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Helping Children Outgrow Food Allergies: Q&A With Terri Brown-Whitehorn, MD

Published on May 17, 2023 in Cornerstone Blog · Last updated 11 months 1 week ago


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Editor's Note: In recognition of Food Allergy Awareness Week, we sat down with Terri Brown-Whitehorn, MD, an attending physician in the Division of Allergy and Immunology and co-leader of the Food Allergy Center Frontier Program, to learn how the field has evolved since she began her career at Children’s Hospital of Philadelphia. With more than 25 years in food allergy research, Dr. Brown-Whitehorn has much to share, including her involvement with a peanut patch study published in the New England Journal of Medicine.

Terri Brown-Whitehorn, MD
Dr. Terri Brown-Whitehorn, a food allergy clinical researcher at CHOP for over 25 year values being part of her patients' and their families' lives and seeing firsthand the impact of her work.

It’s fascinating to hear how science careers evolve. How did you become interested in food allergy research?

I became interested in allergy and immunology during my residency here at CHOP because I wanted a career that allowed me to follow patients from infancy to young adulthood, seeing both common conditions as well as less common. Early on, I was interested in food allergy because of the daily impact on my patients’ and their families’ lives.

Over the years, the number of children with food allergies continued to rise. Our emergency department colleagues were seeing and continue to see on average one patient a day, or every other day, with severe reactions. And although some patients outgrew their food allergy, it wasn’t going away for all of them.

So the question became: Could we do something that could help these children outgrow their food allergy or at least make them safer from an accidental exposure? While avoidance was the mainstay of therapy, I felt like we should be able to do something. 

I have been involved with our food allergy clinical research program at CHOP for both oral immunotherapy (OIT) and epicutaneous immunotherapy (EPIT). With OIT, children take “doses” by mouth on a daily basis; they’re monitored quite carefully before and after dosing with gradual escalation of dosing. With EPIT, a special patch containing a small amount of allergen is placed on a child’s back, exposing the immune system to a very low level of allergen with less risk of a systemic reaction.

We still have work to do — these methods are not successful for everyone, and currently the patch is investigational only — but it amazes me that these approaches work in some patients. We are truly changing peoples’ lives one patient at a time.

How did you get involved in peanut patch studies?

Peanut Patch Trial
All smiles are some members of the CHOP study team of the original peanut patch trial, along with Dr. Brown-Whitehorn (far right) and patient.

Years ago, Jonathan Spergel, MD, PhD, chief of the Allergy Section, asked me to be a principal investigator on a peanut patch study to determine the optimal dose, adverse events, and efficacy of the patch for peanut allergy treatment. I didn’t know much about being on a research trial, or being a PI, or the patch. But I thought it would be an awesome opportunity. And we knew of some early studies that showed the peanut patch may possibly work. And so I wanted to do it.

I thought it was a cool idea to be able to put a peanut patch on somebody’s back to try and change their immune system so that if they ate — not a peanut butter sandwich — but if they had an accidental exposure to peanuts then they wouldn’t get as sick as they would have otherwise. I also knew I had a wonderful research team and colleagues who would learn together.

In the original phase 2b study in patients 6 to 55 years of age, we helped find the optimal patch dose and found significant treatment response versus the placebo patch following 12 months of therapy. These findings led to a follow-up study that showed the approach to be effective in some children ages 4 to 11, a safety study in that age group, and the recent toddler study. Our patients and their families are so courageous to be in these studies. They have double blind placebo controlled food challenges and have a chance of being in the placebo arm. 

The most recent peanut patch study you worked on was published in the New England Journal of Medicine. Would you tell us about that research?

No FDA-approved peanut allergy treatments are available for patients under the age of 4. We were part of the study sites that found that daily use of a peanut patch for one year was effective in desensitizing a majority of peanut-allergic toddlers, lessening the likelihood of an allergic reaction if accidentally exposed.

In this phase 3 clinical trial, 362 patients between the ages of 1 and 3 were randomized into two groups: 244 received the peanut patch, and 118 received a placebo patch. We set a baseline of how much peanut caused a reaction before treatment, and the goal was to see if those with a lower baseline sensitivity could tolerate approximately one peanut after 12 months of EPIT, changing the patch daily, and if those with a higher baseline could eventually tolerate approximately three to four peanuts. After a year of treatment, a significantly larger percentage of those wearing the peanut patch were able to tolerate the required peanut dose. 

Being part of research families’ lives and seeing firsthand the impact of the trial has been wonderful. Even those for whom the study may not have worked are thankful that we are doing something to try and help. Although an allergy patch won’t necessarily work for all toddlers, this study shows that it could be one more tool in an allergist’s toolbox to help prevent a life-threatening allergic reaction. If we can find ways to reprogram these children’s immune systems, that’s a step in the right direction.

Are there other areas of food allergy research you’re interested in?

Terri F. Brown-Whitehorn
Terri Brown-Whitehorn, MD

I’m the director of the Food Protein Induced Enterocolitis Syndrome (FPIES) Center. FPIES is a rare food allergy that affects the gastrointestinal tract, and unlike most food allergies, symptoms of FPIES don’t begin immediately after eating. Instead, it can take hours before severe symptoms such as vomiting, lethargy, and, at times, shock, to begin. There is so much to learn.

Another area of interest is eosinophilic esophagitis (EoE), which is a chronic allergic inflammatory disease of the esophagus. Although this disease affects all age groups, the presentation varies per age. I have been involved as sub-investigator on trials for EoE treatment as well, one of which has led to FDA approval of medication.

Colleagues at CHOP are working hard on basic science and translational aspects of both FPIES and EoE.

How has your field changed in the last 25 years that you’ve been working in it?

I have seen the evolution of management of asthma, eczema, and food allergy. What we thought was the way to do things in the year 2000 has dramatically changed in 2023, based on knowledge we have from both bench-top and clinical research.

I also was involved in some of the very first multidisciplinary clinics at CHOP, like the Center for Pediatric Eosinophilic Disorders, which are now commonplace — but not in the early 2000s. For some conditions, I truly believe seeing multiple specialists at the same time on the same day is so important.

And I have been involved in quality improvement (QI) projects, one of which was with colleagues in our Emergency Department, our QI department, and pharmacy who revolutionized the approach to children presenting to emergency rooms with anaphylaxis.

Why is CHOP Research Institute a good place to do your research?

I’ve been at CHOP for more than 25 years — I did both my residency and fellowship here — and I have had wonderful colleagues and mentors. I stay because of the people. I stay because people like Kathleen Sullivan MD, PhD, my friend and chief of the division of Allergy and Immunology, and Steven Douglas, MD, and Nicholas Pawlowski MD, my original mentors, believed in me. I stay because I know if I reach out to anyone within the institution with a question or concern whether about research or something clinical, they will respond. It’s that kind of collaboration that keeps me here.

Taking care of patients on an individual basis, participating in clinical research trials, collaboration with colleagues, and mentoring others — this is what makes me happy.

What advice do you have for young researchers who are beginning their careers?

Say “yes” to opportunities you are afforded — even if you’re not sure you’ll like them —whether it’s writing a paper, being a sub-investigator on a trial, or being a PI. Who would have known that by being asked by my colleague Dr. Spergel to be a PI on the original peanut patch studies, that I would be where I am today?

Know that your path in medicine may not always be easy and that the path may change. Find what makes you happy, and surround yourself with mentors and friends who support you. Take time to care for yourself too. For me, it is jogging along the Schuylkill, attending musicals, spending time with family and friends, and supporting Philadelphia sports teams with my son and husband.