Research into allergy and intolerance

Much progress has been made in recent years in understanding the mechanisms of allergy, but our knowledge is far from complete. Despite good work done in the UK and the United States and elsewhere, it is still uncertain how and why some people become allergic to certain foods and substances. As far as the allergy sufferer is concerned, all he or she can really do is try to avoid the offending food, scrupulously carry around prescribed medication, devise an action plan for when things go wrong - and wait and hope for better treatments to be developed. Further research is the customer's best hope.

The fact that our knowledge is incomplete poses obvious difficulties for support groups, which rely on information provided by the medical community. This information may have to be modified from time to time and it may even change altogether. Key messages conveyed by support groups one year may be overturned the next, so that advice offered in good faith may later prove to have been unwise or even dangerous. As a purely theoretical example, no one knows for sure what effect minuscule traces of peanut may have on the development of allergy. Traces may sensitise, or they may protect against sensitisation; occasional traces may sustain sensitivity in a person already sensitised, or they may lead to tolerance; occasional traces may protect a person from a severe reaction, or they may build up to a catastrophic reaction. How can we be sure that by advocating total avoidance of allergens we are putting forward the correct messages?

Other questions occupy the forefront of our thinking. Why is nut allergy particularly dangerous? Are there other foods that may be climbing up the allergy table? Today peanuts - what next? Might there be a way to identify 'high-risk' allergy patients early in life? If this were possible, it would release an intolerable burden from those who think they are at risk of a severe reaction, but may not be. Should everyone with peanut allergy be offered adrenaline? Or are those who advocate adrenaline for all nut allergy patients generating needless complications?

Perhaps what we are looking for is a clinical test to identify patients in the high-risk group. It would also be valuable to know what factors increase a patient's vulnerability at any particular time. We know that the patient's general state of health may be important, and we suspect alcohol consumption may play a part in some cases. But there may be other factors coming into play.

Allergy support groups strongly advocate more basic research which will seek to unravel these mysteries and make the risk of anaphylaxis more manageable.

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