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Peanut allergy perplexes, but there's hope on the horizon

A peanut butter and jelly sandwich in the lunch box may not be such a good idea for some kids.

My 8-year-old daughter has a peanut allergy. When I send her off to school every morning, not only am I worried about school stuff: Did she do her homework? Is she doing okay in reading and math? Is there any friend drama? I'm also worried about her food allergy: Does she know how to avoid peanuts at school? Will the school know what to do if she has a severe reaction? Does the school have her EpiPens?

Peanut allergy is one of the most common food allergies, affecting about 400,000 school-aged children in the United States, and it is seen more often in children with other allergic diseases such as asthma, hay fever or eczema. That number has risen exponentially over the past two decades. The reason for this is not entirely known. Some state the hygiene hypothesis: Perhaps we live in too clean of an environment so our immune system doesn't need to fight infectious agents and instead reacts to foods and other harmless allergens. Others postulate that genetically modified foods are a factor. What we do know is that in food-allergic children, the immune system goes haywire and reacts to the proteins found in peanuts. Interestingly, roasted peanuts are more allergenic than boiled peanuts because roasting alters the peanut protein.

Peanut allergy symptoms can range from itchy mouth, lip or tongue swelling, hives, shortness of breath, wheezing, vomiting and abdominal pain to a severe reaction (or anaphylaxis) that can be life-threatening. Reactions typically occur within minutes after a peanut has been ingested. If you suspect you or your child has a peanut allergy, speak to an allergist. Diagnosis can be established through a skin or blood test.

Currently, the only treatment for peanut allergy is to avoid peanuts (read food labels, be vigilant in avoiding peanuts at restaurants, parties, school, sporting events, field trips, vacations, etc.) and carry an epinephrine auto-injector in case of a life-threatening emergency. On Nov. 13, 2013, President Barack Obama signed the School Access to Emergency Epinephrine Act bill, which offers a financial incentive to states if schools stockpile epinephrine. During the signing, Obama stated that the bill "will save children's lives" and revealed that his daughter Malia has a peanut allergy.

There is some hope on the horizon for peanut allergy sufferers. Much research is being done to find a treatment. Most recently, a large clinical trial in the UK revealed that oral immunotherapy, wherein patients with a peanut allergy are given small, increasing amounts of peanut powder over time, allowed patients to tolerate peanuts without severe reactions. There are trials in the United States that show similar promise. People who undergo oral immunotherapy for a peanut allergy would likely need to eat some peanuts daily to maintain that tolerance. Researchers at the Stanford University School of Medicine have found that the DNA in certain peanut-allergic patients' immune cells (T-cells) gets altered in a good way after oral immunotherapy. A blood test to assess this genetic change can help identify patients in whom oral immunotherapy has worked.

Researchers are working feverishly to pin down more information about oral immunotherapy, including how long protection might last, and other efforts at the community and legislative levels are under way to give families with peanut allergies some peace of mind. In the meantime, just think twice before you pack that peanut butter and jelly sandwich in the lunch box.

Dr. Mona V. Mangat and Dr. Ami K. Degala are board-certified allergists and immunologists at Bay Area Allergy & Asthma in St. Petersburg. Find them at bayallergy.com.

Peanut allergy perplexes, but there's hope on the horizon 04/03/14 [Last modified: Thursday, April 3, 2014 5:22pm]
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