Could There Be A Cure For Peanut Allergies In Children? – Health Essentials from the Cleveland Clinic
If your toddler has a life-threatening peanut allergy, current research suggests that he may be able to grow up and do the unthinkable: eat and enjoy a peanut butter and jelly sandwich.
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A treatment program designed for preschoolers and babies with peanut allergies has been shown to be effective in helping children overcome their food allergy, says allergist Sandra Hong, MD. It is a life changing result – and perhaps a life saving one.
Currently, over a million children in the United States are living with a peanut allergy and know that a bite of food can be fatal. “For us, being able to help someone get past that is the most rewarding part of our career,” says Dr. Hong.
This optimism reflects the findings to date of a first oral peanut immunotherapy (EPOIT) treatment program developed at the Cleveland Clinic, where Dr Hong is director of the Food Allergy Center of Excellence.
In the program, children 4 and under who are allergic to peanuts have developed a tolerance to peanuts by ingesting tiny amounts of food in a step-by-step process supervised by an allergist. The doses are gradually increased over several months.
This approach represents a reversal of clinical guidelines shared by allergists a decade ago. Let’s learn the reasons for the change from Dr. Hong.
Food Allergy Facts
Imagine starting every meal, every snack and every little bite knowing that one bite of the wrong food can kill you. It is the life of a person with a severe food allergy.
A food allergy is a condition in which your body’s immune system identifies a food (like peanuts) as harmful. Your immune system goes into attack mode and releases antibodies to fight the threat.
The reaction can lead to hives, vomiting, or in the worst case, narrowing of the airways and death.
Food allergies affect more than 32 million Americans, including nearly one in 9 adults. In schools, the middle class can expect to have two students with food allergies – and the numbers are on the rise.
Peanuts are one of the top eight food allergens that cause the most severe allergic reactions. More than 6.1 million people in the United States are allergic to peanuts. It is the most common allergy in children.
About 200,000 people a year in the United States land in the emergency room due to a food allergic reaction, such as anaphylaxis. This is equivalent to a trip to the emergency room every three minutes of each day.
Digging deeper into the numbers, more than 40% of children with food allergies have experienced a severe allergic reaction.
“It’s clear how serious the problem is,” says Dr Hong.
Changes in approach to treating food allergies
When the number of food allergies began to increase in the 1990s, doctors recommended that allergenic foods such as milk, eggs and peanuts be removed from the diets of children at high risk of allergies.
However, that way of thinking began to change, as research showed that eliminating specific foods did not slow the development of food allergies.
Then came the groundbreaking Allergy Learning Early About Peanut (LEAP) study in 2015. The study found that the development of peanut allergies decreased in at-risk children with early introduction of the food.
“It was completely the opposite of what we had thought,” notes Dr. Hong.
Next Steps in Peanut Allergy Treatments
Ongoing treatment programs aim to refine the treatment process that emerged from the LEAP study, says Dr Hong. More than 50 children with identified peanut allergy are in the program.
The minimum goal is to help these children achieve at least a “bite-proof” peanut tolerance, which means they can eat almost two peanut pits without a reaction, says Dr. Hong. This protects against accidental snacking of a food containing peanuts resulting in a health emergency.
However, many participants see their immune system response change so much that they can eat peanut products, says Dr. Hong. (Read a child’s successful experience.)
The key is the age of the participants, as reactions to food allergens are usually less severe in early childhood. “Their immune system is so malleable, so flexible, that they can tolerate it,” notes Dr. Hong. “There’s this narrow window where we can do that. “
The peanut challenge series offered to participants involves tiny amounts of food. In the initial treatment cycle, for example, the daily dose is 8 milligrams of peanut protein.
Small increases follow every two weeks if there are no setbacks, says Dr. Hong. The process takes four to six months, with maintenance dosing then continuing for at least a year.
Each increase in the dose of peanut butter takes place in an allergist’s office in case there is a reaction. (“It’s not something you do at home,” Dr. Hong emphasizes.) The child is monitored for an hour after the highest dose.
Of the children in the Cleveland Clinic program, more than 80% now have or are reaching “bite-proof” tolerance.
Future prospects for children with peanut allergies
Currently, 1 in 5 children with a peanut allergy passes the condition before adulthood. Dr Hong says advances in treatment could reverse those numbers, with up to 4 in 5 children leaving behind their peanut worries with the bogeyman and other childhood fears.
In 2020, the United States Food and Drug Administration approved a drug called Palforzia® to reduce allergic reactions to peanuts in children aged 4 to 17. It is the first treatment drug for children with peanut allergy.
Dr Hong believes the number of children with severe peanut allergies will soon start to decline. “We are headed for a cure,” she said, “and a lot less worry for families.”