- Can This Treatment Cure a Peanut Allergy? | UNC Health Talk
- A New Treatment for Peanut Allergies?
- Types of Immunotherapy Treatment for Peanut Allergies
- The Future of Allergy Immunotherapy
- Peanut Allergy
- Can peanut allergy be prevented?
- Can We End Peanut Allergies?
- Peanut Allergy Reaction Signs, Symptoms & Treatment
- Peanut allergy facts
- What is a peanut allergy?
- How common is a peanut allergy?
- Why is peanut allergy increasing and what are risk factors for a peanut allergy?
- What are peanut allergy symptoms and signs? How do physicians diagnose a peanut allergy?
- How are peanut allergies managed? What is the treatment for a peanut allergy?
- Can a peanut allergy be cured or outgrown?
Can This Treatment Cure a Peanut Allergy? | UNC Health Talk
On a September morning in 2013, Edwin Kim, MD, gave his 9-month-old son, Elliot, a bit of peanut butter on a cracker. A minute later, a rash broke out over his baby’s entire body. Elliot began to cough, and then he vomited.
Dr. Kim rushed his son to the emergency room and realized this was what his patients’ families go through. As an allergist, Dr.
Kim had heard parents tell their stories, and now he was in their shoes, frightened in the emergency department.
His child was allergic to peanuts, just many of the kids he sees at the UNC Allergy and Immunology Clinic and an estimated 1.6 million other kids in the United States.
A New Treatment for Peanut Allergies?
The day before he rushed Elliot to the hospital, Dr. Kim had been in his lab researching treatment methods to help kids overcome allergies to foods such as nuts, legumes and eggs.
“For the past 10 years, I’ve been trying to develop a therapy that can protect kids from the most severe allergic reactions,” says Dr.
Kim, who is an assistant professor of medicine at the UNC School of Medicine and a member of the UNC Children’s Research Institute.
“We’re less concerned that kids can’t eat peanut butter and jelly sandwiches; we just want to protect kids, including my own, from accidental exposures.”
The latest hope involves placing tiny drops of liquefied peanut protein under the tongue to immunize people against allergic reactions. Dr. Kim is a leader on this kind of therapy, called sublingual immunotherapy, or SLIT.
Here’s how it works: When under the tongue, the tiny peanut droplet is absorbed immediately, and immune cells recognize the protein.
The amount is so small that the immune system does not overreact: In fact, there’s no, or very little, allergic reaction.
Over time, a child’s immune system becomes desensitized to the peanut protein, as it’s slowly trained to not freak out when faced with larger amounts of peanut, which is what often happens in accidental exposures.
Results from Dr. Kim’s latest clinical trial were published in the Journal of Allergy and Clinical Immunology (JACI), and they show that SLIT could offer a safe and effective way to protect people from severe allergic reactions, even anaphylaxis.
“As a parent of a child with a peanut allergy and another with a cashew allergy, I know the fear parents face and the need for better treatments,” Dr. Kim says. “We now have the first long-term data showing that sublingual immunotherapy is safe and tolerable while offering a strong amount of protection.”
Types of Immunotherapy Treatment for Peanut Allergies
SLIT is the least known of three main immunotherapeutic techniques clinician scientists have created for people with peanut allergies. All of them attempt to desensitize the immune system to peanut proteins to help people avoid severe allergic reactions, which Dr.
Kim says can be triggered by about 100 milligrams of peanut protein. That’s the sort of trace amount people fear can show up in food that’s “manufactured in a facility that processes peanuts,” as many food packaging labels say.
For reference, one peanut kernel is about 300 milligrams.
“The main idea beyond immunotherapy is to keep kids safe from the small hidden exposures that could occur with packaged foods, at restaurants and with other food exposures,” Dr. Kim says.
The most well-known and well-studied immunotherapy method is called oral immunotherapy, which requires people to eat a small portion of peanut protein daily. Similar to SLIT, the amount is increased over time to desensitize the immune system.
“Some kids are not thrilled with ingesting peanut flour because of the taste, which they associate with a severe allergic reaction they may have had,” Dr. Kim says. “But some kids don’t mind at all, and parents can hide the taste in other food or drinks.”
