New pediatric research and treatments can help prevent and/or lessen this potentially life-threatening allergy in infants and children
by Abner Bagenstose, MD
Peanut is the most common food allergy in children in the United States with a staggering 25% of reported food allergies being to peanuts! What’s even more alarming is the severity of the reaction, as 100 of 150 children that die each year from an anaphylactic food reaction are reactions to peanuts.
Why are there so many peanut allergies?
The idea of restricting food introduction until later in childhood was made popular in the 80s and 90s. Since then, studies have proved that early introduction of peanuts is more likely to result in tolerance to peanuts instead of allergy. Israel has just a tenth of peanut allergy cases we see in the US and UK, which is believed to be due to their practice of feeding infants a popular Israleli snack made with . . . you guessed it, peanuts! And a study in the last decade showed more than an 80% reduction of peanut allergy in high-risk infants when peanuts were introduced between ages four and 11 months old.
How can I introduce peanut to my infant?
If no history of eczema or family history of food allergy exists, start by giving a tiny amount of peanut, either mixed into baby food or a small piece of a “Bamba” peanut snack puff softened with a small amount of water. If this is tolerated well, you can work up to two teaspoons of peanut butter or 21 pieces of Bamba. Once peanut has been added to the infant’s diet, they should eat about two teaspoons of peanut butter or 21 Bamba puffs three to four times a week until age five.
If your infant has an egg allergy or severe eczema, they are considered high risk, and should be seen by an allergist to undergo testing for peanut allergy with either a blood test or an allergy skin test. If the skin test is negative or mildly positive, then small amounts of peanuts can be carefully introduced with the amount doubling every 15-20 minutes until two teaspoons is achieved without symptoms. If your infant’s skin test or blood test is positive, then they are assumed allergic and would need to be careful to avoid eating peanut, but testing should be repeated later in life as 20% of peanut allergy patients spontaneously lose the allergy and about 80% of those patients lose their allergy by age eight.
What if my older child has a diagnosed peanut allergy?
Peanut allergy is definitely something to be very careful with. Did you know that some people with a peanut allergy can have life-threatening reactions to even tiny exposures to peanuts, such as eating food that was exposed to a cooking vessel or utensil that a food containing peanut had touched. Some patients can have reactions just from walking near a person who is eating peanuts! Unfortunately, such sensitive peanut allergy patients make frequent trips to the ER for these accidental peanut interactions.
Is there a treatment available to help patients with a peanut allergy?
There is no treatment available for adult patients, however, there is now a treatment available for oral immunotherapy called Palforzia (peanut powder) for children 4-17 years of age. This treatment is most helpful for patients with a history of frequent reactions to small amounts of peanuts. Unfortunately, the treatment is not a cure, but a way to increase the amount of peanuts necessary to cause an allergic reaction, and make reactions, when they do occur, less severe. Additional research is ongoing in hopes of finding a cure.
How does the Palforzia treatment work?
Children are given a small amount of peanut in a healthcare setting and observed for one to two hours. The patient will continue this treatment at home daily on a full stomach and will return to the office for a dose increase every two weeks for about 22 weeks to reach a maintenance dose of 300 mg or half a peanut. During this treatment period, the patient cannot participate in any strenuous exercise. If several doses are missed, the child has to return to the office for a dose reduction and then will begin the process of increasing doses again.
Can any child 4-17 years old participate in this treatment?
Not every child is a good candidate for this immunotherapy. Children with poorly controlled bronchial asthma, eosinophilic esophagitis, or any eosinophilic gastrointestinal disorder are not candidates for this treatment. Potential patients should also be aware that this treatment can sometimes cause eosinophilic esophagitis or anaphylaxis.
Should my child go through treatment?
This therapy is meant for very sensitive peanut allergy patients to establish enough of a tolerance to avoid potentially life-threatening reactions to accidental exposure. Potential patients should consider that this is an intensive program that requires an expense of both time and money. If the patient ever stops therapy, the benefit is lost within a few weeks. However, the treatment is effective, as 96.3% of patients who completed this therapy were able to tolerate 300mg of peanut. Most patients who have undergone this therapy have reported an improved quality of life, although they still have to avoid peanuts and take care to read labels as well as carry an injectable epinephrine such as Epi-Pen or Auvi-Q whenever they eat outside the home. For children with frequent reactions, most parents feel the therapy is worth the effort in time and expense. If parents are already able to control their child’s allergy by careful reading of food labels, no benefit would be seen.