A product is being tested to see if it can help make immune therapy a normal occurrence.
People with food allergies can one day be able to treat their symptoms easily by brushing their teeth. A company based in New York City has started a trial to test this idea in a small group of peanut allergy sufferers.
The aim is to gradually increase and sustain tolerance to an allergen by exposing users to small doses of it on a regular basis.
According to researchers at Intrommune Therapeutics, which created the toothpaste, tying this medication to a daily routine should help allergy sufferers stick to standard treatment.
The substance may also deliver the active ingredients in those treatments to immune cells in the mouth more effectively than existing therapies, according to the researchers.
Food allergies impact nearly 32 million people in the United States. Oral immunotherapy, for example, exposes patients to minimal quantities of their allergen in regular doses that are swallowed as food.
However, the drug may cause allergic reactions, and without continued maintenance dosing, the hard-won tolerance sometimes fades.
Sublingual immunotherapy, a gentler procedure that delivers smaller doses by under-the-tongue liquid drops, provides adequate safety with less side effects.
It may be particularly helpful in the case of allergies that are discovered early on. Researchers announced February 27 at a virtual meeting of the American Academy of Allergy, Asthma, and Immunology that the mouth drops have even greater and longer-lasting effects in toddlers than in older children.
Even so, patients will find it difficult to stick to this regular therapy.
When brushing his teeth in front of a mirror many years ago, William Reisacher, an allergist at Weill Cornell Medicine in New York City, was perplexed by these ideas. “I saw all the foam in my mouth going into all the areas I wanted it to go,” he says. He reasoned that delivering food proteins as toothpaste would bring the medication to the right cells and embed it in a daily habit.
“Bill told me this crazy idea he had, and I thought it was genius,” says Michael Nelson, an attorney trained in biology and health care.
To build the product, Nelson cofounded Intrommune. 32 peanut-allergic adults will be included in a recently initiated clinical trial of a toothpaste intended to treat peanut allergy to see how well they handle escalating doses. According to Nelson, potential trials can look at toothpastes that contain multiple allergens.
Other allergists agree with the principle of toothpaste, but some are worried about dosage management and protection. Allergens can have direct entry to the bloodstream when a patient’s gums are sore and inflamed, such as after dental treatment or losing a tooth, which raises the likelihood of systemic allergic reactions, according to allergist Sakina Bajowala.
At Kaneland Allergy & Asthma Center in North Aurora, Illinois, she provides oral and sublingual immunotherapies for food and environmental allergies.
“Safety is something I’m going to be watching closely,” she says. But “if they found something they think they can commercialize and make accessible, and if they can prove it’s safe and effective, then fantastic.”