In a large clinical trial, oral immunotherapy patients started with ingesting 0.5 milligrams of peanut, which was increased to 300 milligrams over many weeks before maintaining that amount every day for the remainder of a year.
This trial showed substantial effectiveness in protecting people, but some had serious side effects. A subsequent analysis of oral immunotherapy data published in The Lancet in April suggested that more clinical research was needed because of the risk of serious side effects.
Today, the Food and Drug Administration is reviewing oral immunotherapy.
The second kind of immunotherapy, which is also under FDA review, involves placing a small patch on the skin that releases a small amount of peanut protein to desensitize the immune system.
“This approach has proven to be safe in clinical research but perhaps not as effective as researchers had hoped,” Dr. Kim says. “Still, it could become an FDA-approved treatment.”
The third approach is SLIT, and it has some advantages over the previous types of immunotherapy. One is that kids don’t taste the tiny drop under the tongue. Another is that, un in oral immunotherapy, the peanut protein in the drop avoids the digestive tract, so it requires much smaller doses.
In 2011, Dr. Kim and colleagues, including Wesley Burks, MD, dean of the UNC School of Medicine, conducted a small study of 18 patients to show that SLIT was safe and effective over one year. Dr. Kim’s team started each child with just a 0.0002-milligram dose of liquefied peanut under the tongue. The researchers increased that amount to 2 milligrams over a few months.
Since 2011, Dr. Kim and colleagues have seen 48 patients in the SLIT protocol of 2 milligrams daily for five years. The results have been encouraging: In the 2019 JACI paper, the researchers showed that 67 percent of patients could tolerate at least 750 milligrams of peanut protein without serious side effects. About 25 percent could tolerate 5,000 milligrams.
The Future of Allergy Immunotherapy
Dr. Kim’s data show SLIT is about as effective as oral immunotherapy. Although the SLIT study was much smaller, he says the approach poses much less risk of serious side effects.
(The most common side effect was itchiness around the mouth that lasted about 15 minutes and did not need treatment.
) Additionally, no one left the multiyear SLIT study because of side effects, which cannot be said for oral immunotherapy trials.
“Our sublingual immunotherapy participants tolerated between 10 and 20 times more peanut protein than it would take for someone to get sick,” Dr. Kim says. “We think this provides a good cushion of protection; maybe not quite as good as oral immunotherapy, but with an easier mechanism (under the tongue) and, as far as we can tell right now, a better safety signal.”
Dr. Kim’s lab has finished a separate SLIT study of 4 milligrams daily for 55 patients over four years. He hopes to publish the results this year.
“With sublingual immunotherapy, we hope we can maintain our safety profile while seeing an even stronger benefit for patients,” Dr. Kim says.
Dr. Kim and colleagues are also studying SLIT in a subset of children ages 1 to 4 because data from oral immunotherapy studies have shown that young patients have a stronger, more lasting benefit from immunotherapy.
“In our clinic, we focus on the idea there is no one perfect drug for food allergy,” Dr. Kim says. “There will have to be a lot of shared decisions between physicians, patients and parents about what method of treatment is best for each person. But we’re confident sublingual immunotherapy could be a good option for a subset of people.”
For more information, contact the UNC Allergy and Immunology Clinic or the UNC Children’s Research Institute.
Peanut is one of eight allergens with specific labeling requirements under the Food Allergen Labeling and Consumer Protection Act of 2004. Under that law, manufacturers of packaged food products that contain peanut as an ingredient that are sold in the U.S. must include the word “peanuts” in clear language on the ingredient label.
To avoid the risk of anaphylactic shock, people with a peanut allergy should be very careful about what they eat. Peanuts and peanut products may be found in candies, cereals and baked goods such as cookies, cakes and pies.
If you’re eating out, ask the restaurant staff about ingredients – for example, peanut butter may be an ingredient in a sauce or marinade. Be extra careful when eating Asian and Mexican food and other cuisines in which peanuts are commonly used.
Even ice cream parlors may be a source for accidental exposures, since peanuts are a common topping.
