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Food oral immunotherapy: Peanut allergy desensitization methods

Food oral immunotherapy is becoming popular in Sacramento as one way to desensitize children who have peanut allergies. Developed by allergists at Mercy Medical Group in Sacramento, the new treatment is the first such program to be rolled out in the region. What food oral immunotherapy is about focuses on peanut desensitization. Some people theorize that if a dog is brought into the home, a child born into an environment with an animal in the home might have more exposure to microbes so that the immune system wouldn't get confused and attack the food as if it were a microbe.

Food oral immunotherapy: Peanut allergy desensitization methods.
Photo by Justin Sullivan/Getty Images

Peanut allergies in children is a growing problem in Sacramento as well as in other cities nationwide. But Sacramento has started using a novel, new treatment for nut-allergic kids. Now the question for scientists to ponder is why are peanut allergies exploding in number in children, including babies in the USA and especially here in Sacramento?

The question is why are peanut allergies and other food allergies growing so rapidly in Sacramento as well as across the country? The Centers for Disease Control and Prevention (CDC) reported that, from 1997 to 2011, food allergies grew in number by 50 percent from 3.4 percent to 5.1 percent of American children.

Scientists only have theories for the rapid rise in food, particularly peanut allergies. One theory is that children are growing up in homes so clean and hands washed so often that the human immune system gets confused which are the microbes the system is supposed to attack. Instead, immune systems attack peanuts in any form and/or other foods such as shellfish. Food allergies on the rise also include reactions to tree nuts, soy, wheat, shellfish and eggs, with eggs being the most common.

Recently, buckwheat joined the list of food allergens. Why is the human immune system, especially of children, attacking these foods? Could it be due to the fact that the foods are genetically changed? Or is it the immune systems of kids so unused to certain microbes in the home, that the immune system attacks the food thinking it's an invading bacteria, virus, or other parasite?

You may wish to check out the Sacamento Bee article by Cynthia H. Craft, "Treatment for deadly peanut allergy exposes children to peanuts." Mercy developed the program to introduce tree nuts to young patients in very small doses, gradually increasing the child’s exposure to try to lessen the body’s immune system reaction to peanuts, explains the article.

No parent wants to his his or her children exposed to a lethal dose of peanuts when someone brings in a sandwich or treat to school and the kid gets a lethal allergy attack from a whiff or coming into contact with a tiny amount of peanut. Children show up in emergency rooms in increasing numbers, especially here locally. They may feel their throat is closing up, swelling, or other throat sensation, or have hives all over their body, or suffer anaphylactic shock.

It's too dangerous for some parents to wait until the child has a lethal exposure to peanuts from some sudden, unexpected source, for example somebody next to the child in a plane, bus, train, boat, or other public transit situation or waiting room opens a snack that contains peanuts and the odor wafts onto the child who then has a reaction, or the child eats food that contains peanuts without knowing that the food contained a small amount of an ingredient that came from peanuts.

The individual is exposed to a tiny, diluted amount of the allergen to encourage desensitization

The new treatment in Sacramento works something like homeopathy where a person is exposed to a tiny diluted amount of the allergen. It also works like innoculation, where a vaccine contains a very tiny amount of the culprit that end up protecting the individual. For example, if a person is allergic to a particular type of pollen, sometimes allergy innoculations or 'shots' are made with that type of pollen to ease the allergy symptoms of those who react to pollen in the air during seasonal situations, such as spring when pollen is wafting in the air.

With the treatment known as peanut desensitization, Mercy's program comes with “significant risk of a serious allergic reaction, including hives, swelling, bronchospasm, difficulty breathing, loss of consciousness and shock, which may necessitate emergency treatment and hospitalization.” And, the unmentionable: risk of death, says the Sacramento Bee article.

The program is run by allergists. What happens in the protocol is a situation focused on preventing harm from coming to the dozen or so children Mercy treats. During a period of more than 18 months, the two allergists in the program painstakingly reviewed research and protocols of a handful of similar programs across the country.

Food allergies also appear to plague mainly urbanites and suburbanites

Why are people from extreme rural areas less likely to be allergic to peanuts, shellfish, eggs, or other foods? It can't be genetic when country people move to the city, the protective effect that may come from living in a rural environment seems to vanish. So, if it's not a peanut allergy gene, for example, but moving from rural areas to urban areas, perhaps it's environmental or related to more pollution in the city, or maybe to cleaner homes with fewer germs? These are all theories scientists research.

What's known from the global allergy data, is that people living in extreme rural conditions seem to be getting exposure to all kinds of microbes, and so their immune systems have targets to focus on. If you look at Europe, you can see in the remote areas there, people work closer to animals and share the animal's bacteria. So is the answer to bring a dog into your house and let the dog's bacteria rub off on your skin? That's still a theory. Scientists are still questioning and researching whether or not a dog in the house will bring in enough microbes from outdoors to help reduce food allergies, asthma, or other immune system reactions being treated as if the foods were microbes to be attacked.

