Research often starts by asking a single question, but for Dr. Timothy Richmond his started by experiencing the question, too.
“I have a personal interest in food allergies because I have them myself,” said Dr. Richmond. “I was working in allergy as a resident alongside Dr. Jinzhu Li when I learned about an opportunity to get funding for a research study. We started talking about all the false positives we see with kids – the skin test shows an allergy to something yet they have no symptoms when it’s ingested. Why is that? It’s a simple question that I think will lead to some fascinating studies.”
It’s estimated that some 15 million Americans have food allergies, and the Centers for Disease Control and Prevention estimates that food allergies among children increased approximately 50 percent between 1997 and 2011.
Science tells us how a food allergy happens – when our immune system attacks a food protein – but it doesn’t tell us why some foods trigger a reaction and others don’t.
For Dr. Richmond, his research study – why people test positive for a food allergen on a skin test, but not when the food is eaten – is hoping to be a first step in helping physicians understand why false positive allergy tests occur and, more importantly, help uncover why food allergies develop in some people and not others.
A need for answers
For Dr. Richmond’s study, he collected data from adults, age 18-50, with no known history of food allergies. Participants took a written survey and attended one to two office visits over a three month period. At the office visits, allergy skin testing and blood draws were conducted with some of the most common food allergy culprits – milk, egg, peanut, tree nuts, soy, wheat, fish and shellfish.
“Everyone really played an important role – volunteers, schedulers, nurses – in the study,” said Dr. Richmond. “I loved that I was able to be as involved in the hands-on data collection as my schedule allowed me to be. I needed help scheduling volunteer appointments, but I could do the blood draws. Other days I just had time to read results…The collaboration was great.”
Collecting sufficient participation data was critical to yielding results.
“Often one of the biggest challenges for a research study is finding people to be a part of it,” said Dr. Richmond. “Since I work at a hospital that puts the best interests of kids into everything they do, I thought recruiting participants from our staff would be my best option to get the data needed.”
Of the 250 participant responses he received, one came from Michelle Dickstein, associate project manager for Akron Children’s Population Health, Information Services.
“I have some seasonal allergies, but I’ve never had allergy testing before…,” said Michelle. “I signed up for the study because I wanted to learn more about food allergies, sensitivities and how the human body reacts to allergens. I’ve been involved in research studies before, but never as a participant…Being a part of this study was a great experience and I hope its results help.”
Once the online survey was complete, participants were asked to come in for allergy testing. A skin-prick test was done that places a liquid, containing a tiny amount of the food allergen, on the skin of the arm. The skin is pricked with a small, sterile probe, allowing the liquid to seep under the skin.
Allergic reactions to food can affect the skin, respiratory tract, gastrointestinal tract and cardiovascular system. Anaphylaxis, the most severe allergic reaction, can come on within minutes of exposure to the trigger food and can be fatal.
“If a person tested positive on the skin test then we’d have him/her come back for a blood draw,” said Dr. Richmond. “We’d draw blood before and after they ingested the food they tested positive for on the skin to see if there was any sign of anaphylaxis or evidence of allergic reaction.”
Michelle tested positive to almonds on the skin test, but had a negative blood test or a false positive.
“The main outcome was my skin showed a sensitivity to almonds but, after eating them, I had no response measurable with blood testing, no symptoms,” said Michelle. “For me, this is good news because it means I don’t have to avoid eating almonds!”
Research is a series of steps
Although the study didn’t use children in the test cases, the results will help drive more studies in the hopes of helping allergists be more or less conservative in how they treat pediatric patients with food allergies.
“What my study found was we didn’t see a real difference in allergic reaction when the food was consumed and entered the blood stream yet it often presented on the skin,” said Dr. Richmond. “We’ve shown there’s a false positive phenomenon, but more research needs to be done now on why we don’t see a reaction when the food is consumed. We can make assumptions about why from the data we’ve collected such as it has something to do with how food breaks down in the digestive tract. However, we hope to present our results nationally and publish our results to get additional input from experts in the allergy field, which will help determine next steps for the research.”
Research is a perpetual process of learning and investigating. One study often leads to another or reveals unexpected results that lead to answers.
“The ultimate goal of research is to help clinicians improve outcomes and that’s what I hope mine will do…I can’t wait to see where this next step will lead us,” added Dr. Richmond.
Watch Dr. Richmond’s recent presentation to learn more about his allergy study and his thoughts about getting involved with research at Akron Children’s Hospital. (download the presentation or stream it; note that it begins at 25:56)