Foods that don’t contain peanuts as an ingredient can be contaminated by peanuts in the manufacturing process or during food preparation.
As a result, people with a peanut allergy should avoid products that bear cautionary statements on the label, such as “may contain peanuts” or “made in a factory that uses nut ingredients.” Note that the use of those advisory labels is voluntary.
It may be a good idea to discuss with your allergist the risks of consuming products with voluntary labeling.
If you’re cooking from scratch, it’s easy to modify recipes to remove peanut ingredients and substitute ingredients that aren’t allergens, such as toasted oats, raisins or seeds.
Most people who can’t tolerate peanuts or eat peanut butter can consume other nut or seed butters.
Keep in mind that these products may be manufactured in a facility that also processes peanuts – so check the label carefully and contact the manufacturer with any questions.
Many individuals with an allergy to peanuts can safely consume foods made with highly refined peanut oil, which has been purified, refined, bleached and deodorized to remove the peanut protein from the oil.
Unrefined peanut oil – often characterized as extruded, cold-pressed, aromatic, gourmet, expelled or expeller-pressed – still contains peanut protein and should be avoided. Some products may use the phrase “arachis oil” on their ingredient lists; that’s another term for peanut oil.
If you have a peanut allergy, ask your allergist whether you should avoid all types of peanut oil.
While some people report symptoms such as skin rashes or chest tightness when they are near to or smell peanut butter, a placebo-controlled trial of children exposed to open peanut butter containers documented no systemic reactions.
Still, food particles containing peanut proteins can become airborne during the grinding or pulverization of peanuts, and inhaling peanut protein in this type of situation could cause an allergic reaction.
In addition, odors may cause conditioned physical responses, such as anxiety, a skin rash or a change in blood pressure.
Can peanut allergy be prevented?
In 2017, the National Institute for Allergy and Infectious Disease (NIAID) issued new updated guidelines in order to define high, moderate and low-risk infants for developing peanut allergy. The guidelines also address how to proceed with introduction of peanut risk in order to prevent the development of peanut allergy.
The updated guidelines are a breakthrough for the prevention of peanut allergy. Peanut allergy has become much more common in recent years, and there is now a roadmap to prevent many new cases.
According to the new guidelines, an infant at high risk of developing peanut allergy is one with severe eczema and/or egg allergy. The guidelines recommend introduction of peanut-containing foods as early as 4-6 months for high-risk infants who have already started solid foods, after determining that it is safe to do so.
If your child is determined to be high risk, the guidelines recommend having them tested for peanut allergy. Your allergist may do this with a skin test or blood test.
Depending on the results, they may recommend attempting to try peanut for the first time in the office.
A positive test alone does not necessarily prove your child is allergic, and studies have shown infants who have a peanut sensitivity aren’t necessarily allergic.
For high-risk infants, if the skin test does not reveal a large wheal (bump) updated guidelines recommend that infants have peanut fed to them the first time in the specialist’s office. However, if the skin test reaction is large (8 mm or larger) the guidelines recommend not pursuing an oral challenge, as the infant is ly already allergic at that point.
Therefore, an allergist may decide not to have the child try peanut at all if they have a very large reaction to the skin test. Instead, they might advise that the child avoid peanuts completely due to the strong chance of a pre-existing peanut allergy.
An allergist might also still proceed with a peanut challenge after explaining the risks and benefits to the parents.
Moderate risk children – those with mild to moderate eczema who have already started solid foods – do not need an evaluation. These infants can have peanut-containing foods introduced at home by their parents starting around six months of age.
Parents can always consult with their primary health care provider if they have questions on how to proceed.
Low risk children with no eczema or egg allergy can be introduced to peanut-containing foods according to the family’s preference, also around 6 months.
Parents should know that most infants are either moderate- or low-risk for developing peanut allergies, and most can have peanut-containing foods introduced at home. Whole peanuts should never be given to infants as they are a choking hazard. More information can be found here and also in the ACAAI video, “Introducing peanut-containing foods to prevent peanut allergy.”
Although parents want to do what’s best for their children, determining what “best” means isn’t always easy. So if your son or daughter is struggling with peanut allergies, take control of the situation and consult an allergist today.
