Dr. Factor: Nut Allergies: Desensitizing Technique Can Help, 90% success rate; CT, 2015

Progress On Nut Allergies: Desensitizing Technique Can Help, Hartford Courant, JOSEPH A. O’BRIEN JR., August 29,2015 

Arnold Schwarzenegger’s catchphrase from the 1984 film “The Terminator” — “I’ll Be Back” — might just be on the tip of Mr. Peanut’s tongue these days.

In recent years, Mr. P, the iconic monocled mascot of the Planters Peanut Co., has been persona non grata in school districts across the state as educators and health officials adopted measures to protect the health and safety of the growing number of students with potentially fatal food allergies.

But while the first line of defense for those with known food allergies has been avoidance, researchers also are looking for ways to better manage allergies with the hope being that one day they can be eliminated all together.

Technically there is no “cure” for allergies as yet, but there are signs that they can be tamed in most people.

For the past five years, Dr. Jeffrey M. Factor, an allergist who heads the New England Food Allergy Treatment Center in West Hartford, has used oral immunotherapy to treat patients with known peanut allergies.

“We have treated more than 600 patients with peanut allergies … and have had over a 90 percent success rate,” Factor said.

In the parlance of allergists, foods that can trigger an allergic reaction are known as allergens. There are more than 100 food allergens, but the Big Eight are milk, eggs, fish, shellfish, tree nuts, peanuts (actually a legume), wheat and soybeans. An allergic reaction is an abnormal response to an allergen by the body’s immune system. These reactions can range from an annoying rash, itching and a runny nose to life-threatening anaphylaxis, a severe allergic reaction that causes swelling in the throat that can lead to death by suffocation in minutes.

Emergency treatment of anaphylaxis involves administering an intramuscular injection of epinephrine, a chemical that quickly reverses the effects of an allergic reaction caused by foods, insect bites or stings, and some medications, including penicillin. The state Department of Education has developed guidelines for local school districts to follow when developing plans for managing life-threatening food allergies involving student.

As strange as it may sound, closely monitored patients undergoing oral immunotherapy for a peanut allergy initially ingest trace amounts of the allergen, peanut protein, that triggers their immune system — the idea being that, over time, their body will become desensitized to the allergen and no longer have an allergic reaction to it. And it seems to work.

This method of treatment was devised by doctors at Duke University Medical Center and Arkansas Children’s Hospital, who reported the findings of their small study to the American Academy of Asthma and Immunology in 2009. In January 2014, a larger study involving 99 children at Addenbrooke’s Hospital in Cambridge, England, reported results similar to Factor’s.

Factor said patients are initially given a minuscule amount of peanut protein in the form of peanut flour to gauge how their body reacts or doesn’t react to it. If they tolerate that amount with no adverse reaction, the amount of allergen can be increased slowly over time in a process known as desensitization.

In terms of the treatment, success is defined as a patient eating three peanuts without an adverse reaction, Factor said. “We target them to eat as many as 10 a day as a maintenance dose,” he said.

That his patients, who have ranged in age from 4 years old to early adulthood, are able to eat even half a peanut is significant considering that otherwise they would have faced the real possibility of an anaphylactic reaction that would guarantee a trip to a hospital emergency department. Doctors at the West Hartford allergy center have worked with children with allergies to tree nuts, milk and eggs.

When it comes to peanut allergies, until recently, “the only options had been epinephrine [injection] or avoid the food,” Factor said.

Allergen avoidance and training in the use of an epinephrine injector are the pillars of the response by school systems across the state and the country to what one study showed as a tripling of the rate of peanut allergies among 18-year-olds in just a decade. Allergy researchers at Mount Sinai Hospital in New York found the rate of reported peanut allergies in the United States had risen from 0.4 percent in 1997 to 1.4 percent by 2007. A similar increase was found in the rate for tree nuts.

“It appears that food allergies have been on the rise in the past 15 to 20 years,” Factor said.

Avoidance, epinephrine and desensitization don’t address the root cause of the sharp increase in food allergies, which are more prevalent in people with a genetic predisposition for them and other allergy-related afflictions, including asthma.

Researchers have found a number of possible contributors. Among them may be the advice from the American Academy of Pediatrics in 2000 that parents wait until their children were at least 3 years old to introduce peanuts (not whole) to their diet and 2 years old for eggs.

At the time, several studies had found an apparent link between early exposure to peanut protein and the development of peanut allergies in infants. It was also suggested that women with a family history of allergies not eat peanuts if they were pregnant or planned to nurse their babies.

In 2008, the academy backed away from that guideline as evidence mounted that delaying introduction of peanut protein to a child’s diet not only did not slow the increase in peanut allergies but may have been making matters worse.

According to the federal Centers for Disease Control and Prevention, the prevalence of food allergies among children up to age 17 was 5.1 percent in 2009-2011, up from 3.4 percent in 1997-1999. Allergic reactions to food are the most common cause of anaphylaxis in community health settings.

Food Allergy Research and Education, a non-profit, research-support and food-allergy information source, estimates that 15 million people in the United States, a number that includes 6 million children, have a food allergy. The agency was formed in 2012 from the merger of the Food Allergy & Anaphylaxis Network and Food Allergy Initiative. A similar education and research-support effort, End Allergies Together Inc., was launched in Fairfield in 2013 by Elise Bates and Kimberly Hall, whose own children have multiple food allergies involving eggs, dairy, cashews, almonds, pine nuts, kiwi and raw fruits and vegetables and peanuts.

“We have been waiting too long” to introduce peanuts to the diet, Factor said, noting that in Israel, where infants snack on Bamba, a peanut-flavored puffed corn, peanut allergies are almost non-existent. Bamba would not be good, however, for someone who is already allergic to peanuts.

A prophylactic dose of Bamba might do wonders when it comes to peanut allergy prevention, but it could sicken and possibly kill someone who is already allergic to its ingredients.

Food, however, is just one in a constellation of allergy triggers that, when combined with our genetic predispositions, bring out the drama queen in our immune systems, causing them to overreact to the point of death.

Most cases of asthma, a chronic, inflammatory disease that causes periodic swelling and spasms of the body’s airways (nose, throat, trachea, bronchioles and lungs) are allergen-inspired. The triggers most cited by the American College of Allergy, Asthma and Immunology include dust mites, animal dander, roach droppings, pollen and mold. The list, however, also includes smoke, chemicals and — believe it or not — exercise.

The American Asthma Foundation estimates that 25 million people in the United States, including one in nine children, have some form of asthma that accounts for 3,500 deaths annually.

Judging from the numbers of people dealing with overactive immune systems, Factor won’t run out of patients any time soon. He says that of all that he has done, he finds his work with peanut-allergy sufferers at the food-allergy center has been the most satisfying.

Many young patients and their parents have arrived at the center nearly “paralyzed by fear” that even a chance encounter with even a piece of a peanut or a peanut by-product could end in death. Through his treatment regimen, Factor and his medical team have been able to desensitize 90 percent of the peanut allergy sufferers who have come through the door.

“It puts a lot of parents and patients at ease,” he said. “It’s one of the most rewarding things I’ve done since I have been an allergist in the past 25 years.”

View article here in the Hartford Courant

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