New treatments may soon be available for patients with peanut allergy. For decades, our best therapy was identification, avoidance and treatment of reactions with epinephrine and antihistamine. But this could change with a new procedure called oral peanut desensitization.
While attending an allergy conference, I listened to a debate about peanut desensitization and whether it is helpful, safe and ready for the general public. An allergist from Lake Oswego, who is currently treating selected patients with desensitization, argued for it, while an allergist from Seattle argued against it.
Here’s how the treatment works: Peanut-allergic patients are given gradually increasing doses of peanut in the doctor’s office, followed by smaller doses taken regularly at home. Patients who make it through the protocol are asked to eat a specific dose of peanut each day for the rest of their lives. Skipping one or more doses could potentially lead to an anaphylactic reaction. The goal of the therapy is to make the patient “bite proof” to peanut. It is not considered a cure for peanut allergy.
The proponent described how more than 100 patients in Oregon are currently being desensitized successfully. Other small-scale studies have published similar successful outcomes.
The opponent focused on the risks. Giving an allergic patient peanuts could theoretically bring about a fatal reaction. Are such risks with this procedure one in 10,000? One in 10 million? The answer is unknown. Without quantifying this risk, we cannot know if the risk outweighs the benefit. Researchers are attempting to answer this question, but the studies take time and are not complete.
Other questions also have not been answered. If a patient missed their peanut dose, how long could they go before the entire procedure would have to be repeated? Presently, there are several well-controlled studies being undertaken by the Consortium of Food Allergy Research that take multiple approaches to addressing this problem.
Many patients and parents are excited about the prospect of removing some fear from their lives. Talk with your allergist to discuss whether this procedure is for you and whether the appropriate time it is now or later. Currently, there is only one board-certified allergist in Oregon doing this, and it is not considered the standard of care. But one day, it may be available here in Eugene.