Oral Immunotherapy For Peanut Allergy
If your 4-17-year-old has a peanut allergy, a new treatment using peanut protein powder may offer additional protection. Palforzia is the only oral immunotherapy product currently approved by the FDA for treatment of peanut allergy. This type of treatment is called oral peanut immunotherapy. It slowly exposes an allergic child to peanuts so their immune system is less likely to react after an accidental ingestion of peanut product. That means if your child accidentally eats something containing peanuts, the treatment may protect them from a severe reaction. Even with this treatment, your child must continue to avoid peanuts and carry two epinephrine auto-injectors.
Its important to understand:
- The treatment is not a cure your child will still be allergic to peanuts and must avoid them.
- It will not enable your child to eat peanuts or peanut products anytime they wish.
- It works only while your child is taking it on a daily basis.
- Your child will need to continue to carry two epinephrine auto-injectors and you and your child will still need to read food labels.
- Reactions can occur due to the treatment itself.
For children with peanut allergy and their parents, the benefits may be worth the drawbacks. Discuss peanut oral immunotherapy with your allergist if your child is interested.
Several Ways To Come In Contact
Most people who are allergic have trouble when they have direct contact with peanuts — whether eating them by accident or not realizing they are part of a salad or recipe.
It can also happen through skin contact or by breathing in peanut dust or eating something made with gourmet or unrefined peanut oil.
But did you know that if you are very sensitive, indirect contact can trigger a reaction?
Its called cross-contact. For instance, a chef might be making a meal for you. It contains no peanuts, but they may have used their knife for an earlier task. If the knife touched peanuts and wasnt washed well, trace pieces could get into your dish.
Make sure any restaurant or dinner host is aware and taking care to avoid cross-contact.
Living With Peanut Or Tree Nut Allergy
If allergy skin testing shows that your child has a peanut or tree nut allergy, an will provide guidelines on what to do.
The best way to prevent a reaction is to avoid peanuts and tree nuts. Avoiding these nuts means more than just not eating them. It also means not eating any foods that might contain tree nuts or peanuts as ingredients.
The best way to be sure a food is nut-free is to read the food label. Manufacturers of foods sold in the United States must state on their labels whether the foods contain peanuts or tree nuts. Check the ingredients list first.
After checking the ingredients list, look on the label for phrases like these:
- “may contain tree nuts”
- “produced on shared equipment with tree nuts or peanuts”
Although these foods might not use nut ingredients, the warnings are there to let people know they might contain traces of nuts. That can happen through “cross-contamination,” when nuts get into a food product because it is made or served in a place that uses nuts in other foods. Manufacturers are not required to list peanuts or tree nuts on the label when there might be accidental cross-contamination, but many do.
Some of the highest-risk foods for people with peanut or tree nut allergy include:
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Who Is At Risk And Why
Children — especially toddlers and infants — are more likely to develop food allergies.
If you or other family members have other types of allergies, peanuts could be a problem.
Also, if you have eczema, you may also be more likely to be allergic.
If you have peanut allergy, that doesnt have to mean you are more likely to have a problem with other nuts or legumes. Peanuts grow underground and are different from almonds, cashews, walnuts and other tree nuts.
But recent studies found that 25% to 40% of people who have peanut allergy are allergic to tree nuts, too.
Dangers Of Delayed Anaphylaxis
Some allergic reactions are mild, but anaphylaxis is a very serious condition. Your airways can tighten to the point where you cant breathe. People with anaphylaxis can die within a half hour if they dont get medical help.
In some cases, people whove been treated for an allergic reaction and seem completely fine develop a reaction hours later. In 2013, 13-year-old Natalie Giorgi ate a small bite of a peanut-laced dessert while on summer vacation with her family. She received three doses of epinephrine, a medication that helps reverse the symptoms of an allergic reaction. Natalie seemed fine afterward, but she died of a severe allergic reaction later that evening.
