The science behind food allergies is quite possibly the most fascinating part of my job.
It’s also the topic that most patients understand the least. A lot of mystery, misconceptions, and fear swirl around food allergies.
Imagine you are a parent of a small boy, and you are beginning to introduce solid foods into his diet.
You read somewhere that the top eight allergens in the world are peanut, tree nut, egg, milk, soy, shellfish, fish, and wheat – but you nor your spouse have never experienced any sort of food allergy, so you can’t imagine that your child would be allergic.
Last week, you tried giving your child (let’s call him Tyler) oatmeal, which he seemed to like.
Today, you are going to try giving him some peanut butter mixed into his oatmeal.
As you feed him, you start to notice some red patches appear around his mouth, which quickly turns into full-body hives, non-stop crying, and vomiting.
Good thing you live close to the Children’s Hospital because after a quick dose of Benadryl you are zooming to the emergency room, where the nurses quickly deliver epinephrine to your child.
After several hours of observation, Tyler seems back to normal and is quietly sleeping against your chest.
Parents of kids with food allergies live in constant fear, and when children reach an age at which they can comprehend the ramifications of eating foods they are allergic to, they also carry fear with them.
All of a sudden, Halloween, birthday parties, and eating at restaurants have a certain apprehension associated with it. And unfortunately, there’s no magic pill to cure food allergies.
So that’s where an allergist comes in and helps patients diagnose and manage food allergies throughout the lifespan.
The American Academy of Allergy, Asthma, and Immunology (AAAAI) is a large body of clinicians and researchers who deal a lot with food allergies.
The AAAAI tentatively predicts that there will be a new therapy option by Spring 2020. Thus far, peanut-allergic patients have simply been told to avoid peanut and always carry an epi-pen with them.
The new and exciting therapy is called peanut oral immunotherapy (OIT). (An important note: this is not a CURE, it is a therapy).
Peanut OIT has been in the works for a while, and the first form of the drug was called “AR101.” The predicted name of the FDA-approved product that is to come later in 2020 is “Palforzia.”
My office has been eagerly following the most recent research regarding peanut OIT because we work with peanut-allergic patients every day, and for many of those patients, there is a lot of hope wrapped up in desensitization: a promising avenue to reduce the fear of anaphylaxis.
How does it work?
Peanut OIT utilizes the age-old concept of desensitization that allergists have been using for years with allergy shots. Basically, if you slowly increase your exposure to the allergen source, your body will adapt and desensitize over time.
OIT involves giving the patient increasing doses of peanut, starting from incredibly minuscule (such as 1/125,000th of a peanut) and going up to 12 total peanuts.
Patients who complete OIT build-up are not expected to be able to eat spoonfuls of peanut butter: they are still instructed to carry their epi-pen, read labels of products that could contain peanut, and avoid known sources of peanut.
The hope of OIT is that patients will be able to tolerate exposure to the peanut protein with reduced severity of the reaction. It is meant to ease some of the fear that patients and parents have around accidental ingestion.
Does it work?
The research seems to support it.
One study had 270 patients participate in OIT, and 80% made it to the final 12 peanut dose (source: AAAAI).
Another study has shown 60%-80% of patients who received OIT were desensitized after completing the process.
While these results seem promising, little is known about the long term picture. Science supports the idea that patients would need continued exposure to peanut (e.g. a certain amount of peanuts per day as a “maintenance exposure dose”) to remain desensitized.
Peanut OIT does have side effects for patients.
Patients who received OIT in trials reported side effects like abdominal pain, cramping, vomiting, mouth itching, rashes, hives, wheezing, swelling, and in a few cases – anaphylaxis.
When considering a new therapy option, researchers and clinicians must always weigh the risk vs benefit picture: for those with food allergies, the benefits of peanut OIT might outweigh all of these possible side effects.
Just as patients are individual beings, treatment options should be individualized based on patient needs, desires, and lifestyle.
As I mentioned, the FDA has yet to approve peanut oral immunotherapy, but the date when it will be approved is fast approaching.