Advances in Peanut Allergy Treatments

Food allergies affect millions of people worldwide, with a peanut allergy being one of the most common and dangerous allergies.  An allergy is an abnormal autoimmune response to a typically harmless substance, known as the allergen.  While an allergy is an immune response (the immune system reacting to a typically harmless substance), it is not an autoimmune disease (the immune system attacks healthy cells or tissues).

Peanut is one of eight allergens with specific labeling requirements under the Food Allergen Labeling and Consumer Protection Act of 2004.  Under that law, manufacturers of packaged food products that contain peanut as an ingredient must include the word "peanuts" in clear language on the ingredient label.

About 2%, or 1 in every 50, of all children in the United States are allergic to peanuts.  Some of these children outgrow the allergy, but most must avoid peanuts for life.  A 2018 report determined that the prevalence of peanut allergies in the US has tripled over the past 20 years, but the reasons for this trend aren't clearly understood.

Some common peanut allergy symptoms include skin reactions (itching, hives, or eczema flare-ups), gastrointestinal issues (abdominal pain, nausea, vomiting, or diarrhea), respiratory symptoms (nasal congestion, runny nose, sneezing, coughing, or wheezing), and cardiovascular symptoms (drop in blood pressure, lightheadedness, dizziness, or rapid or weak pulse).  Anaphylaxis is a severe and potentially life-threatening allergic reaction that can occur within a few minutes of peanut exposure.  People with possible anaphylaxis reactions from a peanut allergy, or any other allergy, should have an epinephrine auto-injector, commonly called an EpiPen, with them at all times.

While there is no cure for a peanut allergy, there have been some promising treatment advances recently.  For example, in 2020, the Food and Drug Administration (FDA) approved Palforzia, developed by Aimmune Therapeutics, which is a special peanut powder that can protect against severe reactions.  This powder is taken daily in tiny amounts, often mixed in with safe foods, that are gradually increased over months.  Palforzia trains a child's immune system to better tolerate peanuts so that an accidental exposure is less likely to cause a severe reaction.  Nina Nichols, who suffers from a peanut allergy, calls this treatment a "security blanket" and a "life saver."  This treatment is currently approved for children ages 4-17 and is currently being tested for use with toddlers.

There is a new possible treatment on the horizon - a skin patch from France's DBV Technologies called Viaskin.  The daily patch is coated with a very small amount of peanut protein that is absorbed into the skin.  The late-stage trial, which involved more than 200 children ages 1-3 with peanut allergies, found that after wearing the experimental patch for 22 hours a day for one year, 67% were able to tolerate the equivalent of between one and four peanuts.  The study's lead author Dr. Matthew Greenhawt said, "Amazingly, not only did it raise the amount of peanut [tolerance] in these children, but the nature of the reaction also changed.  There was a decrease in the number of severe reactions."  The findings were published in the New England Journal of Medicine.

With both Viaskin and Palforzia, users must still avoid peanuts like they always have; neither is a cure.  

The recent trial results are "very good news for toddlers and their families as the next step toward a future with more treatments for food allergies," said Dr. Alkis Togias of the National Institutes of Health.  Some other promising treatments in study are allergen drops under the tongue (study from University of North Carolina, Chapel Hill) and allergy shots that deliver antibodies to tamp down the inflammatory cascade that follows accidental exposure (study from Stanford University).