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Peanut-allergic kids helped by desensitization

Kids with severe peanut allergies were able to eat the food after building up their tolerance with a daily dose of peanut flour, British doctors report today.

By the end of a small, six-month study of four boys, the children were able to eat up to five peanuts a day — not so many that they could safely sit down to a peanut butter and jelly sandwich, but enough that they didn’t need to worry about accidentally swallowing peanut ingredients hidden in other foods, according to research by Addenbrooke's Hospital in Cambridge in the journal Allergy.

"You wouldn't want to say it's a cure because it's not that and gives people false hope," says Wesley Burks, a professor of pediatrics at Duke University on whose protocol the British study was modeled. But, "As long as you use the treatment, the disease is better."

More research is needed on larger numbers of kids to tease out who can tolerate the treatment and who can't, says Scott Sicherer, an associate professor of pediatrics at Mount Sinai Medical Center in New York, who was not involved in the study. And once it was clear who could tolerate the treatment, studies would still need to test it on kids eating real peanut products, instead of just those who were accidentally exposed to peanuts.

"The real trick is, have you treated the allergy in a permanent way, or created a higher threshold?" he says. "If they have accidental exposure to peanut, if by giving some dose every day to keep them used to it, that’s a benefit. [But] If they miss a few days of medicine, then they might have a reaction if it's not getting rid of it but covering it up."

Some 40 children are being treated with the technique at Duke and Arkansas Children's Hospital. Of the 10 kids who have been followed for more than 30 months, half have been able to stop the therapy and are able to eat peanut products, deliberately or as ingredients in other foods, Burks says. (That research hasn’t yet been published.)

More than 3 million people in the U.S. report being allergic to peanuts, tree nuts or both, according to the American Academy of Allergy and Immunology. For unknown reasons, their prevalence doubled in children between 1997 and 2002. (Skeptics say the extent of the problem is overblown but that avoidance of peanuts may paradoxically lead to more cases.) In severe cases, patients can experience anaphylaxis, which causes the throat to close up, effectively choking them.

Doctors previously have tried treating peanut allergies with injections like those used against hay fever, but those programs were tabled after patients suffered severe, systemic side effects, including hives, wheezing and vomiting, Burks said. It's not fully understood why the peanut flour treatment may work better than shots for peanut allergies, but any medication taken by mouth is less likely to cause a reaction than one given through an IV or a muscle injection, and the dose is increased much more slowly, Burks notes.

In general, food allergies have proven harder to treat than environmental allergies, possibly because they begin earlier in life, he said. (Then, of course, there’s the other health problem peanuts have been linked to lately: salmonella.)

The new report "is exciting," Sicherer says, but, "this is not something to try at home."

Image © iStockphoto/Klaudia Steiner

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