Fewer food allergies show up when people live in extreme rural areas

In the meantime, scientists are looking at all the possibilities of why allergies are on the rise. For example, why do more people, including babies and children become allergic when they move from extreme rural environments to urban or suburban lifestyles? If you look at timelines, you can see how fast food allergies have grown over the past century.

Parents are wondering whether the kids are not playing outdoors long enough because in modern times, it's too dangerous to let kids play outdoors for hours when there's no one to supervise who makes contact with them or what they are doing. In the past kids played in mud. But here in California, if kids play in mud, they may come down with the Valley Fever fungus, warts, or other conditions. Interestingly, the treatment for food allergies somewhat resembles homeopathy and innoculation, which were new and suspect treatments a century or more in the past.

Homeopathy is a system of medicine which involves treating the individual with highly diluted substances, given mainly in tablet form, with the aim of triggering the body’s natural system of healing. Based on their specific symptoms, a homeopath will match the most appropriate medicine to each patient, according to the website of the Society of Homeopaths. To read more about safety studies: click here.

How the peanut allergy - food oral immunotherapy treatment works is that it focuses on peanut desensitization

A child might get daily an exact dose, such as 6 grams of peanuts measured precisely. The parents would use a digital scale. Then another dose would come 12 hours later. The child would be monitored for any immune system reaction for an hour, and no vigorous exercise would be allowed for two hours. The child also would be kept from getting overheated.

The dose might be different for another child. But for the child mentioned in the Sacramento Bee article, the treatment started with a tiny bit of peanut powder mixed into liquids or soft foods. The child is brought back to Mercy allergists every two weeks. Gradually, the peanut dose would be increased by a tiny amount until the child reaches a maintenance dose.

The big issue is when the maintenance dose is stopped, the full force of allergy to peanuts may come back. But the maintenance dose is continued for 18 months, which is part of the program. No promise is made to families whether or not the child will someday be free of the peanut allergy in the future.

The purpose of the treatment is to desensitize a child to peanuts, not to cure the food allergy

The treatment is supposed to be a safety net in case the child accidentally comes in contact with a food that contains some peanuts, such as eating a treat outside the home and not knowing whether any ingredient in that food has peanuts, peanut butter, powder, or any ingredient derived from peanuts.

You have families who live in fear their child will come into contact with some food or other item that contains an ingredient that came from peanuts. The desensitization also helps the rest of the family lessen their anxiety. However, there is a risk when allergic kids expose themselves to peanuts in the treatment regimen.

Parents keep watch as the treatment progresses, keeping the EpiPen at hand, for any signs of swelling, hives or trouble breathing. The issue for now is desensitizaton rather than thinking the kid will be cured. But anything is possible with food oral immunotherapy.

In other studies, a new approach to treating peanut and other food allergies appears in recent research

These days, more and more people seem to have food allergies, which can sometimes have life-threatening consequences. In ACS' Journal of Agricultural and Food Chemistry, scientists report the development of a new type of flour that someday could be used in food-based therapies to help people better tolerate their allergy triggers, including peanuts in the latest study, "Novel Strategy To Create Hypoallergenic Peanut Protein–Polyphenol Edible Matrices for Oral Immunotherapy," published online April 23, 2014.

Mary Ann Lila and colleagues note that of the 170 foods that cause allergic reactions, peanuts can be the most dangerous. These reactions can range from mild itching and hives to life-threatening anaphylactic shock, in which a person's throat swells, making it difficult or impossible to breathe. An experimental treatment that involves giving minute quantities of the trigger food to patients over a period of time in a clinic is successful for some patients who are allergic to peanuts.


The process, called desensitization, sets off beneficial responses by the body to the food. But the milled roasted peanut flour that is currently used can have severe side effects. Lila's team set out to design a new type of flour that could help control food allergies without causing dangerous side effects, according to the May 14, 2014 news release, "A new approach to treating peanut and other food allergies."

They turned to plant polyphenols, which have shown promise as compounds that can dampen allergic reactions. The scientists developed a modified flour powder in which cranberry polyphenols were bound to peanut proteins. With this extra cargo, the peanut-containing powder triggered the beneficial desensitization reactions, without provoking harmful allergic responses in laboratory tests with mice. The scientists note that the technique could also be adapted for other food allergies.

The authors acknowledge funding from the Everett W. Byrd Endowment and the North Carolina State University's Plants for Human Health Institute at the N.C. Research Campus at Kannapolis. The American Chemical Society is a nonprofit organization chartered by the U.S. Congress. With more than 161,000 members, ACS is the world's largest scientific society and a global leader in providing access to chemistry-related research through its multiple databases, peer-reviewed journals and scientific conferences. Its main offices are in Washington, D.C., and Columbus, Ohio.

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