Food Allergy in Wisconsin - Wisconsin Food Allergy

Wisconsin family learning about oral immunotherapy OIT treatment options from allergist Dr Ringwala

How Oral Immunotherapy Works: A Detailed Breakdown for Wisconsin Families

For families living with food allergies, the constant vigilance required to avoid allergenic foods can feel overwhelming. Every meal outside the home, every birthday party, every school event carries the weight of potential danger. But what if there was a way to reduce that fear? What if children with severe food allergies could build tolerance to the very foods that once threatened their lives? Oral immunotherapy (OIT) represents a paradigm shift in food allergy treatment. Rather than simply avoiding allergenic foods indefinitely, OIT aims to gradually desensitize the immune system, reducing the risk of severe reactions from accidental exposures and, in some cases, allowing patients to consume previously forbidden foods. For Wisconsin families navigating the challenges of food allergies, understanding how OIT works, who might benefit, and what the treatment process entails can help determine whether this emerging therapy is right for their situation. What OIT Is Designed To Do Oral immunotherapy doesn’t cure food allergies in the traditional sense, but it fundamentally changes the relationship between a patient’s immune system and allergenic foods. Understanding the goals and mechanisms of OIT helps set appropriate expectations about what this treatment can and cannot accomplish. Building tolerance The primary goal of OIT is to increase the threshold amount of an allergen needed to trigger a reaction. Someone who might previously have experienced anaphylaxis from a trace amount of peanut could, after successful OIT, tolerate intentional consumption of several peanuts without severe symptoms. This increased tolerance dramatically reduces the danger posed by accidental exposures—the restaurant meal prepared on shared equipment, the cookie that contained unlabeled tree nuts, or the cross-contaminated snack at school. For many families, the goal isn’t necessarily to eat allergenic foods freely and regularly, but rather to create a safety buffer that protects against the inevitable slip-ups that occur despite careful vigilance. This “bite-proof” level of protection means that a small, accidental exposure—licking a frosting that contained milk protein, or eating a cookie that was cross-contaminated with peanut—won’t result in emergency room visits or life-threatening reactions. Some patients undergoing OIT do eventually incorporate the allergenic food into their regular diet, eating it freely without restriction. However, this isn’t the primary measure of success. Even patients who choose to continue avoiding the allergenic food after treatment benefit enormously from reduced anxiety and increased margin of safety in their daily lives. The psychological impact of increased tolerance extends beyond just the patient. Parents of food-allergic children often describe constant, exhausting hypervigilance. Every ingredient label, every restaurant meal, every playdate requires intense scrutiny and carries the fear that despite their best efforts, their child might be exposed. Our comprehensive food allergy treatment approach can significantly reduce this anxiety burden, allowing families to approach eating situations with less fear and more confidence. It’s important to understand that OIT creates desensitization rather than true tolerance in most cases. Desensitization requires ongoing exposure to the allergen—patients typically need to consume the allergenic food regularly (daily or several times weekly) to maintain their protection. If they stop consuming the food for extended periods, desensitization may fade, and they could become reactive again. Desensitization science The science behind OIT involves gradually retraining the immune system’s response to specific food proteins. In people with IgE-mediated food allergies, the immune system has incorrectly identified certain food proteins as dangerous threats. When these individuals consume the allergenic food, their immune system launches an aggressive defensive response, releasing histamine and other chemicals that cause allergic symptoms. OIT works by introducing tiny amounts of the allergenic food—far below the amount that would trigger a reaction—and slowly increasing the dose over time. This gradual exposure appears to shift the immune response away from the aggressive IgE-mediated pathway toward a more tolerant response involving different types of immune cells and antibodies. During OIT, the body begins producing IgG4 antibodies specific to the food allergen. Unlike IgE antibodies that trigger allergic reactions, IgG4 antibodies are thought to have a protective, blocking effect. They can bind to food proteins before IgE antibodies do, preventing the cascade of events that leads to allergic symptoms. Over time, the ratio of IgG4 to IgE increases, contributing to greater tolerance. Changes also occur in regulatory T cells (Tregs), specialized immune cells that help maintain immune system balance and prevent overreactions. Research published by the National Institutes of Health shows that OIT appears to increase food-specific Tregs, which help calm the immune response to the allergen and promote tolerance. Additionally, mast cells and basophils—the immune cells that release histamine during allergic reactions—become less reactive over the course of treatment. The exact mechanisms underlying successful OIT are still being researched, and individual responses vary considerably. Some patients achieve robust desensitization relatively quickly, while others progress more slowly or reach a plateau below full desensitization. Understanding these individual differences is part of why [OIT requires close medical supervision](internal-link: /about/dr-ringwala) and individualized treatment planning. Research continues into ways to optimize OIT protocols, potentially combining oral immunotherapy with other approaches like probiotic supplementation, anti-IgE medications, or modifications to treatment schedules. Wisconsin families participating in OIT are benefiting from years of accumulated research and clinical experience that have refined protocols to maximize safety and efficacy. Who Qualifies for OIT Not every patient with food allergies is an appropriate candidate for oral immunotherapy. Board-certified allergists carefully evaluate multiple factors when determining whether OIT is suitable and likely to benefit a specific individual. Age groups OIT has been studied and implemented most extensively in children, typically starting around age 4-5 years. This age range represents a balance between being old enough to cooperate with daily dosing and follow safety instructions, while still being young enough to potentially benefit from years of reduced allergy burden. Many Wisconsin allergy practices focus their paediatric OIT programs primarily on this age range for these reasons. The lower age limit reflects practical considerations. Younger children may have difficulty reliably swallowing doses, might not communicate symptoms clearly, and could struggle to follow restrictions like avoiding exercise or hot showers after dosing. However, some practices