This page was reviewed and updated 3/14/2019.
Can We End Peanut Allergies?
If approved, a new treatment for peanut allergy may enable kids to eat small amounts of peanuts without a severe allergic reaction.
Share on PinterestFor some children, even a trace amount of peanuts can be dangerous. Getty Images
For children with a peanut allergy, every bite of food outside the home stirs up anxiety.
Exposure to trace amounts of peanuts in cookies, cakes, or other foods from cross contamination can end with a severe allergic reaction and even hospitalization.
The results of a new study may lead to the approval of a new treatment that reduces the risk of these kinds of potentially deadly reactions, providing relief not just for children, but also for their parents.
The treatment is not a cure for peanut allergy. Nor is it designed to allow kids to eat entire peanut butter and jelly sandwiches. Instead, the goal is to allow them to tolerate small amounts of peanuts.
“Being able to safely eat one or two peanuts is a huge improvement in terms of kids’ quality of life — such as when they go to a friend’s house overnight or to a potluck, and they’re avoiding peanuts but could still accidentally ingest a small amount,” said Dr. Stephen Tilles, one of the study’s co-authors and past president of the American College of Allergy, Asthma, and Immunology.
For many kids with a peanut allergy, this is enough protection.
“Some children don’t ever want to eat food with peanuts. They just want to be protected in case they get exposed to it,” said Dr. Tina Sindher, a clinical assistant professor at the Sean N. Parker Center for Allergy & Asthma Research at Stanford University, who was not involved in the study.
The results of the research were presented Sunday at the American College of Allergy, Asthma, and Immunology in Seattle and published Monday in The New England Journal of Medicine.
In the study, 372 children with a known peanut allergy consumed an increasing amount of peanut protein every day for sixth months, starting with minute amounts. This was followed by six months at a “maintenance dose,” the equivalent of one peanut daily.
This type of treatment is known as oral immunotherapy and is designed to build up the immune system’s tolerance to an allergen.
After one year, over two-thirds of these 4- to 17-year-olds were able to consume 600 milligrams of peanut protein — the equivalent of two peanuts — during a food challenge “with no more than mild symptoms.”
In contrast, only 4 percent of 124 children who had been taking a non-peanut powder throughout the study — the placebo group — were able to tolerate the same amount of peanut protein.
Half of the children in the treatment group were also able to safely consume 1,000 milligrams of peanut protein during the food challenge.
This treatment, though, may not work for everyone.
Almost all of the children experienced some adverse reactions during the study. The most common ones in children taking the peanut protein were gastrointestinal pain, vomiting, nausea, itchy skin, coughing, and irritation of the throat.
About one-third of children in the treatment group had only mild symptoms, compared to 50 percent in the placebo group.
Severe side effects occurred in 4.3 percent of kids in the treatment group and less than 1 percent of kids in the placebo group.
In addition, during the study, 14 percent of children in the treatment group received injections of epinephrine for a severe allergic reaction, compared to 6.5 percent of the children in the placebo group.
Certain side effects were bad enough that some children dropped out before the end of the study — almost 12 percent of children in the treatment group. Sindher is not surprised at this high dropout rate.
“We see this all the time in the clinic,” she said. “Some kids do not tolerate oral immunotherapy. For example, some have an anaphylactic reaction on a dose they’ve been taking for two or three weeks in a row. There’s a lot of variability in the real world.”
Unfortunately, it’s not possible to predict which children will have bad reactions.
“It’s hard to know who will be on the treatment 1 or 2 years later,” said Tilles. “But this trial suggested, at least after a year of therapy, that there’s a large proportion of patients still doing well.”
While the study made headlines among the allergy community, there were a few caveats.
The protein powder used in the study, known as AR101, was developed by Aimmune Therapeutics, which designed and sponsored the clinical trial.
The New York Times reported that 5 of the 13 main authors are employees of Aimmune Therapeutics. The others are paid to serve on the company’s scientific advisory board.
The treatment still needs approval from the U.S. Food and Drug Administration before it will be available in the clinic. But there’s ly to be a big demand for it.
