“Dad, maybe you just don’t make enough epi?” asked my son, who was 9 years old at the time.
The simplicity of the question caught my attention. I have food allergies, and I carry an EpiPen as a precaution.
As a physician, I knew the more technical way to pose my son’s query. Even though food allergy is a disease triggered through the immune system, the solution for food allergy anaphylaxis—a shot of epinephrine—primarily controls our neurological system, not the immune system.
Specifically, epinephrine activates our “adrenaline rush,” which, as the name indicates, is the job of the adrenal system. (The adrenal gland, which sits next to your kidney, is part of your body’s “fight-or-flight” shock response system.)
So do food allergy patients suffer from an underlying autonomic (“fight-or-flight”) insufficiency or adrenal insufficiency that leaves them vulnerable to anaphylaxis? Put another way, do they have a previously undiagnosed defect in their adrenal systems?
Since that initial question almost a decade ago, our family has been hunting for clues to answer it. The initial round of meetings with the top scientists in the field yielded no answers—there was no prior research in this area—but generated great interest. We subsequently funded a research study through Stanford with renowned scientist Dr. Kari Nadeau to better understand baseline autonomic function and autonomic responsiveness among food allergy patients.
The preliminary observations from these studies suggested that patients with food allergies exhibit some defects in their adrenal system. The number of patients studied was not large enough to make any definitive conclusions, but the preliminary findings were intriguing enough to discuss with scientists in the field including those working with Food Allergy Research and Education (FARE) and Food Allergy Science Initiative (FASI). On March 19, 2019, FASI gathered scientists at the Broad Institute for a Symposium entitled Neuro-Immune Communications in Food Allergy—an encouraging sign.
However, as is almost always the case in any area with brand new hypotheses, research funding for studying the contribution of the neurological system in food allergy is non-existent. As a result, many basic questions remain unanswered: (1) Is there a better way to characterize the neurological dysfunction in patients vulnerable to anaphylaxis?; (2) Why do such patients have this dysfunction in the first place?; (3) What can be done to fix the problem?
At the minimum, this line of thinking offers fresh places to look for the underlying causes and potential solutions for the growing epidemic of food allergies around the world. For example, in the UK, admission rates for anaphylaxis from food allergies doubled from 1998 to 2012, and in Australia, admissions for anaphylaxis caused by food increased at an average annual rate of 13.2 percent between 1994 and 2005.
Do such patients have spinal cord or brain abnormalities that affect the adrenal response? Do they have adrenal insufficiency created by chronic stress coming from their environment? Could biofeedback-based entrainment of the autonomic function alleviate adrenal insufficiency to a degree that mitigates anaphylaxis?
The good news is the community could help solve some of these mysteries. Thanks to the emergence of many consumer technologies, continuous monitoring of the autonomic nervous system has become possible. These devices can capture baseline data and report what happens when patients experience an allergic reaction. If the community finds ways to pool all this data into projects where entire population levels can be analyzed, we could provide scientists with a much better understanding of the nature of the defect in the neurological system of food allergy patients.
Physicist J. Robert Oppenheimer once said: “There are children playing in the street who could solve some of my top problems in physics, because they have modes of sensory perception that I lost long ago.” It raises the question of what would happen if, as my son did for me in food allergies, the natural curiosity of the younger generation could lend fresh eyes and spark new thoughts on seemingly intractable medical problems such as cancer and Alzheimer’s disease.
Joon Yun is a Principal of the Yun Family Foundation.
