Tag: peanut allergies

Is There a Cure for Peanut Allergies?

Many parents likely got excited recently when they read about a possible cure for peanut allergies.

Peanut allergy could be cured with probiotics
Medical News Today

While these types of treatments are called cures by some people, what they do is desensitize you to peanuts, so that if you have a reaction, it is less severe. Some don’t have reactions anymore though. Probiotics were just part of the ‘cure’ though. They were paired with oral immunotherapy.

Is There a Cure for Peanut Allergies?

So is there really is a cure for peanut allergies?

I’m guessing it doesn’t matter if you call it a cure or a treatment if you have a child with a severe peanut allergy, you really just want to know if it is available for your child, right?

And again, there isn’t a simple answer.

Although it does seem like they are being used more and more, many of these treatments are still being tested, so they likely aren’t available everywhere, or in some cases, anywhere outside of a trial.

Among the treatments for peanut allergies, besides avoidance and treating anaphylactic reactions with epinephrine, you some day soon might be able to get your child with peanut allergies:

  • a wearable skin patch to provide epicutaneous immunotherapy (EPIT)  – in phase III studies
  • a pill to provide orally administered biologic immunotherapy  – in phase III studies
  • oral immunotherapy with Xolair (FASTX) – in phase II studies
  • a combination of probiotics with peanut oral immunotherapy (PPOIT)
  • sublingual immunotherapy (SLIT) – in phase III studies
  • a vaccine – in early phase I studies

How do these treatments work?

The patch is the easiest to explain. Kids simply apply a new patch that contains peanut protein on their skin each day.

Oral immunotherapy is similar, kids are exposed to peanut protein, but unlike the patch, the dose is steadily increased each day, until you read a maintenance dose, that you continue eating each day. Most of these treatments use some variation of the characterized oral desensitization immunotherapy (CODIT) method to control and maintain desensitization.

And these treatments are not just for peanuts. Similar studies are being done for eggs and milk. And theoretically, they can be done for anything that can trigger an IgE-mediated allergic reaction, from foods and medicines to environmental allergens.

The downside? In addition to side effects, in most cases, you have to continue eating the thing you are allergic to every day, otherwise your allergy might return.

So, Is There a Cure for Peanut Allergies?

While many of these treatments are promising, they are not ready for regular use in every doctor’s office.

“The aim of OIT is to administer a food allergen slowly, in small but steadily increasing doses, until the patient stops reacting to the food (termed becoming desensitized to the food). OIT studies have shown promising results, though adverse reactions are frequent and may cause significant side effects like abdominal pain, wheezing and/or diarrhea. Published data from placebo-controlled trials have shown that only 50 to 70 percent of patients attempting OIT complete desensitization, with the failures primarily due to side effects. Also, there currently are no standardized protocols or foods used in OIT and no FDA approved approach that could allow insurance to reimburse for this therapy. Thus, there are challenges with the current practice of OIT.”

FARE Statement on Oral Immunotherapy for Food Allergies

That doesn’t mean that you can’t get some of these treatments right now or overcome those challenges.

Avoiding peanuts is not always as easy as you think... Peanuts under my seat on a plane.
Avoiding peanuts is not always as easy as you think… Peanuts under my seat on a plane. Photo by Vincent Iannelli, MD

Just keep in mind that “An allergist doing OIT for patients in a private practice develops his/her own individualized protocols and uses his/her unique food preparation.”

If your child’s food allergy has led to severe stress and anxiety for your family, that might not matter though. You probably don’t want to wait anymore if there is a chance at reducing your child’s chance of having a severe, life-threatening allergic reaction.

Still, find a pediatric allergist who has a lot of experience doing private practice OIT.

On the other hand, if you are fine refilling your child’s epi-pens every year and working hard to avoid peanuts, then maybe wait until the jury comes in and we get an official recommendation and more standardized treatments become more widely available.

What Else Should You Be Doing About Food Allergies?

If you don’t do private practice OIT, then in addition to strictly avoiding the things to which your child is allergic and making sure that an epi-pen is always readily available, the latest guidelines recommend that your child have:

  • annual testing if they have a milk, egg, soy, or wheat allergy
  • testing every two to three years if they have a peanut, tree nut, fish, or shellfish allergy

Why retest?