According to the Food Allergy Research & Education website, the rate of peanut or tree nut allergy among U.S. children more than tripled between 1997 and 2008.
About 40 percent of children with food allergies have experienced a severe allergic reaction such as anaphylaxis.
This isn’t the only potential treatment for dangerous and deadly food allergies being researched.
Multiple treatments for peanut and other food allergies are currently under development. Sindher said many of these are designed to help children tolerate oral immunotherapy.
DBV Technologies has submitted an application to the FDA for an immunotherapy patch that delivers very small amounts of peanut to the skin — micrograms, not milligrams.
Sanofi is working on an immunotherapy that is delivered under the tongue. In addition to the peanut protein, this includes a compound that may increase the immune system’s tolerance to peanut allergens.
Another treatment being tested uses omalizumab — the allergy medicine Xolair —alongside immunotherapy. This drug blocks an antibody involved in the peanut allergic reaction.
Stanford researchers are also testing a DNA vaccine that may reduce the body’s inflammatory response to peanuts. The vaccine also doesn’t include the actual peanut proteins, so the risk of an anaphylactic reaction during treatment is lower.
Sindher doesn’t think so.
“If anything, we’re seeing the incidence of peanut allergies going up every year,” she said. “But we are coming up with more treatments. We are also trying to learn more about food allergies to help with prevention strategies.”
One 2015 study found that introducing some infants to peanuts early on may reduce their risk of developing a peanut allergy.
These treatments may offer children more options than just “avoid, avoid, avoid” and carrying two EpiPens everywhere they go.
“If the treatments work, children will be protected when they eat the equivalent of one peanut,” said Sindher. “This is what we call ‘bite-proof.’ If a kid accidentally gets a bite of a cookie with peanuts in it, they’re not going to need to be rushed to the hospital.”
There’s one line of research, though, that may drastically reduce the need for these kinds of treatments — genetically engineering a hypoallergenic peanut, something researchers are working on right now.
Peanut Allergy Reaction Signs, Symptoms & Treatment
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Peanut allergy facts
- The prevalence of peanut allergy in the United States is approximately 0.6% to 1.3%.
- The rate of peanut allergy is higher in individuals with additional allergic conditions or a family history of allergic conditions, including a sibling with a peanut allergy.
- One-third of patients with peanut allergy are also allergic to tree nuts.
- About 90% of reactions to peanut occur within 20 minutes of exposure.
- Peanut allergy with asthma is a risk factor for a severe allergic reaction.
- Peanut allergy symptoms and signs include
- skin redness,
- rash (hives).
- More severe symptoms and signs include:
- Epinephrine is the treatment of choice for a systemic allergic reaction to peanut.
- Roughly 20% of children outgrow peanut allergy by their school-age years.
- There is no cure for peanut allergy.
It's common to have a bad reaction to foods we eat on occasion, such as gas from eating beans or headaches from drinking wine. If you're lactose intolerant you may experience diarrhea when you consume dairy.
These are all examples of food sensitivities or intolerances, which are different from allergies in that they are not immune system reactions. With a food allergy.
The immune system reacts to specific foods which can result in symptoms that range from:
- mild skin rashes or
- to anaphylaxis, a serious reaction that can be fatal.
Learn more about food allergy triggers »
What is a peanut allergy?
Peanut allergy develops when the body's immune system has an abnormal, hypersensitivity response to one or more of the peanut proteins. Peanut allergy is one of the most common food allergies in both children and adults. It receives particular attention because it is relatively common, typically lifelong, and can cause severe allergic reactions.
Peanut allergy is the leading cause of anaphylaxis and death due to food allergy. It can lead to significant burden on patients and their families. Peanut is a common food ingredient making strict avoidance difficult. Therefore, there is a relatively high rate of accidental peanut ingestions for those trying to avoid peanuts.
For all of the above reasons, peanut allergy has become an important public-health issue.
Allergies can best be described as: See Answer
How common is a peanut allergy?
This prevalence of peanut allergy has increased significantly over the past decade, most notably in westernized countries. The prevalence of peanut allergy in westernized countries is approximately 0.5%, with the greatest prevalence in children under 3 years of age.
