Carly Edwards found out at just about the worst time possible that her oldest daughter is allergic to eggs.
It was Elsie Jane’s first birthday. And shortly after the birthday girl dived head-first into her smash cake, the allergic reaction hit: hives, vomiting.
“So that was fun for my whole family to watch,” Edwards, who lives in Denver, said. “That was a pretty low moment.”
The birthday revelation kicked off months of trying to understand what had made Elsie Jane sick — while she can tolerate eggs that have been sufficiently baked, it turned out to be egg whites in the frosting that triggered the reaction. Then, once Edwards and her husband learned the parameters of Elsie Jane’s allergy, came the obstacle course of trying to avoid exposure out in the world.
While manufacturers must list common allergens on the label of food sold in stores, eggs can ultimately hide in many things. Restaurant menus can be particularly opaque, and that’s before you consider the risk that bits of egg might accidentally end up in menu items that aren’t supposed to have them.
“We didn’t eat out for a whole year of life because we were so concerned about cross-contamination,” Edwards said.
But a newly authorized treatment could help take the stress out of everyday eating for Elsie Jane and millions of people like her across the country. The federal Food and Drug Administration last month gave approval to a drug called Xolair to help people with certain types of food allergies avoid severe reactions from accidental exposure.
The drug’s approval comes at an especially important time, as the prevalence of food allergies is rising across the country.
Xolair is not a cure for food allergies — it must be taken regularly to remain effective and, even then, it doesn’t allow people with food allergies to eat as much as they like of the thing they’re allergic to. But it can help people avoid the worst when they are accidentally exposed, and that’s a breakthrough.
“It’s almost impossible to avoid reactions and live in the real world,” said Dr. BJ Lanser, a pediatric allergy specialist at National Jewish Health in Denver. “That peace of mind and knowledge of the protection that is there is obviously of significant benefit to many.”
Denver’s fingerprints on the breakthrough
Xolair treats only certain types of food allergies — ones that in medical terms are said to be “IgE-mediated.” That’s the most common type of allergic reaction to food. In simple terms, it means that the presence of a particular food particle causes your immune system to go into attack mode.
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The drug works by binding to an antibody called IgE, which triggers the allergic immune response. By tackling IgE and preventing it from binding to receptors, the drug stops the allergic reaction from flaring up.
Xolair, which is injected once every two to four weeks, is not a new medicine. It has previously been approved to treat certain types of asthma.
But the idea of using an anti-IgE drug on food allergies isn’t new either — in fact, it has roots in research first conducted at National Jewish and its predecessors.
A husband-wife team of researchers working in the 1960s at the Children’s Asthma Research Institute and Hospital in Denver were among the first in the world to discover IgE.
Roughly 35 years later, National Jewish researchers led by Dr. Donald Leung studied the use of an anti-IgE drug to treat peanut allergies. The results of the study were so promising that Leung and his colleagues concluded the drug “should translate into protection against most unintended ingestions of peanuts.”
But Leung said the vagaries of pharmaceutical development and federal regulatory approval ultimately meant the research didn’t go anywhere right away. At the time, in the early-2000s, food allergies were also less common.
“Food allergy is a relatively new problem when you look at it in terms of history,” Leung said.
Still, Leung and his National Jewish colleagues didn’t give up and continued to study the origins of food allergies. (Among his research interests is examining the connection between food allergies and skin conditions like eczema.)
When a major study looking at Xolair’s potential to treat food allergies was published last month in The New England Journal of Medicine — research that helped inform the FDA’s approval — Leung was among the authors.
“It’s not the perfect drug,” Leung said, noting that the drug didn’t work for some patients and can even come with a small risk of anaphylaxis. “But it is a big step forward.”
Help for Elsie Jane
As they learned more about Elsie Jane’s allergy, Edwards and her husband worked with doctors at National Jewish to gradually build up Elsie Jane’s tolerance to eggs and then test that tolerance through what are known as food challenges.
Nearly every day, she eats something containing baked eggs — maybe homemade bread or a baked waffle. Every week, she can have challah at school, which is hugely important to her and her family, who are Jewish.
“It makes her so happy and a part of the class,” Edwards said.
They know now that Elsie Jane is unlikely to have an anaphylactic reaction — the most severe and life-threatening type of allergic reaction — unless she eats a lot of eggs. And she is old enough now to start recognizing the warning signs on her own.
But the risk still remains. Recently, Elsie Jane, now 3, had an allergic reaction while at school from a cross-contamination of a food containing egg whites.
“It’s just little things like that,” Edwards said. “It’s just when you let your guard down.”
Elsie Jane has not yet been prescribed Xolair. Lanser, the National Jewish doctor, said some patients whose allergies are well managed in other ways may never need it.
But Edwards is grateful that there is something that could be available if it’s needed — both for Elsie Jane and for the Edwards’ younger daughter, who is also allergic to eggs.
“The fact that this could, as scary as it is, save her life is life-changing,” Edwards said.
“I could not be more excited.”