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How To Safely Introduce Peanut Products To Your Child
After your baby is already eating other solid foods, you can safely introduce age-appropriate peanut-containing foods at 4 to 6 months, unless your child is at high risk.
High-risk children are those who have severe eczema, an egg allergy or both. In these cases, your child should be screened by a healthcare provider. That provider may complete a skin or blood test first to measure your childs reaction to tiny amounts of peanut products.
If your child has mild or moderate eczema, you may feel more comfortable asking your primary care provider before you introduce peanut-containing foods.
For babies at no risk: Bring on the peanut-containing foods just not a whole nut, as it can be a choking hazard. Read these instructions created by the expert panel.
Unorthodox Allergy Tests Are Unproven
There are several methods of unorthodox tests for food allergy. Examples include cytotoxic food testing, Vega testing, kinesiology, allergy elimination techniques, iridology, pulse testing, Alcat testing, Rinkel’s intradermal skin testing, reflexology, hair analysis and IgG food antibody testing. These tests have no scientific basis, are unreliable and can’t be reproduced. ASCIA advises against the use of these tests. No Medicare rebate is available in Australia for these tests, and their use is not supported in New Zealand.
Adverse consequences may arise from unorthodox testing and treatments. Treatment based on inaccurate, false positive or clinically irrelevant results can lead to ineffective and expensive treatments, and delay more effective therapy. Sometimes harmful therapy may result, such as unnecessary dietary avoidance and risk of malnutrition, particularly in children.
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Beyond The Physical Reactions
Making the effort to plan ahead for potential allergy exposure, especially around food-based events like ordering from a restaurant or going to a family cookout, can be very helpful in reducing frustration for both kids and parents as well as adults with peanut allergy.
In the European APPEAL-1 study, quality of life difficulties cited by respondents included the following:
- 65% report feelings of isolation
- 43% report being bullied by their peers at least once because of their allergy
- 71% of parents and caregivers of children with peanut allergies experience high levels of anxiety in situations where food is involved
- General uncertainty around the use of an autoinjector
The prevalence of foods containing peanuts along with the severity of allergic reactions is having a significant impact on the quality lives of those who live with a peanut allergy.
A Peanut Allergy Myth
Contrary to urban legend, a childs peanut allergy cannot be triggered by a classmate eating a peanut sandwich across the table. The allergens are not airborne in this way.
Younger children do need to be monitored so they dont share foods accidentally. Wash eating areas and hands with soap and water after eating so a smudge of peanut butter doesnt accidentally get transferred to a child with an allergy.
However, it is not necessary to ban all peanut products from a school because one child is allergic. Peanut allergy is just one of many food allergens. Talk with your allergist about common safe practices for school. There are many resources available to help manage school safely for a child with food allergies.
Contributed by: Megan O. Lewis, MSN, RN, CPNPDate: April 2018
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What To Do If Your Child Has A Peanut Allergy
Avoiding the allergy-triggering food is the number 1 treatment.
Read restaurant menus carefully, ask a lot of questions about ingredients, and request a different preparation if necessary. Peanut is one of the top eight food allergens and will be listed on all packaged and prepared foods.
Create a list of foods your child cant eat, plus some snacks that they can eat, and share that with schools and family friends.
Youll also want to keep epinephrine and diphenhydramine on hand, and be sure your childs school has these too.
As your child matures, you and your allergist will also teach them about their food restrictions and how to ask questions and advocate for themselves.
Diagnosis Of Nut Allergies
If you have allergic symptoms, visit your doctor who will ask some questions about your allergic reactions. You can also discuss the diary record of your symptoms.
To diagnose your allergy, your doctor may refer you to a clinical immunology/allergy specialist who can test for allergies using a number of methods, depending on the type of potential allergy. To test for an allergy to peanuts, tree nuts and seeds, the specialist might:
- do a skin prick test
- do a blood test
- ask you to temporarily avoid all nuts or products containing nuts , then follow up with the introduction of nuts back into your diet under strict medical supervision.