This increase in prevalence has also occurred with other allergic conditions, such as eczema (atopic dermatitis), asthma, and hay fever (allergic rhinitis). Peanut allergy is much less common in underdeveloped areas of the world, such as Africa and Asia.
Emerging literature suggests that the increasing rate of peanut allergy may be leveling off in many nations, including the United States.
Why is peanut allergy increasing and what are risk factors for a peanut allergy?
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It is not clear why the rate of peanut allergy is increasing in the United States and other westernized nations. This is an area of active medical research. Risk factors for peanut allergy include a personal or family history of allergic conditions, such as asthma, hay fever (allergic rhinitis), and particularly eczema (atopic dermatitis).
A sibling of a child with peanut allergy has approximately a 7% chance of developing peanut allergy, as compared to the baseline population risk of 0.5%.
Other factors influencing peanut allergy include exposure during pregnancy and lactation, exposure to peanut protein through household dust, and exposure to skin-care products containing crude peanut oil.
There has been significant recent research on the timing of peanut exposure into a child's diet and its effect on the risk of allergy. In the early 2000s, recommendations were to delay the introduction of peanuts until 3 years of age. The rates of peanut allergy more than doubled in countries following these recommendations.
It was also observed that rates of peanut allergy were significantly lower in countries, such as Israel, where children were introduced to peanuts at a younger age. In 2008, the recommendation regarding delayed introduction of peanut was retracted, and research began to indicate that earlier introduction of peanut may be protective against food allergy.
In a landmark study publish in 2015 (LEAP study), it was shown that early introduction of peanut into a child's diet, at 4 months of age, significantly decreased the risk of developing peanut allergy in a high-risk population.
This study, along with additional research, may very well lead to updated guidelines on the timing of introduction of peanuts and other highly allergenic foods into a child's diet.
The Most Common Food Allergies for Kids and Adults See Slideshow
What are peanut allergy symptoms and signs? How do physicians diagnose a peanut allergy?
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The most important step in the diagnosis of peanut allergy is a detailed history. A good history may essentially make the diagnosis of a peanut allergy. Important factors for a suggestive history of peanut allergy include the following:
Timing of symptoms: The majority of reactions occur within 20 minutes, with nearly all reactions occurring within two hours of exposure to peanuts.
Types of peanut allergy symptoms: About 80% to 90% of reactions involve skin manifestations such as
- a rash, including hives,
Nevertheless, reactions can occur in the absence of a rash, and these reactions may be the most severe. Other common signs and symptoms involve the
- respiratory system (difficulty breathing, coughing, wheezing),
- gastrointestinal system (nausea, vomiting, diarrhea),
- cardiovascular system (increased heart rate, decreased blood pressure),
- neurological system (lightheadedness, passing out),
- even changes in behavior, especially in children.
Consistency: Reactions should consistently occur with every peanut exposure.
Following the history, the skin prick test (SPT) is generally the test of choice in making a diagnosis of peanut allergy. It is very important to be aware that a positive SPT alone does not make the diagnosis of peanut allergy.
Of note, many individuals with a positive SPT to peanut will not be peanut allergic. The usefulness of a peanut SPT increases as the size of the reaction increases.
Sometimes, SPT results are inconclusive and may be followed up with a blood test known as peanut specific IgE levels.
Similar to the SPT, peanut-specific IgE levels must be interpreted based upon the clinical history. Undetectable peanut-specific IgE levels do not rule out the possibility of peanut allergy, with reaction rates of up to 20% being reported in individuals with undetectable peanut-specific IgE. Much SPT, the lihood of true peanut allergy increases with increasing levels of peanut-specific IgE.
Despite a thorough clinical history, SPT, and peanut-specific IgE levels, the diagnosis of peanut allergy may still remain in question. In these instances, a physician-supervised oral food challenge (OFC) may be indicated.
In an OFC, patients are given gradually increasing amounts of peanut, usually in an allergist's office, and closely monitored for allergic symptoms.
