With nearly 30 thousand shares, one mother’s Facebook post about peanut allergies is going viral. Sarah Wynia Smith began her post with “Today my peanut-allergic son ate 24 peanuts. You read that right. He scarfed down two handfuls of his allergen. And he liked it!”
How does a kid who is allergic to peanuts safely consume them? His mother gives all the credit to a new program called Oral Immunotherapy (OIT). Before OIT, her son’s allergy was so severe that trace amounts of peanut on a stranger’s hand would cause a reaction. Now, this up-and-coming treatment has allowed her son to build a tolerance to an allergen that once threatened his life.
For her son, it has taken eight months of traveling 90 miles to the doctor on a nearly weekly basis. His first appointment, last November, took six hours to complete. His OIT started with 5 micrograms of peanut protein that had been diluted into a glass of juice. For homework, they were given a bottle of the same solution and instructed to give it to their son each day. A week later they drove back to the doctor and were given an increased dose of peanut protein while under the supervision of their allergist. This process continued until July, a total of “over 25 appointments and hundreds of home ‘doses’” culminating in their victory of 24 whole peanuts without an allergic reaction.
Today my peanut-allergic son ate 24 peanuts. You read that right. He scarfed down two handfuls of his allergen. And he…
While increasing the amount of peanuts he was exposed to, he gradually built up a tolerance to each dose and then graduated to a higher dose. His mother writes: “At this level of consumption, he is officially declared ‘desensitized’ or ‘tolerant’ of the food.” He still has the potential for an allergic reaction, but maintaining his current dose of peanut intake daily will keep his tolerance high.
Over four thousand miles logged and a daily dose of peanuts for the rest of his life sound like a high price to pay, but as Smith describes, it was well worth the work. Watching her young son go into anaphylactic shock, administering Epi-Pens and “years of managing a life-threatening food allergy” brought a great deal of anxiety to the family. “I felt trapped and terrified almost constantly. He too was starting to get anxious about food that wasn’t safe. Any food with a trace of peanut in it could have literally killed him.” Before OIT, they could not eat at restaurants due to the risk of cross-contamination. They had to say no to baseball games, birthday parties, wedding cakes, potlucks and anything of the like. “It was all just too anxiety-provoking for the benefits to outweigh the negatives to attending such things.”
But now he can consume a meal that has been cross-contaminated. “I wouldn’t worry about anything that even had actual peanut in it because his daily maintenance regimen will protect him from exposure,” Smith said. “Our family does all of those things we used to avoid without worry. I’ll send him to kindergarten this fall without worry that an innocent-looking cupcake sent in by a well-meaning classmate would send him to the ER.”
Food allergies are not like other life-threatening diseases. “The people they affect are completely healthy unless they are exposed to the allergen.” This disease impacts eight percent of U.S. children and two percent of adults. It is a growing problem, one that has more than doubled over the past decade. The highest rate is amongst preschoolers. It is estimated that one-fourth of those with food allergies will experience anaphylaxis, which requires a shot of epinephrine to stop. Anaphylaxis is responsible for 90,000 emergency room visits a year.
This type of immunotherapy has been standard practice for environmental allergens such as cat dander, trees, grass and so forth, but it was considered too big of a risk to try on food allergens until the 1980s according to Melanie Thernstrom at Stanford Medicine. In the last ten years, trials have been performed at several U.S. hospitals “where children could be safely desensitized to peanut, milk and egg.” At that time, each allergen was approached one at a time. Recently, Kari Nadeau, an immunologist at Stanford Health Care and Lucile Packard Children’s Hospital Stanford, attempted to tackle all three allergens at once.
Dr. Nadeau’s trials have impacted 309 patients, both children and adults, with another 1,200 people on the waiting list. The first doses are so small “they look like sprinkles of cinnamon… 1/700 of an egg, 1/200 of a peanut, 1/200 of a hazelnut 1/250 of an almond and 1/300 of a cashew.” Most patients experience a reaction at some point (vomiting, hives, swelling tongue, etc.), but only 15 have had a reaction severe enough to require an Epi-Pen. The trial has seen a 100 percent success rate for patients who completed the study. Her team now has the longest-running trial of this kind in the United States, eight years long.
For patients who stop the treatment, the tolerance wears off quickly. One study, published by Dr. Nadeau, looked at 20 patients who had gone through OIT for two years, each working up to a full serving (1 tablespoon of peanut butter or 20 peanuts) without any reaction. Three months later, without their daily dose, 13 of them were allergic to peanuts again by six months, and 17 out of the 20 had gained the allergy again.
While Oral Immunotherapy requires a lifelong commitment, its benefits are changing the lives of sufferers of food allergies. Kids who had never gone to an overnight camp because the risks of cross-contamination were too great now bring along their bag of peanuts to much on while they enjoy camp with their friends. Parents horrified to send their kids to school, where food could not be monitored as closely, can now send them with peace of mind. Kids who never got to enjoy birthday treats their classmates brought from home can now indulge without being rushed to the emergency room.
Click here for a directory of board-certified allergists who offer OIT and more information on this developing new therapy.