One in 13 children in the U.S. have a food allergy, and peanut (1 in 50)
is one of the most common and can also be the most dangerous. Accidental
exposures are frequent – 1 in 4 affected children end up in an ER
The FDA recently approved Palfzoria, the first treatment for peanut allergies
in children.It is not a cure, but a big step forward for those families
who live in fear of an accidental exposure to peanuts. It’s important
that peanut-allergic kids still avoid them as usual and still carry an
EpiPen at all times.
Many families dealing with peanut allergies have to structure their everyday
life around minimizing exposure -- everything from eating out, traveling,
and socializing have to be carefully considered. For these families, the
drug may act as a sort of security blanket, giving an added layer of protection
and sense of freedom. For others, its side effects may not be worth it.
Approved for ages 4-17, the drug is made with a peanut powder and given
daily in tiny doses that gradually increase over about six months. (By
then, the dose is equal to about one peanut.) The powder is typically
mixed in to a smoothie or applesauce. The first and each increased dose,
which is every few weeks, is given under clinician supervision, as there
is a chance of a severe allergic reaction.
This type of oral immunotherapy -- swallowing an allergen to build tolerance
-- trains kids’ bodies to better tolerate peanuts, so an accidental
exposure at school or a birthday party is less likely to cause a serious,
or even fatal, reaction.
In a study of nearly 500 children, two-thirds who received Palforzia could
eat the equivalent of two peanuts — and some, three or four —
compared to just 4 percent of patients given a placebo drug. But, most
also had side effects, from mild reactions like hives and stomach aches
to severe reactions (9 percent). A fifth dropped out of study altogether.
Families need to discuss with their child’s doctor if this type
of treatment makes sense for their child, as there can a pretty big trade-off.
Researchers are unclear on how long a patient has to stay on the drug.
In other words, if you stop taking it, you may lose that protection.
This new drug is also a big step in the future of food allergy treatments.
While allergy shots have been used for a long time, this type of oral
immunotherapy is relatively new. Tests using the same process are in the
works with eggs, milk and tree nuts. Researchers are also working on a
skin patch for peanut allergy.
Rachael Kermis, MD
Baton Rouge General Physicians