Dr. Wasserman: Dallas clinic tries new strategy for dealing with kids’ allergies; The Dallas Morning News, 2015

Dallas clinic tries new strategy for dealing with kids’ allergies
By JASMINE AGUILERA, jaguilera@dallasnews.com, 01 March 2015

Epinephrine pens sit at the ready in the Mathis home in North Dallas. So far, son Ben has been able to eat peanuts without a reaction after treatment to develop a tolerance.

Ben Mathis is 6, and for the first time in his life, he can eat peanuts without having a severe allergic reaction. For the last year, as part of a treatment at a local clinic, he consumed peanuts in small doses to develop a tolerance.

That’s similar to a tactic used in a recent study suggesting that many peanut allergies can be prevented by feeding young children food containing peanuts beginning in infancy, rather than avoiding such foods.

Ben’s father, Jim Mathis, remains cautious about the new research but says the results are worth the benefit of the doubt, considering the progress his son has made by slowly consuming larger and larger amounts of peanuts to build up immunity.

“I only wish we had started … [Ben’s] therapy earlier on in his life,” Mathis said. “It would have saved our family so much hardship.”

The study, conducted by the Immune Tolerance Network, an international clinical research consortium, found that infants who are considered at high risk of developing peanut allergy are less likely to become allergic to peanuts if they consume the food as infants.

An editorial published last week in The New England Journal of Medicine along with the study, called the results “so compelling” and the rise of peanut allergies “so alarming” that guidelines for how to feed infants at risk of peanut allergies should be revised soon.

Infants 4-11 months of age were fed foods containing peanuts, and others were denied such food. Researchers found that by age 5, there was a more than 80 percent reduction of peanut allergy in the children who began consuming the nut at an early age, compared with those who avoided the food.

Ben began oral immunotherapy at age 5, and recently completed his last therapy session at DallasAllergyImmunology, during which he was able to eat 30 peanuts without having a reaction.

Dr. Richard Wasserman, a pediatric allergist at the clinic, is excited about the study. He said he will begin using its findings immediately. “It’s not the first study, it’s just the best study,” he said. “Now we can change the advice that we give to parents of newborn children and potentially change the lives of so many.”

According to a 2010 study in The Journal of Allergy and Clinical Immunology, the percentage of U.S. children allergic to peanuts has more than tripled since 1997, from 0.4 percent to 1.4 percent in 2008.

Allergy to peanuts and tree nuts is the leading cause of fatal allergic reactions in the U.S., according to the study.

In 2000, the American Academy of Pediatrics recommended that peanuts be withheld from children at risk of developing allergies until they are 3. In 2008, the academy revised its position, saying there was no conclusive evidence that avoidance of certain foods beyond 4 to 6 months of age helped prevent allergies.

Pediatricians caution that parents should not feed whole peanuts to infants because of the choking risk, but rather peanut butter or other foods.

The academy will continue to work on recommendations based on the new research, according to Dr. Scott Sicherer, a New York physician specializing in pediatrics, allergy and immunology. In order for doctors to safely repeat the study, they can do skin-testing, supervise feedings and continue to instruct families on how to safely incorporate peanuts into children’s diet, he said.

Wasserman said it is important to note that the only children who were studied in the Immune Tolerance Network research were at high risk of developing a peanut allergy. These are children who develop severe eczema or have an egg allergy. Infants who fall under this category are the only ones who should be considered for early consumption of peanuts.

Dr. John Bird, director of the Food Allergy Center at Children’s Medical Center Dallas, said that the study’s findings are exciting but that further research is needed to provide more specific care for patients.

He also said it is important for parents to understand that introducing peanuts to their newborn is not a guarantee that the child won’t develop a peanut allergy — it only decreases the odds.

Parents’ receptiveness to the research “depends on how the allergist communicates it to the parent,” Bird said. “The parent has to understand that if your child is in the higher risk group and if that kid may develop a peanut allergy, then this is certainly something that should be tried.”

Mathis said he will leave it up to the doctors to decide if introducing infants to peanuts is a good idea. In the meantime, the Dallas parent says he enjoys being able to sleep through the night without worrying that his son might be exposed to something dangerous.

He said that he and Ben’s mom used to feel bad. “We were those overbearing parents who examined every piece of Halloween candy and never let him eat anything the other kids brought to class,” he said. “Even at school — if they claimed to be nut-free — he’d sometimes come home with some peanut M&M’s.”

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