by Marek M. Pienkowski, M.D., Ph.D.
Severe reactions to peanuts are increasing in frequency and now affect over 1% of the general public. The onset of these reactions happens in early childhood, as early as 12 months or younger, and reactions tend to get progressively worse. Unfortunately, for the majority of individuals, the reactivities to peanuts continue to persist through their life. Over three quarters of individuals with peanut reactions have them because of inadvertent exposure to peanuts, emphasizing great difficulties to just stay on a peanut-free diet.
Recently, there was a tragic event in California where a 13-year-old daughter of a physician died in his arms because of a peanut allergy anaphylactic reaction, despite all treatment. This, of course, has brought a great deal of attention to the issue of peanut allergies and the dangers and that the current management measures may not always prove effective. Children or adults with a history of laryngeal swelling, hives and loss of consciousness (anaphylaxis) to peanuts, are advised to carry with them at all times an Epi pen® or some other form of injectable epinephrine to use in case of reaction. This young lady in California died despite the use of her epinephrine.
Several years ago, there was an unfortunate death of a young lady in Tennessee due to accidental ingestion of a peanut, resulting in anaphylaxis. This resulted in significant legislative efforts to regulate the management of foods in school settings, called the “Food Allergy Action Plan.” This plan would outline that in the case of reactions like swelling of the throat, shortness of breath, coughing, hives and dizziness, the child should receive epinephrine, Benadryl®, etc. However, we are learning that these measures may not always be sufficient to protect children in the case of severe reactions, like the heartbreaking example of the young 13-year-old in California.
“…in the field of clinical immunology…it has been shown that patients who are allergic to peanuts can be effectively desensitized to the peanut allergens.”
It is important to recognize that severe anaphylaxis to peanuts can occur with only a trace amount of exposure to the peanut allergens. Therefore, this doesn’t just happen when the child eats a bag of peanuts, but rather enough from one simple bite of something that contains trace amounts of peanut allergens. Furthermore, peanut allergens are relatively resistant to heat processing, so some people may react even to a well-cooked product with trace amount of peanut allergens, and possibly even peanut oil.
What is even more shocking to learn is that in recent studies, it was shown that patients allergic to peanuts developed allergic reactions after being transfused with the blood of someone who had recently eaten peanuts.
There are certain factors which predispose an individual for a severe anaphylactic reaction, which include asthma or other concomitant allergies, as well as the use of certain medications like beta blockers and ace inhibitors (generally used for the treatment of high blood pressure or even migraine headaches in children).
Fortunately, there has been recent progress in the field of clinical immunology, both in the United States and in Europe. It has been shown that patients who are allergic to peanuts can be effectively desensitized to the peanut allergens. Desensitization to peanuts is not the same as immunization. It does not create permanent and total protection from the peanut allergens. The allergic individual would have to, after desensitization, take the equivalent of one-half a peanut a day (in the form of a capsule) to continue to be desensitized. Those individuals would not be able to “overdo it” on peanuts, meaning they will never be able to enjoy eating a large bag of peanuts. However, incidental intake of peanut or peanut traces is highly unlikely to ever cause anaphylactic reaction for them. This desensitization process takes approximately four to six hours and can only be performed by specialized physicians in the field of allergy and immunology.
The desensitization process should not be considered for the patient with just an average reaction to peanuts, but only for those with a history of severe reactions who, for a variety of reasons, cannot avoid incidental exposure to these allergens. This risk is especially high in children who may be developmentally disabled or others who, because of their profession, may come in contact with traces of peanut allergens. We have learned, unfortunately, through the tragic example of the young girl in California, that children with a history of severe anaphylaxis to peanuts should seriously be considered for this desensitization process, as it could save their life.
Marek M. Pienkowski, M.D., Ph.D. was educated in clinical immunology at Johns Hopkins School of Medicine in Baltimore and internal medicine at Henry Ford Hospital in Detroit. Dr. Pienkowski has been serving patients in East Tennessee with allergies, asthma and immunological disorders for nearly 30 years through Allergic Diseases, Asthma & Immunology Clinic, P.C.. Active both in biomedical research and academia, he has published more than sixty scientific papers as well as two books.