by Marcin Gornsiewicz, M.D.
Dr. Marek Pienkowski says he is the only allergist in Tennessee practicing a game-changing countermeasure against peanut allergies: peanut desensitization, a process that attempts to minimize the immune system’s violent reaction to peanut allergens.
“The prevalence and intensity of allergic reactions by people with peanut allergies is currently increasing,” Pienkowski said. “About 71 percent of the allergic reactions experienced by children are moderately severe, meaning they require epinephrine or a trip to the emergency room.”Avoidance is typically considered the best method of living with a peanut allergy. However, incidental exposure still accounts annually for 12 percent of the allergic reactions by people with peanut allergies. This has led allergists to seek out a more progressive approach to the problem.
The procedure Pienkowski practices, desensitization, gradually accustoms his patients’ immune systems to the presence of peanut proteins. During the initial phase, called the build-up phase, the physician administers small dosages of peanut proteins, starting with a minute dose of approximately 0.1 milligrams and gradually increasing every 30 minutes. The process continues until the patient has ingested 50 milligrams worth of peanut proteins. The initial phase takes about 6 to 8 hours to complete.
After the build-up phase, patients are sent home and given small daily doses of peanut allergens in capsules. Patients return to the clinic periodically so their condition can be evaluated. The dosage is increased every two weeks until the subject has eaten up to 300 milligrams of peanut proteins. This process takes about six months. “Once a peanut allergy sufferer has eaten 300 milligrams of peanut proteins, they generally react well to incidental exposures,” Pienkowski said. Then the patient enters the maintenance phase and, depending on the patient’s tolerance, they will ingest a grand total of 4,000 milligrams of peanut proteins. “Four thousand milligrams is about the equivalent of a dozen peanuts,” Pienkowski said. The process Pienkowski is using has an estimated 70 percent success rate. Most of the patients who undergo this procedure can tolerate an incidental exposure to peanuts.
It’s clear that we need to find a new method of treating peanut allergies, preferably one that makes patients more resistant to peanut allergens.
Approximately 5 percent of children suffer from peanut allergies. In a school setting, complete avoidance is generally difficult to accomplish. The practice can also isolate children, separating them from their friends during lunch or snack time. “Children with peanut allergies are typically told to eat lunch in an isolated area and that tends to ostracize them from their peers,” Pienkowski said. “It’s also hard to isolate yourself from these allergens. I had a girl come into my clinic with a peanut reaction because she had kissed her boyfriend recently after he ate a peanut product.” These problems emphasize the need to confront the problem at its source.
Pienkowski is attempting to establish a dialogue with local elementary schools, familiarizing them with the procedure he’s offering. “The people in the school systems engaged in this process are mainly nurses,” Pienkowski said. “I delivered a lecture in Sullivan County on peanut allergies in early September, but it seems like there isn’t as much interest in this problem as one would expect.”
Recently, doctors have found that the customary treatments for anaphylactic shock, epinephrine in particular, are becoming increasingly ineffective. “There was a physician in California whose daughter went into anaphylactic shock and died in his arms despite receiving several shots of epinephrine from an Epipen,” Pienkowski said. “It’s clear that we need to find a new method of treating peanut allergies, preferably one that makes patients more resistant to peanut allergens.”