The Future of Medicine: Combating Chronic Food Allergies in Kids

Marc Rothenberg of the Cincinnati Center for Eosinophilic Disorders (CCED) at Cincinnati Children’s Hospital Medical Center

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Because of my interest in allergies, particularly eosinophils—white blood cells that are reflective of allergy—I started to talk to my colleagues here about this disease. We took biopsies from patients and looked at them under the microscope. They had this characteristic appearance—a swelling of the esophagus. We called that eosinophilic esophagitis, which got recognized as part of a whole syndrome: eosinophilic gastrointestinal disorders, or EGID.

EGID is a chronic allergic reaction. Patients have multiple foods that their bodies and immune systems become sensitized to and subsequently develop a swelling of the GI tract. That can cause a variety of symptoms that vary with age. The young kids in the first few years of life had difficulty growing. As they came closer to adolescence, the typical symptom was difficulty swallowing. Then as teenagers, a recurring problem was food actually getting stuck in their throats; that’s known as impaction. Often, they have to come to the emergency room just to have the food removed.

By 2000, we had a working group of 10 people with different backgrounds who developed a common interest in this disorder. We recruited them from within our own walls: The pathologist who focuses on tissue samples and understanding diseases, the gastroenterologist who does the endoscopy, the allergist who takes care of the allergy, and expert geneticists, statisticians, psychologists, and other specialties. I’m mainly the guy who works on research, trying to understand things so that they can have an impact internationally. But I’m not doing this alone. I work with master clinicians who are essential pieces to the puzzle.

One in 1,000 children have eosinophilic esophagitis. Unlike the food allergies you may be familiar with, this is life-altering. [These patients] become allergic to maybe 10 or 20 foods in the main food groups, like milk, egg, soy, wheat, and meat. They have a greatly restricted diet. When you get these diseases, they typically do not disappear; they require ongoing treatment—removing foods from their diet; prescribing anti-inflammatory agents or oral steroids; an elemental diet [involving] a specialized medical formula that is amino-acid based and allergen-free—and analysis.

One of our most prominent studies over the last year was the genetic analysis of the disease, using a full genome approach, looking at 550,000 genetic variants among 2,000 to 3,000 patients and fine-tuning exactly where the actual genetic risk is. I’m interested in understanding how we can use cutting-edge research to better the lives of children. Our mission is to find a cure.

Originally published in the January 2011 issue.

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