Food Allergy Thresholds: What Are They and How Can Knowing Yours Help You

AllergyHealth for Allergenis  

“How allergic am I?”

Understanding sensitivity is the question on everyone’s mind when they learn they have a food allergy. It’s a great question that has had an unfortunate answer: until recently, there was no easy way to evaluate how much of an allergen a person could tolerate. 

Food allergies are triggered by the proteins in allergens. How much protein it takes to elicit an allergic reaction differs for each person and can change under certain circumstances. Allergists have known that different people can likely tolerate different amounts of protein but had no easy way of determining how much each person can safely consume. 

What is a threshold?

The amount of protein a person can tolerate without triggering an allergic reaction is called a threshold. Thresholds can change over time and under the influence of cofactors (such as exercise, alcohol, illness, and others). Thresholds can be measured in a single tolerated dose or as a build up over several doses – also known as cumulative threshold.

Until recently, the only way to evaluate your threshold tolerance was to undergo an oral food challenge (OFC). These tests are conducted in a medical facility where someone with a food allergy is given increasingly larger and larger doses of their allergen until they react or reach a target amount of protein. OFCs require trained medical personnel, are lengthy (4-5 hours each), come with a risk of reaction, and can therefore be stressful for people with food allergies.

Many people confuse sensitivity with severity. Thresholds tell us how sensitive someone is to their allergen, but they cannot predict how severe or serious a reaction may be. Reaction severity depends on many things including how allergic or how sensitive a person is, the amount of allergen consumed, and the impact of cofactors. Currently, there is no test available (including an OFC) that can predict the type of reaction or degree of severity (mild hives/swelling, vomiting, or anaphylaxis) you may have to your allergen. And reactions can differ after every exposure, even to the same allergen.

How knowing your threshold can help you.

Knowing your threshold is crucial to making better everyday decisions. Without this information, a person with food allergies must assume they are highly sensitive (have a low threshold/tolerance), even to trace amounts of protein - amounts so small they may not be visible. This can greatly limit both those with food allergies and their families as they must alter their lifestyle to stay safe and protected.

Understanding your threshold allows you and your healthcare provider to make informed decisions about your life. For example, if you were able to tolerate moderate to high amounts of peanut protein, you may be able to purchase and consume food with precautionary labels (such as “may contain”). You may be able to start oral immunotherapy (OIT) or another therapy at a higher starting dose or reduce treatment time. This may give you the confidence to move ahead with an OFC or OIT, knowing you will not immediately react. You may be able to travel, go to school or work, or engage socially with less anxiety and fear. 

If you were able to tolerate a low amount of allergen, you would want to know that too! Increasing your tolerance through OIT or another therapy may become a priority. You could use your threshold information to establish safe protocols at school or work. You would know to take precautions more seriously and limit the interference of cofactors to keep yourself healthy.

Allergenis uses new technology to help you discover your threshold today.

Using epitope mapping (otherwise known as bead-based epitope assay, or BBEA), the Allergenis Peanut Diagnostic can help you discover your threshold. The Allergenis Peanut Diagnostic not only accurate diagnoses a peanut allergy with 93 percent accuracy (compare that to traditional tests which have 50 percent false positive rates), it also assesses a person’s cumulative threshold. All in one blood draw!

Allergists and healthcare providers will no longer have to treat everyone with a peanut allergy the same - as if they are very highly sensitive and have a low threshold. Now, they can evaluate a person with a peanut allergy and give them tailored, personalized guidelines to make decisions and enjoy a full life. The Allergenis Peanut Diagnostic will give people with peanut allergies and their families the confidence to make healthy, balanced decisions about how to stay safe.

Allergenis is working hard to bring tests for other allergens to market. Dairy, egg, tree nuts, and shrimp are in the works. Allergenis’ milk diagnostic should be available by the end of 2023.