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Reality: Epinephrine Is The First
Benadryl can provide some relief for mild allergic symptoms, like itchy skin or a stuffy nose. But the only drug known to rapidly reverse the most dangerous effects of a life-threatening anaphylactic allergic reaction is epinephrine. Epinephrine works quickly to stop two of the most dangerous symptoms of anaphylaxis: airway constriction and a sudden drop blood pressure. Benadryl does not treat those symptoms and should not be given in place of epinephrine for a severe allergic reaction. Every person with a life-threatening food allergy should get a prescription for epinephrine and should carry two epinephrine autoinjectors at all times. If you or someone you are responsible for has a life-threatening food allergy, talk to your doctor about whether Benadryl or other over-the-counter drugs should also be part of your emergency treatment plan.
Peanuts Tree Nuts And Seeds Are Hard To Avoid
Peanuts, tree nuts and seeds are widely used in Western and Asian foods. This poses significant problems for people with severe peanut, tree nut or seed allergy. Laws require that any product containing peanut, tree nuts or sesame must be clearly labelled. Therefore, it is important to check the labels of all foods before purchase. Further information about reading food labels, food selection and allergen avoidance is available on the ASCIA dietary avoidance information sheets.
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Reality: Peanut Butter Is Made From Ground Peanuts People With Peanut Allergies Need To Avoid Eating Peanuts In All Forms
If you are shaking your head right now and asking why on Earth I included this one, GOOD FOR YOU. You get an A+ in food knowledge. However, if you happen to be a seasoned food allergy parent, youve almost certainly already heard from at least one well-meaning but food-unsavvy person that it ought to be all right for a person with a peanut allergy to eat peanut butter because thats not the same thing.
Peanut butter is made from peanuts. Really. Check the ingredient label. its the first ingredient. People with peanut allergies are definitely allergic to peanut butter.
A Clinical Trial Desensitized Peanut Allergy In 71% Of Children
A clinical trial¹³ funded by the National Institutes of Health found that immunotherapy safely desensitized most highly peanut-allergic children 1-3 years old. The treatment also induced remission of peanut allergy in one-fifth.
In this context, remission is being able to eat the equivalent of 1.5 tablespoons of peanut butter, without having an allergic reaction for six months after finishing the therapy. Again, those who were the youngest and began the study with lower levels of peanut-specific antibodies were most likely to achieve remission.
Tapping into the potential of oral immunotherapy early in life while the immune system matures might change a childs immune response to peanuts.
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Treatment For Peanut Allergy
As peanut allergy has the potential to cause severe life-threatening reactions and is relatively common, extensive research has been done to look at new forms of treatment. One method that is available privately in some specialist allergy clinics is oral immunotherapy . This is the process of increasing the tolerance of food allergens that are eaten. The concept is that very small amounts of an allergen are introduced and the amount gradually increased until a target amount of the food is reached and maintained. This should never be tried without medical supervision at a specialist centre, where currently it remains the subject of active research programmes. Please contact your GP or allergy specialist if you would like more information.
How Is Nut Allergy Treated
If you or your child has reacted to eating nuts, the first step is to see your doctor. They may send you to an allergy specialist who will do a skin or blood test to see what you are allergic to. You may be allergic to several different types of nuts.
There is no cure for nut allergy. The only proven treatment is to completely avoid exposure to the nuts you are allergic to. Research is underway into how to prevent nut allergies in people who may be at risk, and how to ‘switch off’ nut allergy using immunotherapy.
If you are at risk of anaphylaxis, you may be given an adrenaline autoinjector . You should also have an anaphylaxis action plan so you and everyone else knows what to do if you are exposed to nuts.
