Of course, for all the hope sparked by the new thinking, it’s important to recognize its limitations—namely, that it applies only to peanut allergies, and is about prevention, not treatment. Once a baby or child develops a food allergy, avoidance is still critical to keep them safe.
But other studies hold promise for children already struggling with allergies. They involve immunotherapy—treatments that enlist the immune system in preventing an allergic reaction. You know the approach—think of the allergy shots that make spring bearable for people with hay fever or allow those with an allergy to cat dander to pet a kitty without swelling, sneezing and breaking out in hives.
At this year’s annual meeting of the American Academy of Allergy, Asthma and Immunology, researchers reported on the results of studies on two different approaches to immunotherapy for peanut allergy. In one, allergic volunteers (mostly children and teens) were given tiny but gradually increasing doses of an investigational medication derived from peanut protein, which they stirred into something like yogurt or applesauce, downing the mixture every day for six months. The regimen proved very effective, says study leader Brian Vickery, MD, currently associate professor of pediatrics at Emory University School of Medicine. (Dr. Vickery led the study for the biopharmaceutical company Aimmune Therapeutics, where he was senior medical director.) The volunteers were extremely sensitive to peanuts at the start of the trial—during an oral food challenge, just a fraction of a peanut was enough to trigger a reaction. But by the end of the six-month study, a full 67 percent of the treatment group was able to eat the equivalent of about two peanuts without a reaction, compared to just 4 percent of the placebo group. In the research world, that’s a home run. “You don’t need to be a statistician to see it,” Dr. Vickery says.
In the other immunotherapy study, kids between the ages of 4 and 11 wore either a “peanut patch”—a skin patch that contained peanut protein—or, for comparison’s sake, a sham patch containing no peanuts. This approach also helped, but not as much: Of the children wearing a real peanut patch, 35 percent were less sensitive to peanuts by study’s end, compared to about 15 percent of the kids in the placebo group. (Side effects in the peanut patch study also tended to be less severe than with the oral approach to immunotherapy.)
For both approaches, much remains to be worked out, including how long treatment has to last—the current assumption is that it will have to continue for life. It’s also not clear whether real-life complications like a bout of flu or an asthma flare (many kids with peanut allergies also have asthma) can rev up the immune system and make a reaction more likely. But these studies are remarkably promising, Dr. Vickery says. Both treatments are currently under review by the Food and Drug Administration (FDA), which has given them special “fast-track” and “breakthrough” designations—labels that promise an expedited assessment and are usually reserved for treatments for diseases like cancer.
If the FDA approves these treatments—they appear to have a good shot—it will be critical for people to understand that they do not amount to a cure. Children who have been through immunotherapy will still be allergic to peanuts; the hope is simply that they’ll be less likely to have a lethal reaction to an accidental exposure, though no one can be sure of that until a real-life test occurs. So teachers, restaurant workers and everyone else will still have to be alert to these kids’ needs—and that will be true even if other treatments follow for allergies to tree nuts, eggs and other foods. Nevertheless, immunotherapy may provide a safety buffer, and that’s a very big deal indeed.
“These families feel they cannot rest for a second—they never get a day off,” Dr. Vickery says. “They know that a small amount of exposure in a granola bar could precipitate a life-threatening event. That’s a big burden to carry around.”
So to have their child able to tolerate minor exposure can be life changing for families. “With this treatment, they feel like they can take a breath, and some of them start to change the decisions they make,” he says. “They may feel comfortable enough to allow their children to take a trip and do things that they’ve never done before. I’ve had people in tears in the office because a child went and visited his or her grandparent for the first time. It can be a transformative experience.”