A new pilot study testing “rapid” peanut desensitization has resulted in 92 percent of subjects being able to tolerate 160 to 400 times more peanut than they could at the study’s outset.
Published in the Journal of Allergy and Clinical Immunology, the study’s aim was to test whether combining the asthma drug omalizumab – known by the brand name Xolair – with controlled peanut exposures would speed up and/or improve the process of oral immunotherapy or OIT. In OIT, the patient consumes tiny, then increasing amounts of an allergen with the aim of becoming desensitized to it.
Though the study was small, the results were impressive. The 13 participants, all highly allergic to peanut, were pre-treated with Xolair for three months. Then, after just one day of OIT treatment, all of them were able to tolerate 992 mg of peanut flour. After an average of eight weeks, 12 out of 13 patients were able to tolerate 4,000 mg of peanut flour, or roughly 10 peanuts. At this point, treatment with Xolair stopped, but the subjects continued to eat 4,000 mg of peanut per day.
Six months later, they were all able to tolerate about 20 peanuts without reacting. Depending on the patient, this represented an increase of 160 to 400 times what they could tolerate when the study began.
By using the combination of Xolair and OIT, the patients were able to become desensitized much more rapidly than previous studies have shown. For example, a previous peanut desensitization study that didn’t use Xolair found that it took an average of 30 weeks for subjects to reach doses of 500 to 2,000 mg of peanut. With Xolair incorporated into the treatment method, not only was the amount of time required cut by more than half, but the amount of peanut tolerated was more than doubled.
Xolair works by preventing IgE antibodies (the antibodies involved in allergy) from attaching to mast cells in the body, which is an important step in the process that leads to allergic reaction. Xolair is typically used for allergic asthma.
However, there were some drawbacks to the treatment: 2 percent of peanut ingestions were associated with reactions. While most of these were mild and easily controlled with antihistamines, three patients had reactions that required epinephrine. However, considering how quickly the peanut doses were increased, and that the patients were a high-risk group to begin with, the study authors note that overall the reactions were “surprisingly mild”.
The next step for this research is to conduct a much larger study. If results are similar, this could represent a giant step forward towards a food allergy treatment.
This is terrifying to think about. My daughter could turn her back for one instant and someone could sneak something into her food or drink and next thing you know she'll be in anaphylactic shock. We need to bring more awareness to this life-threatening food allergy so that teens are aware that their "prank" could result in a trip to the emergency room ~~ or worse.
This story hits so close to home because my own is 13 years old and is also anaphylactic to peanuts and tree nuts. This could have easily been my precious daughter. My heart goes out to this family.
CARMICHAEL, Calif. - It was supposed to be the last day of a family vacation at a popular summer camp, but it ended in tragedy for one Sacramento-area family when a loved one had a fatal allergic reaction.
Relatives says 13-year-old Natalie Giorgi died from a severe allergic reaction to peanut butter while she was attending Camp Sacramento off Highway 50 in El Dorado County.
Now, the family says it really wants to get the message out about how dangerous and deadly food allergies can be.
Giorgi was very careful about what she ate and always made sure her food did not have nuts, according to family and friends.
But she had unknowingly eaten a Rice Krispies-type snack made with peanut butter.
On Friday night, the final night of camp, there was entertainment and refreshments. A dessert tray was put out in a dark area of the camp.
Giorgi reached for a treat and took a bite out of it. She knew something wasn't right, spit it out and told her mother, who also tasted the treat.
They later realized it contained peanut butter. Natalie felt fine for about 20 minutes, but then began vomiting, had trouble breathing and went into cardiac arrest.
3 epinephrine pens were used but they could not help save the girl, according a family friend.
Giorgi was taken to the hospital by ambulance where she was pronounced dead.
Family and friends are coming to terms with Giorgi's sudden death.
"She took every care. She knew the situation, that's (connected to) the allergy she had. And they were really on it all the time," said Pastor Michael Kiernan of Our Lady of the Assumption Church in Carmichael.
A special vigil was held at the church for Giorgi Sunday evening.
Some say they'll remember her smile and laughter. Others will remember how much she loved to draw and how much she loved her friends.
Her family said Giorgi wanted to become a neonatologist, to care for premature babies like her and her twin sister.
Meanwhile, family members extended their gratitude to the paramedics, firefighters and everyone who tried to help save Natalie.
They offered the following written statement:
"While our hearts are breaking over the tragic loss of our beautiful daughter Natalie, it is our hope that others can learn from this and realize that nut and food allergies are life threatening. Caution and care for those inflicted should always be supported and taken."
An allergist said food allergies and nut allergies have tripled in the past decade. He says more people need to understand the dangers of food allergies and that they can sometimes be fatal.
Q. I’ve read differing views on whether it would be safe for a nut-allergic person to eat baked goods with coconut or coconut oil. What’s your view on coconut?
Dr. Scott Sicherer: Despite its name, coconut is not actually a nut, but a fruit. Regardless, the Food and Drug Administration considers it a tree nut, which is why it’s included in U.S. labeling laws.
It is difficult to assess the risk of coconut allergy among those with tree-nut allergies because allergic individuals may become wary of coconut and avoid it. Still, coconut allergy appears rare, and uncommon even among those with tree-nut allergies.
In a national registry of 5,149 people with peanut or tree-nut allergies, only four self-reported an allergy to coconut. And a more recent study of 40 children with positive tests or known allergy to peanuts or tree nuts showed no increased risks for having positive tests or allergy to coconut.
Your allergist would consider your personal allergy history in deciding whether to add coconut to your diet or to perform any testing. However, be aware that tests are often positive to coconut in people who could actually tolerate it, so a physician-supervised feeding test may be necessary for a conclusive answer.
When it comes to coconut oil, there is almost no medical literature on allergic reactions to it, which may reflect the likelihood that the processed forms of coconut oil contain little or no protein, although this has not been studied. Still, for those with verified coconut allergy, avoidance of coconut oil should be considered because it may have residual protein.
Finally, it’s important to note that people with peanut or tree-nut allergies who choose to eat coconut must be diligent to avoid cross-contact with avoided tree nuts or peanut.
Dr. Scott Sicherer is Chief of the Division of Allergy and Immunology of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai in New York. Together with Dr. Hemant Sharma, he writes “The Food Allergy Experts” column in the American Edition ofAllergic Living magazine. Questions submitted below will be considered for answer in the magazine.