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What Foods Should I Avoid If I Have A Peanut Allergy
Adults with peanut allergies must be vigilant to avoid accidental exposure to peanuts or peanut-containing foods. Also, be mindful of any foods containing tree nuts such as walnuts, almonds, Brazil nuts, cashews and pecans people with peanut allergies may also be allergic to tree nuts.
According to Kids with Food Allergies , around 35 percent of American toddlers with peanut allergies will also develop tree nut allergies. For those with severe peanut allergies, also be wary of cross-contamination and cross-contact. Always read labels on packaged foods and be careful while eating in restaurants.
Peanuts may be hidden in a lot of common foods, including:
- African, Asian, and Mexican foods
- cereal and granola
What Happens With A Tree Nut Or Peanut Allergy
When someone has a nut allergy, the body’s immune system, which normally fights infections, overreacts to proteins in the nut. If the person eats something that contains the nut, the body thinks these proteins are harmful invaders and responds by working very hard to fight off the invader. This causes an allergic reaction.
Even a small amount of peanut or tree nut protein can set off a reaction. But allergic reactions from breathing in small particles of nuts or peanuts are rare. That’s because the food usually needs to be eaten to cause a reaction. Most foods with peanuts in them don’t allow enough of the protein to escape into the air to cause a reaction. And just the smell of foods containing peanuts won’t cause one because the scent doesn’t contain the protein.
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Reality: Peanut Allergies Put More People In The Hospital Every Year Than Any Other Food Allergy And Are The Leading Food
If a person with a peanut allergy eats even a small amount of peanut protein, he or she may experience a life-threatening allergic reaction called anaphylaxis. Anaphylaxis is more than just sneezing or a few hives. Symptoms of anaphylaxis may include hives, stomach cramps, vomiting, swelling of the lips, tongue or throat, difficulty breathing, dizziness, or loss of consciousness. If left untreated, anaphylaxis can lead to a number of serious consequences including heart failure, brain damage or death.
Even people who have previously only experienced mild allergic reactions to peanuts are at risk for anaphylaxis. The severity of previous allergic reactions to a food does not reliably predict the severity of future allergic reactions to that food. For this reason, most allergists advise that all people with a known peanut allergy strictly avoid eating peanuts and carry an autoinjector filled with epineprhine, the medicine used to treat anaphylaxis.
What Is Still Unknown
- Which consequences of the move indoors were most important to the rise in asthma: i) increased sensitization to indoor allergens ii) long periods of time spent sitting with inadequate expansion of the lungs: iii) changes in diet.
- The reasons why peanut allergy has become more common may include: i) changes in vaccines particularly the change from cellular to acellular pertussis iii) excessive washing of the skin that could have increased penetration of the skin by peanut proteins iv) attempts to avoid oral peanut.
- After the primary changes in hygiene, has the move indoors added a further element that can best be reversed by having a dog in the house?
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Peanut Allergies And Delayed Anaphylaxis
Peanut allergies
If you have a peanut allergy, your immune system will launch an attack anytime it senses the proteins in peanuts. This will cause the release of chemicals that trigger symptoms like itchy hives, nausea, or facial swelling. Peanut allergies are common in the United States.
Some people have severe peanut allergies. When theyre exposed to even the tiniest trace of peanuts, they develop a life-threatening total-body reaction called anaphylaxis.
An anaphylactic reaction often starts within seconds after someone with a severe allergy eats peanuts. Rarely, symptoms can appear minutes or hours after exposure.
You can be treated for a severe reaction, think youre perfectly fine, and then develop a second reaction hours or days later without being exposed to peanuts again. A reaction that occurs long after youve been exposed is called delayed or late phase anaphylaxis.
Learn why this type of response is so dangerous, and find out how to prevent it from happening to you or your child.
Symptoms of a delayed anaphylactic reaction can show up an hour or more after you were exposed to peanuts. Some people dont start to see symptoms until a few days later.
Common anaphylaxis symptoms include:
The symptoms of a delayed reaction can be more or less severe than symptoms of an immediate reaction.