Kids do sometimes outgrow their allergies, especially if the allergy isn’t to peanuts or tree nuts. And even for peanuts, about 20% of kids have a chance of outgrowing their allergy.

Also remember that it is now recommended that infants at high risk for peanut allergies, especially those with eczema, have an early introduction of peanut proteins, sometimes as early as four months of age.

Hopefully that will help decrease the number of kids who need these kinds of treatments in the future.

What to Know About Treating Peanut Allergies

Oral immunotherapy and some other treatments are providing new options to help kids with severe food allergies avoid life-threatening reactions.

More About Treating Peanut Allergies

How To Avoid Peanut Allergies

Infants with eczema are at high risk for developing peanut allergies.
Infants with eczema are at high risk for developing peanut allergies. Photo courtesy of the NIAID.

The worst part of having a severe allergy to peanuts isn’t the high price of EpiPens.

It is that peanut allergies can be deadly, even when you have access to an EpiPen.

And since there is no 100% fool proof way to avoid peanuts and peanut containing foods, doctors have been trying to come up with ways to prevent kids from ever developing peanut allergies.

The first efforts, to avoid peanuts and other high risk foods during pregnancy and early infancy, likely backfired, leading to even more kids with peanut allergies. That’s why recommendations for starting solid foods changed back in 2008, when the American Academy of Pediatrics began to tell parents to no longer delay giving solid foods after age 4 to 6 months and that it wasn’t necessary to delay “the introduction of foods that are considered to be highly allergic, such as fish, eggs, and foods containing peanut protein.”

The latest guidelines are the next evolution of that older advice.

Now, in addition to simply not delaying introducing allergy type foods, as part of a new strategy to prevent peanut allergies, parents of high risk kids are being told to go out of their way to be sure that they actually give their infants peanut-containing foods!

Prevention of Peanut Allergies

Developed by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, with 25 professional organizations, federal agencies, and patient advocacy groups, these clinical practice guidelines recommend that parents:

  1. introduce peanut-containing foods into your infant’s diet as early as 4 to 6 months of age if they have severe eczema, egg allergy, or both (strongly consider allergy testing first)
  2. introduce peanut-containing foods into your infant’s diet around 6 months of age if they have mild to moderate eczema
  3. introduce peanut-containing foods into your infant’s diet in an age-appropriate manner with other solid foods if your infant has no eczema or any food allergy

Keep in mind that it is possible that your baby already has a peanut allergy, so discuss your plan to introduce peanut-containing foods with your pediatrician first. But don’t be in such a rush that you make peanut-containing foods your baby’s first food. Offer a cereal, veggie, fruit, or meat first. If tolerated, and you know that your baby is ready for solid food, and with your pediatricians okay, then consider moving to peanut-containing foods.

And although not always necessary, it is possible to do allergy testing even on younger infants. Testing is an especially good idea if your infant has severe eczema or an egg allergy. For these higher risk kids, referral to an allergy specialist might even be a good idea, where infants can start peanut containing foods in their office (supervised feeding) or as part of a graded oral challenge. Your pediatrician might also consider supervised feeding for your higher risk child who is not allergic to peanuts.

Peanut-Containing Baby Food Recipes

So how do you give a 4 or 6 month old peanut-containing foods?

It’s not like Gerber has any 1st or 2nd foods with peanuts – at least not yet…

So for now, you can:

  • add 2 to 3 tablespoons of hot water to 2 teaspoons of thinned, smooth peanut butter. Stir until the peanut butter dissolves and is well blended. You can feed it to your baby after it has cooled.
  • mix 2 to 3 tablespoons of a fruit or veggie that your baby is already tolerating in 2 teaspoons of thinned, smooth peanut butter.
  • mix 2 to 3 tablespoons of a fruit or veggie that your baby is already tolerating in 2 teaspoons of peanut flour or peanut butter powder.

Each of these recipes will provide your baby with about 2g of peanut protein. Since the goal is to give your child about 6 to 7g a week, you should offer them three separate times.

During the first feeding, it is important to only “offer your infant a small part of the peanut serving on the tip of the spoon,” and then wait for at least 10 minutes to make sure there are no signs of an allergic reaction, such as hives, face swelling, trouble breathing, or vomiting, etc.

Of course, because of the risk of choking, you should not give infants or toddlers whole peanuts or chunks of peanut butter.

More Information on Preventing Peanut Allergies