OFCs have not only been shown to significantly improve quality of life regardless of whether the challenge is passed or failed, but they have also been shown to be very safe when performed in an appropriate setting under the supervision of a physician experienced in the management of food allergy.
During the diagnostic process of peanut allergy, it is also important to determine if peanut-allergic individuals are allergic to tree nuts, since up to one-third of patients with peanut allergy will also react to tree nuts.
How are peanut allergies managed? What is the treatment for a peanut allergy?
Strict avoidance of peanuts and prompt treatment of accidental ingestions are the mainstays of management of peanut allergy. The goals of treatment are to minimize the risk of accidental ingestion while maintaining adequate nutrition and an acceptable quality of life.
Although there is significant research focused on oral immunotherapy and desensitization protocols for peanut allergy, these treatment options are still not ready for widespread clinical use. There is also significant research involving a peanut patch, also known as epi-cutaneous immunotherapy.
Early studies of this patch have shown that by applying a patch containing peanut protein to the skin, it may be possible to make peanut allergic individuals less sensitive to peanut protein and it may protect certain peanut-allergic individuals from experiencing a reaction to an accidental peanut exposure.
There are still many questions regarding this possible form of therapy and it is still not ready for widespread clinical use.
Peanut is a common food in the Unites States, and strict avoidance requires constant awareness of food labels and food ingredients. United States legislation requires all food companies to identify on labels whether their products contain the most common food allergens, including peanuts.
Advisory labeling practices, such as those stating “may contain peanut,” “manufactured on shared equipment with peanut,” or “manufactured in the same facility as peanut,” are not regulated.
The potential risk of ingesting peanut from foods labeled with advisory labeling is unknown, so peanut-allergic individuals should also avoid these foods.
Despite attempts at strict avoidance, accidental ingestions occur in up to 15% of patients per year, as evidenced by a British study. All individuals with a peanut allergy should have an emergency action plan outlining the treatment plan for an acute reaction.
Since epinephrine injection is the only treatment for a significant allergic reaction, all individuals with a peanut allergy should carry an epinephrine auto-injector (Auvi-Q, Epipen, Twinject) at all times.
Although antihistamines such as diphenhydramine (Benadryl) may also be used in the management of acute allergic reactions, epinephrine generally remains the treatment of choice. Individuals who experience an acute allergic reaction to an accidental peanut exposure should also notify a health-care professional.
It is very important to note that the severity of acute reactions is variable and cannot be predicted by diagnostic testing or previous reactions. Risk factors for poor outcomes from peanut allergy include asthma and delayed treatment with epinephrine.
There are important additional considerations in managing and counseling individuals with peanut allergy. Research has shown that reactions due to skin contact are typically limited to the site of contact and unly to cause a systemic reaction or anaphylaxis.
Similarly, the vast majority of peanut-allergic individuals will tolerate being around peanuts and the smell of peanut, since peanut protein is not airborne.
The majority of peanut-allergic individuals will also tolerate peanut oil, since the peanut protein is not present in the highly purified oils, except in the rarer cold-pressed oils. Although peanut is a legume, most peanut-allergic individuals will also tolerate other legumes, such as soy, peas, and green beans.
Exposure to peanut through another person's saliva (such as from kissing) has been shown to trigger a reaction. All peanut-allergic individuals should discuss these considerations and other questions with their health-care provider.
Can a peanut allergy be cured or outgrown?
Unfortunately, there is no cure for peanut allergy. Although the natural history of peanut allergy is often difficult to predict, peanut allergy can be outgrown. Approximately 20% of children with peanut allergy will tolerate peanuts by their school-age years.
Favorable factors to outgrow peanut allergy include smaller SPT at the time of diagnosis, lower specific IgE levels at the time of diagnosis, milder initial reaction to peanuts, and minimal additional allergic conditions, including a lack of additional food allergies (particularly tree nuts).
If there is a significant lihood that a child has outgrown peanut allergy, a physician-supervised oral food challenge can be pursued.
Medically Reviewed on 12/4/2018
Medically reviewed by Michael E. Manning, MD; American Board of Allergy and Immunology REFERENCE:
Du Toit, George. “Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy.” New England Journal of Medicine 372 (2015): 803-813.