It is estimated that 4 percent of American children and 1 percent of American adults have a true food allergy (not just a food intolerance). In 2015, the LEAP study was published, proving that feeding peanuts to infants at high risk for developing food allergy significantly decreased the risk that they would become allergic to peanut. Only 1.9 percent of the treated group developed peanut allergy by age 5, whereas 13.7 percent of the peanut-avoidance group became allergic to peanuts. This was a complete paradigm shift from “expert consensus” developed in the 1990s, which recommended that high risk children avoid common food allergens until age 3 or 4.
But what about those already allergic?
The lack of treatment has been a source of frustration. A successful phase 3 trial was presented in November 2018, showing that those allergic to peanuts can undergo desensitization. Aimmune, the company trying to bring the treatment to market, hopes to get FDA approval sometime in late 2019 or perhaps 2020. However, some allergists across the country, including us, have been performing off-label food desensitizations for several years. This involves once a week trips to our office to increase the dose from a few milligrams of peanut flour (diluted in water) until we have our patients eating 4 to 8 peanuts twice each day. Once we have someone eating that many peanuts, they have a very low risk to have an allergic reaction to peanuts. The main disadvantage is that you must continue eating the peanuts indefinitely, or you may become allergic again. Thus, rather than a “cure,” our goal is “desensitization,” which is defined in the New England Journal of Medicine as “an increase in the reaction threshold to a food allergen during active therapy.” (NEJM 2017;377:1168-1176) Desensitization requires ongoing therapy indefinitely.
Aimmune is currently studying only peanuts, and plans to start studying egg allergy after their peanut product is on the market. Off label, though, we have protocols for almost all foods that cause true food allergies, including eggs, milk, wheat, soy, cashews, pecans, walnuts, and seafood. Again, there are risks to the desensitization procedure, but those risks are less than full blown anaphylaxis by accidentally eating the food one is allergic to. And the comfort of not having to be hypervigilant at all times is a great relief. If you are interested in this procedure for yourself or your loved one, please contact our office.
No one nose allergies like we do.™
Note: Information contained in this article should not be considered a substitute for consultation with a board-certified allergist to address individual medical needs.