Why you should care
Because if you’re one of the 3 million Americans who live in deathly fear of the peanut, you may no longer need to question and check every plate.
For peanut allergy sufferers, constant vigilance is a way of life. Forgetting to check whether a meal contains peanuts, even once, can trigger itchy hives, swollen airways and a sharp drop in blood pressure — a potentially fatal reaction known as anaphylactic shock.
Peanut allergies plague more than 3 million Americans. Even more alarming, the number of children with peanut allergies in the United States has tripled in just over a decade. Scientists aren’t sure why, but some blame an increasingly wealthy, modern society, where a lack of exposure to bacteria might stunt immune system development. As a result, the immune system mistakenly attacks even harmless agents — such as peanut protein — releasing chemicals that cause swelling, itching and other allergy symptoms.
A word of caution: The following experiment was done under carefully controlled conditions. Do NOT try at home.
At the moment, no treatment for peanut allergy exists. An EpiPen device can deliver an injection of epinephrine to ward off severe allergic reactions — but it can’t prevent them.
The number of children with peanut allergies in the United States has tripled in just over a decade.
Allergy sufferers may find hope in an unlikely source: tiny amounts of the very food they fear.
Studies have shown that gradually increasing peanut consumption may actually reduce the immune system’s sensitivity to peanut protein. The drawback? Developing this tolerance can take years, causing severe allergic reactions along the way. But a breakthrough study has found that injecting patients with an asthma drug beforehand can vastly speed up the process, with mostly mild reactions. Published last month in the Journal of Clinical Allergy and Immunology, the two-step method shows promise as a quick, permanent treatment for peanut allergies.
Boston Children’s Hospital and Harvard Medical School researchers recruited 13 children whose allergies were so severe that as little as one-quarter of a peanut would have been enough to trigger a reaction. First, they treated the patients with omalizumab — which blocks a protein that can trigger intense allergic reactions — every few weeks for about three months, in order to dampen the immune system’s response to peanut protein. They then fed the patients tiny specks of peanut flour, gradually scaling up their intake over the next few months as they continued administering omalizumab.
The results were stunning.
Within six hours, every child was able to safely munch on the equivalent of two peanuts.
Within six hours, every child was able to safely munch on the equivalent of two peanuts. Two to three months later, all except one were able to eat 10 peanuts, at which point the researchers took them off the drug. Three months later, the same number of patients could consume about 20 peanuts. “It was very exciting,” pediatrician Dale Umetsu of Boston Children’s Division of Allergy and Immunology said in a statement.
That’s not to say the process was completely painless. Most of the participants experienced allergic reactions during the first few weeks as their immune systems learned to tolerate peanut protein. Seven children had mild reactions, such as nausea and excess saliva production, while two suffered from more severe reactions, including an asthma attack. One child dropped out from the study after experiencing nausea and vomiting that lasted for weeks.
Another downside? Although doctors prescribe omalizumab for asthma, the FDA has yet to approve it for food allergies. Even then, it would still carry a hefty price tag, thanks to its long, complicated production process. Even a low-dose regimen would cost each patient over $7,000 per year, according to a Journal of Managed Care Pharmacy study.
Still, omalizumab treatments shows promise as a means of fast-tracking desensitization. In earlier studies without omalizumab, only 26% of patients at most tolerated the equivalent of half a peanut. Even the ability to tolerate two peanuts a day is enough to safeguard against foods that don’t list peanuts as an ingredient but contain them in trace amounts — a leading cause of allergic reactions.
The ability to tolerate two peanuts a day is enough to safeguard against allergic reactions.
The researchers continue to track the children’s progress, encouraging them to continue eating eight to 10 peanuts daily to keep their allergies at bay. While some can now eat peanut butter and jelly sandwiches, others still find the taste and smell of the nuts repulsive. Capsules containing peanut protein powder might offer a more palatable alternative for these children.
“[Our] protocol has the potential to be much faster and more effective than current treatments,” Umetsu said. “Now we’re excited to incorporate more patients, centers and clinicians to prove it’s as successful as we believe it can be. I am very hopeful for what the future of food allergy treatment may hold.”To further test their approach, Umetsu and his colleagues are launching a larger trial that will recruit patients at three additional hospitals: Children’s Hospital of Philadelphia, Stanford University’s Lucille Packard Children’s Hospital and Ann & Robert H. Lurie Children’s Hospital of Chicago.
For the millions of children and families forced to question and inspect every plate, that future may finally be within reach.
For information about Dr. Umetsu’s clinical trial (ClinicalTrials.gov identifier: NCT01781637), which is currently recruiting participants, contact Sara Little at email@example.com or (617) 355-6127.