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Peanut Allergy Treatment: Peanut (SLIT) Drops
In predisposed people, allergies can start very early in life. Food allergy is the first allergy to develop due to immaturity of the digestive tract. Food allergies are very common in the first three years of life with up to 8% of children being affected.
While many of food allergies start relatively early, they also disappear. Up to 80% of infants with an egg allergy, are able to consume eggs by five years of age. Also, about 85% of children with cows milk allergy, can tolerate milk by three years of age. Although previously it was thought that peanut allergy is a permanent allergy, now we know that about 20% of patients outgrow it. Although peanut allergy is not the most common food allergy, it is the most common food, which is associated with severe reactions.
In several studies, peanuts gave the highest percentage of severe reactions upon a challenge. This occurred mostly in patients of 15 years of age and older. This strongly suggests that clinicians should seize the opportunity, when the diagnosis of peanut allergy is most likely to be made, and when food challenges are least likely to produce severe reactions, in children younger than four years, to confirm the diagnosis by challenge testing, before a lifetime of strict avoidance is prescribed.
The risk of severe allergic reaction upon the challenge can be reduced by careful history taking as well as allergy testing for peanuts and obtaining IGE levels to peanut allergen. Lower levels of IGE antibody to peanuts are helpful to determine patients who will less likely have severe reaction during the challenge.
At the point when the diagnosis of allergy to peanut is made and confirmed, the next step is to establish subsequent approach to this problem. Until recently we had basically one available approach, that is strict avoidance of peanut ingestion. However within the last few years, new development to treatment of food allergies emerged. This was based on the knowledge regarding inhaled allergies.
Since 1912, curative treatment of immunotherapy, so called “allergy shots” was available. Many studies showed improvement in symptoms of allergic rhinitis and asthma after administration of a series of injections containing allergens to which patients were sensitized. That brought interest in a similar approach to treatment of food allergies, such as peanut allergy, milk allergy, and egg allergy.
However, those attempts were unsuccessful. This was caused by a very high rate of adverse reactions, including severe anaphylaxis. Then the approach changed slightly to try administering the allergen in a more natural oral route. However, those attempts also were unsuccessful with not acceptable levels of severe allergic reactions.
Early oral attempts to immunotherapy were implemented using dilutions of cooked egg, milk or grounded peanuts. In the last few years, those attempts became more refined. Several studies involving sublingual therapy (SLIT) were conducted. In those trials, an aqueous solution of the allergen is being administered under the tongue of the patient, and subsequently either spit or swallowed.
Because mucous membranes in the mouth are very vascular, absorption of the allergen is very rapid. (For example, that is why some medications are administered in the form of mouth dissolvable and absorbed medications, such as Nitroglycerin for example). Because of this route of administration, side effects are very minimal with mostly involving oral areas such as itching, tingling, and those uncommonly required treatment with antihistamines or slowing the rate of progression of immunotherapy. There were no described systemic reactions such as anaphylaxis.
Peanut SLIT immunotherapy starts in the office with a really small dose of the allergen, equivalent of about .25 micrograms, and this dose is continued in the patient's home for a period of five weeks. Subsequently, the dose is escalated in the office every 6 to 8 weeks. After a while, the patient is able to tolerate the equivalent of a couple of peanuts. This can provide a significant safety cushion for accidental exposure to peanut ingestion in real life. Similar desensitization can be performed with egg and milk.
Allergy & Asthma Center of Rochester has been using sublingual immunotherapy for inhaled allergens for over three years. We also have been pioneering peanut desensitization in Michigan, having several patients undergoing this treatment. Please contact us today to start peanut SLIT at 248 - 651 - 0606.
The information provided in this Web site is not intended to replace consultation with your physician.
Entire contents © 2016 Ulrich O. Ringwald, M.D. Reproduction in whole or in part without
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