised children to identify new targets for definitive treatment of food allergy. Professor Santos has received multiple prestigious awards from the Medical Research Council (MRC) and additional funding from the NIH, Food Allergy Research and Education (FARE), the Wellcome Trust, the European Commission, Asthma UK as Principal Investigator of Asthma UK Centre in Allergic Mechanisms of Asthma. She is the Chair of the Board of the Food Allergy Interest Group of European Academy of Allergy and Clinical Immunology (EAACI) and of the upcoming EAACI Food Allergy Guidelines. 

Disclosures: Professor Santos has grants from Medical Research Council (MR/M008517/1; MC/PC/18052; MR/T032081/1), Food Allergy Research and Education (FARE), the NIH, Asthma UK (AUK-BC-2015-01), Immune Tolerance Network/National Institute of Allergy and Infectious Diseases (NIAID, NIH), the European Commission and the Wellcome Trust; consultancy and/or speaker fees from Thermo Scientific, Nutricia, Infomed, Novartis, Allergy Therapeutics, Buhlmann, as well as research support from Buhlmann and Thermo Fisher Scientific through a collaboration agreement with King's College London.

Professor Montserrat Fernández-RivasProfessor Montserrat Fernández-Rivas

Dr Montserrat Fernández-Rivas is Head of the Allergy Department at the Hospital Clínico San Carlos in Madrid, and Associate Professor of Medicine at the Universidad Complutense de Madrid. She is also Head of the Allergy research group at the IdISSC (Instituto de Investigación Sanitaria San Carlos). Professor Fernández-Rivas is active in research into food allergy, specifically in food allergens, diagnosis, epidemiology, severity, food safety and immunotherapy of food allergy. She was a recipient of the 2019 EAACI Clemens von Pirquet award for clinical research, and was principal investigator in food allergy research projects funded by the Spanish Government, in the Spanish research Networks ARADyAL (2016-2021) and Vegetalia, in several integrated projects funded by the European Commission under 6th and 7th Framework Programs (SAFE, CREATE, EuroPrevall, FAST, iFAAM), and in clinical trials of oral immunotherapy and biologicals for food allergy. 

Disclosures: Professor Fernández-Rivas received grants/research support to her institution from ISC III and Aimmune; and received honoraria or consultation fees from Aimmune, ALK, Diater, Ga2LEN, HAL Allergy, GlaxoSmithKline, Medscape, Novartis, Reacta Healthcare, SPRIM and DBV.


Professor Gideon LackProfessor Gideon Lack 

Professor Gideon Lack is Professor of Paediatric Allergy at King’s College London and Head of the Children’s Allergy Clinical Academic Group at King’s Health Partners Institute of Women and Children’s Health at Evelina London, Guy’s & St. Thomas’ NHS Foundation Trust. He was co-author on the LEAP (Learning Early About Peanut allergy) study that showed that early consumption of peanuts in atopic infants reduces the development of peanut allergy by >80%, which translated to changes to health policy in the USA and Australia. His research focuses on the prevalence of food allergies in children and the relationship between food allergies, eczema, and asthma. He works on novel immune-modulatory treatments for food allergies and on developing new strategies to prevent the development of allergies and asthma in children and adults. 

Disclosures: Professor Lack is a stock shareholder in DBV Technologies, Mission Mighty Me, and serves as a Member of Scientific Advisory Board at DBV Technologies S.A. He received an honoraria from EPG Health for participating in a company-sponsored speaker’s bureau.

Key take home messages and unanswered questions

During the ‘Improving patients’ journeys in food allergy’ symposium presented at the EAACI Hybrid Congress 2022 in Prague, many questions were put to the expert faculty, some that remained unanswered. View the follow-up videos below to see their answers to your questions that were not addressed during the main symposium, along with the key take home messages from each of the faculty members.

Key takeaway messages

Key takeaway message from Professor Alexandra Santos – Food allergy diagnosis: future strategies to improve the patients’ experiences
Key takeaway message from Dr Montserrat Fernández-Rivas – Avoiding avoidance: novel strategies for food allergy management
Key takeaway message from Professor Gideon Lack – Prevention of food allergy and the ‘window of opportunity’

Unanswered questions

Professor Alexandra Santos is joined by Dr Montserrat Fernández-Rivas and Professor Gideon Lack to answer the remaining questions asked during the live symposium. Watch the videos below to see their responses.

Professor Alexandra SantosProfessor Alexandra Santos

Would basophil activation tests replace oral food challenges and other tests?
Which patients should we be testing with basophil activation tests?

Professor Montserrat Fernández-RivasDr Montserrat Fernández-Rivas

What is the role of anti-IgE agents, both as monotherapy and in combination with oral immunotherapy?
How can we convince regulators that OIT and other expensive treatments are justified in food allergy?
What is your advice to colleagues who are looking at setting up an immunotherapy service?
Who is the right patient to select for peanut OIT?

Professor Gideon LackProfessor Gideon Lack

What do you think about using specific products for early food introduction versus the foods in nature?
Should peanuts be introduced early everywhere in the world?

EAACI 2022 Congress highlights

Dr Sharon Chinthrajah, Director of the Clinical Translational Research Unit, Sean N. Parker Center for Allergy & Asthma Research, Stanford University, USA , and associate professor of medicine at Stanford University  shares some of the most exciting news from the EAACI 2022 Congress in Prague, Czech Republic.

How important is it to understand the combination of biologics therapies with oral immunotherapies for future food allergy management?
The importance of moving away from food allergen avoidance towards active management
Considering and managing the mental health of food allergy patients
Benefits of BAT/MAT testing over conventional skin prick tests

Dr Chinthrajah explains the importance of avoiding avoidance and the paradigmatic shift towards actively managing food allergies; followed by a discussion of novel diagnostic and prognostic techniques such as the basophil activation test and mast-cell activation test, and how they perform against the current gold standard of skin prick testing and oral food challenges. Dr Chinthrajah also delves into the necessity of oral immunotherapy treatments in treating food allergies, culminating in a discussion on how vital mental health support is for food allergy sufferers.


  1. Maurer M, Casale T, Saini S, et al. Dupilumab efficacy in patients with chronic spontaneous urticaria by IEG level: LIBERTY-CSU CUPID study. A. Ann Allergy Asthma Immunol. 2022;129(5, Supplement):S11.
  2. Shannon C, Lavelle J, Brown-Whitehorn T, et al. Characterizing anaphylaxis in infants presenting to the emergency department. Ann Allergy Asthma Immunol. 2022;129(5, Supplement):S18-S19.
  3. Beheshti R, Stone S, Hicks S. The use of multi-omics to identify predictive factors for food reactions. Ann Allergy Asthma Immunol. 2022;129(5, Supplement):S6.
  4. Burks A, Sindher S, Wang J, et al. Epitope study results: phase 3, randomized, double-blind, placebo-controlled study of epicutaneous immunotherapy in peanut-allergic toddlers. Ann Allergy Asthma Immunol. 2022;129(5, Supplement):S12.
  5. Yost J, Brown E, Winders T, et al. Epinephrine autoinjector utilization and access in a nationally representative food-allergic adult sample. Ann Allergy Asthma Immunol. 2022;129(5, Supplement):S7.