Food Allergies in Wisconsin: Why Cases Are Rising and What Families Need to Know

Food allergies in Wisconsin have become an increasingly pressing health concern across the United States. Families throughout the state are grappling with diagnoses that affect daily life, from grocery shopping to school lunches to family gatherings. Understanding why food allergy cases are rising, recognizing symptoms early, and knowing when to seek specialized care can make a significant difference in managing this growing health challenge. Understanding the Surge in Food Allergy Cases The rise in food allergies isn’t just a perception—it’s a documented trend that has medical professionals and researchers working to understand the underlying causes. Wisconsin families are experiencing this surge firsthand, with more children and adults receiving food allergy diagnoses than ever before. National vs Wisconsin-specific statistics Nationally, food allergies affect approximately 8% of children and 11% of adults, representing a substantial increase over the past two decades. Research indicates that food allergy prevalence among children increased by 50% between 1997 and 2011, and this upward trend has continued into recent years. Emergency department visits for food allergy reactions have similarly climbed, highlighting the severity and frequency of allergic episodes. In Wisconsin, the picture mirrors these national trends, though some regional variations exist. Wisconsin’s diverse population and geographic spread mean that food allergy rates can vary between urban centers like Milwaukee and Madison and more rural communities. Healthcare providers across the state report seeing more patients with multiple food allergies, a phenomenon that complicates dietary management and increases the risk of accidental exposure. Environmental and dietary factors Several environmental theories attempt to explain why food allergies are becoming more common. The “hygiene hypothesis” suggests that reduced exposure to microbes in early childhood—due to increased sanitation, smaller family sizes, and less time spent outdoors—may prevent the immune system from developing properly, making it more likely to react to harmless proteins in food. Wisconsin’s climate and environmental factors may also play a role. The state’s long winters mean children often spend extended periods indoors, potentially limiting microbial diversity exposure. Additionally, changes in dietary patterns, including increased consumption of processed foods and altered timing of food introduction during infancy, may contribute to rising allergy rates. Vitamin D deficiency has emerged as another potential factor. Wisconsin’s northern latitude means residents receive less sunlight exposure, particularly during winter months, which can lead to lower vitamin D levels. Some research suggests that vitamin D deficiency may be associated with increased food allergy risk, though more studies are needed to establish a definitive link. Early childhood exposure patterns How and when infants are introduced to allergenic foods has been a subject of evolving guidance. For years, parents were advised to delay introducing common allergens like peanuts, eggs, and fish. However, groundbreaking research has since reversed this recommendation. Current guidelines from organizations including the American Academy of Pediatrics now encourage early introduction of allergenic foods—typically around 4-6 months of age—as a strategy to prevent food allergies. Even earlier introduction by maternal diet in utero and during breast feeding can be an added strategy. Despite this updated guidance, many Wisconsin families remain unaware of the importance of early allergen introduction, or they feel hesitant to try it without medical supervision. This knowledge gap may contribute to continued high rates of food allergies as optimal prevention windows are missed. Common Food Allergies Seen in Wisconsin Patients While food allergies can develop to virtually any food, certain allergens are far more common than others. Understanding which foods most frequently trigger allergic reactions helps families stay vigilant and prepared. Peanut, tree nut, milk, egg The “Big Eight” food allergens account for approximately 90% of all food allergic reactions in the United States: milk, eggs, peanuts, tree nuts, soy, wheat, fish, and shellfish. Among Wisconsin patients, peanut and tree nut allergies are particularly prevalent and tend to persist into adulthood, unlike milk and egg allergies, which some children could outgrow. Peanut allergy affects approximately 2% of children and is one of the leading causes of severe, life-threatening allergic reactions. Tree nut allergies—including reactions to walnuts, cashews, almonds, and pecans—often occur alongside peanut allergies but can also develop independently. These allergies require strict avoidance, as even trace amounts can trigger serious reactions. Milk and egg allergies are most common in infants and young children. Milk allergy affects about 2-3% of infants, though some may outgrow it by age 5. Egg allergy follows a similar pattern. For Wisconsin families, managing these allergies during early childhood means carefully reading labels, finding suitable substitutes for baking and cooking, and coordinating with daycare providers and schools to ensure safe meals. Regional food patterns and hidden triggers Wisconsin’s strong dairy heritage and agricultural traditions mean that milk and dairy products are deeply embedded in the local food culture. From cheese curds to Friday fish fries with tartar sauce, navigating Wisconsin’s culinary landscape with a dairy or egg allergy presents unique challenges. Cross-contamination is a significant concern, particularly in restaurants and at social gatherings. Foods that appear safe may contain hidden allergens through shared cooking equipment, preparation surfaces, or ingredients. For example, many Wisconsin bakeries use the same equipment to prepare products containing nuts, eggs, and dairy, creating cross-contamination risks even in items that don’t list these ingredients. Seasonal considerations also matter. Wisconsin’s vibrant farmers market culture means families often purchase fresh, local foods. While this has many health benefits, it also requires vigilance in asking vendors about ingredients and potential cross-contact, as these settings may lack the detailed labeling found in commercial products. Symptoms to Watch For Recognizing the signs of an allergic reaction is critical for prompt treatment and prevention of severe complications. Food allergy symptoms can range from mild discomfort to life-threatening emergencies, and reaction severity isn’t always predictable. Mild to moderate reactions Mild to moderate allergic reactions typically begin within minutes to two hours after consuming the triggering food. Symptoms may include: While these symptoms may seem manageable, they should never be dismissed. A mild reaction on one occasion doesn’t guarantee all future reactions will be mild. Some individuals experience progressively more severe reactions