If you are pregnant and you have a family history of food allergy, especially peanut allergy, it is natural to worry about having a child with a peanut allergy. Food allergies do tend to run in families. If you have lived with peanut allergy, you know how frightening that can be. Peanut allergy is the most common cause of death from food allergy. It affects over one million children in the United States. About 12 to 14 percent of children with peanut allergies end up in the emergency room for treatment every year.
Parents who have to worry about a child coming into any contact with even a tiny amount of peanut live in constant fear. Even one tenth of one peanut can cause an allergic reaction in some children. The most severe type of reaction is anaphylaxis. It may cause swelling of the throat that blocks breathing, along with a sudden, dangerous drop in blood pressure.
One of the most frustrating aspects of living with a peanut allergy is that there is no treatment or cure. Children can only avoid peanuts at all cost. They always need to carry a dose of epinephrine (EpiPen) to inject at the first signs of a severe reaction. Since most children never outgrow peanut allergy, these problems and worries can last a lifetime.
Hope may be on the way. Experts at the Food and Drug Administration (FDA) have recently voted to approve the first drug to prevent or decrease peanut allergy reactions. The drug is expected to have final approval in early 2020. It is intended for children and adolescents ages 4 to 17. Studies did not find that this treatment worked well after age 17. By that time, it is harder to change the immune system.
The brand name will be Palforzia. Palforzia is a standardized dose of refined peanut protein. It will come in a capsule that can be swallowed or broken open and added to food. Treatment starts at a very low daily dose and is increased gradually over about 6 months. This allows your child’s immune system to build up a gradual tolerance to peanut protein. This type of treatment is called oral immunotherapy.
Oral immunotherapy for peanut allergy is not really new. Some allergists have been treating children with small doses of peanut flower. This treatment works like Palforzia, gradually increasing the dose until tolerance kicks in. But the dose is not standardized and there are no approved guidelines. Palforzia will be the first approved drug with guidelines for treatment.
In the clinical trial that the approval was based on – published in The New England Journal of Medicine – 67 percent of children were able to tolerate the equivalent of two whole peanuts without an allergic reaction after about 6 months of treatment. Before treatment started, these children were unable to tolerate one tenth of a peanut.
Not a Cure
Palforzia will not be a cure for peanut allergy. It should reduce severe reactions and reduce the risk of anaphylaxis significantly. Children will still have to carry their EpiPen and avoid peanuts.
Treatment will need to be started at a doctor’s office. Every time there is a dose increase it will need to be done at the office, where a severe reaction can be managed. Daily treatment also has to continue indefinitely.
There may also be some mild allergic reactions during early treatment. Despite these drawbacks, the peace of mind that comes with a very reduced risk of a life-threatening reaction to accidental peanut exposure should make life a lot easier for many families. Quality of life should improve.
A First Step to a Cure?
For many families, Palforzia will be a big relief, but it may be old news within a few years. New peanut allergy treatments are in the clinical trial pipeline that may prove to be better. One treatment combines oral immunotherapy with a man-made antibody called a biologic. In early trials this treatment seems to be able to achieve sustained unresponsiveness. That means a long-term change in the immune system that will allow people with peanut allergy to be free of drugs and an EpiPen. That could be the next step towards a cure for the most dangerous food allergy.