But treatments are advancing to make them more manageable, too.
For decades, the common peanut—staple of sandwiches, sauces and snack packs—has struck fear into parents of children with peanut allergies. But new therapies and some myth-busting are helping abate that anxiety, local allergy specialists say.
Peanut allergies affect about 1.25 million children in the United States, and that number is rising, according to the American College of Allergy, Asthma and Immunology. A 2017 study found such allergy cases have risen by more than 20 percent since 2010.
One in five children eventually outgrows the allergy, but for the rest, there is no cure. Children and parents have to go to great lengths to avoid exposure and prevent serious and potentially life-threatening reactions. That takes a toll on families, says Dr. Andrew Dang, an allergy and immunology specialist at Premier Allergy & Asthma. “Parents are afraid the next thing their 5-year-old eats may kill them,” he says. “It has a huge impact on their social lives and living with misunderstanding. You fear most what you don’t understand.”
“There are real risks to worry about with food handlers and in restaurants and schools,” says Dr. David Stukus, director of the Food Allergy Treatment Center at Nationwide Children’s Hospital. “Families want to do something.”Stay up to date with the region’s thriving business scene. Subscribe to Columbus CEO’s weekly newsletter.
While the rule has been to strictly avoid peanuts until children are 3 to 5 years old, recent studies have suggested that exposing children to peanut protein as early as 4 to 6 months of age is a better path.
In a landmark study called LEAP (Learning Early About Peanut Allergy), high-risk infants who were exposed to peanut protein at age 6 months were about 80 percent less likely to develop allergies at ages 1 to 5, Dang says. Experts believe immunologic “memories” made in infancy have a protective effect going forward, he says.
That study and other information helped change treatment guidelines for physicians. Exposing babies to peanuts rather than completely avoiding them “is a complete shift in mindset—the idea that we may be able to prevent these cases from occurring,” Stukus says. “I’ve changed my views.”
Some Columbus allergists are using the early exposure approach, which involves gradually exposing children to larger amounts of peanut so they may eventually safely consume a small amount without fear.
In January, the U.S. Food & Drug Administration approved a drug to help lessen or prevent severe reactions that may occur within seconds of accidental exposure to peanuts. The drug, known as Palforzia, is started in children 4 to 17 years old. It comes in a capsule containing a product made from peanut that is mixed into a small amount of semisolid food such as applesauce. Capsules are color-coded to signify dosages, which increase with time. Children still cannot consume peanuts and must carry injectable epinephrine with them.
As with other oral immunotherapy, children must be observed in a health care setting after consuming the product and return for follow-up doses.
Other treatments on the immediate horizon include a patch worn on the skin and a treatment that is dissolved under the tongue. Both work on the same principle of gradual exposure to the allergen and carry pros and cons. For example, capsules may allow more precise dosing, while patches or sublingual delivery methods carry fewer side effects but don’t deliver the same dose as orally administered medications, Dang and Stukus say.
Stukus says oral immunotherapy “can be a life-changing experience for many families” who’ve lived in a state of fear for years. Parent advocacy has spurred changes in school cafeterias, classrooms and even restaurants. “Ten years ago, these kids and their parents were pioneers in their school districts. As that has changed, so has public awareness,” Stukus says.
It’s not just at school but at restaurants and other communal eating places where parents express concern. Asking about ingredients “absolutely is a trend,” says John Barker, president and CEO of the Ohio Restaurant Association. Most menus at larger restaurants carry warnings that items may have been in contact with peanuts prior to being served, and chefs and management should be able to answer questions about cross-contamination. “Being careful about your sourcing is what culinary is all about. It’s the right thing to do,” Barker says.
More restaurants offer nuts and salad dressing in separate packaged containers to avoid accidental exposure, he says, but “to some extent, it is the consumer’s personal responsibility ... to understand the inherent risk.”
With the rise in online ordering and food delivery, the picture is murkier, Barker says. “If you can’t determine online whether (a menu item) contains peanut, you probably shouldn’t order it.”
Laurie Allen is a freelance writer for Columbus CEO.