Exposing a child with a peanut allergy to a small amount of peanuts over a period of time has long been considered an effective way to lessen the impacts of the allergy, but a recent study has found that oral immunotherapy (OIT) can increase a child’s risk of severe allergic reaction by three times compared to if they were to avoid peanuts altogether.
“We’re not outright saying that this treatment doesn’t work for anyone or that this treatment should be abandoned … but right now this is an experimental treatment,” said Dr. Derek Chu, a fellow in clinical immunology and allergy at McMaster University.
Led by Chu, researchers conducted a meta-analysis of 12 controlled studies of peanut oral immunotherapy. Altogether, the analysis involved more than 1,000 patients between the ages of five and 12.
The results were clear: the frequency of anaphylaxis was 7.1 per cent for those on a placebo or practicing avoidance (which is the practice of avoiding exposure to the allergen at all costs).
For those undergoing a peanut treatment, it rose to 22.2 per cent.
An allergy to peanuts is different from other allergies, according to Chu. It’s thought to be lifelong and it’s often associated with severe allergic reactions.
“It’s one of the most common causes of food-induced anaphylaxis presenting to the emergency room,” said Chu.
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The severity of the allergy has long perplexed doctors, which is why OIT as a possible way to mitigate those omnipresent and often life-threatening symptoms has excited the medical community.
As both a doctor and someone who has had a peanut allergy his entire life, Chu hopes OIT will one day be an effective way to manage symptoms. However, he is skeptical about the practice as it stands.
“(OIT) may work for some, but we don’t know who and we don’t know how to optimize that yet. We need to make improvements,” Chu said.
Food allergies are extremely common, and peanut allergies even more so.
According to Food Allergy Canada, more than 2.6 million Canadians self-report having at least one food allergy, and peanut allergies affect two out of 100 children in Canada.
Depending on its severity, a peanut allergy can cause a range of symptoms — from hives and nausea to shortness of breath and trouble breathing.
Severe allergies can make everyday activities difficult
Burlington mom Hiromi Okuyama has a four-year-old son with food allergies so severe that they affect her entire family.
“Our grocery bill is much higher than the average family. We hardly ever eat out, (and) fast food isn’t in his vocabulary,” said Okuyama. “We pack his food all the time, we’re nervous about eating at restaurants and travelling is hard.”
Okuyama’s son has anaphylactic reactions to dairy, wheat and eggs so she needs to watch him almost constantly.
“He is so sensitive that he reacts just by touching something with the allergen,” she said. “We have to clean all surfaces before he eats. When he goes to public places and there is carpet, I can see rashes appear sometimes because the carpet probably has food particles in it that he’s allergic to.”
For Okuyama, her son’s allergies can be extremely stressful — especially when her family wants to do something relatively “normal,” like join their extended family at a restaurant for a special event.
“We usually bring his own food because we worry about cross-contamination,” she said.
“Some people may think my husband and I are overprotective, but they don’t understand how lethal dairy, wheat and egg is to my son. (They) can have fatal consequences.”
In the view of Dr. Harold Kim, president of the Canadian Society of Allergy and Clinical Immunology (CSACI), OIT could be an effective way to ease some of the anxiety that often accompanies severe allergies.
He believes the treatment could lead patients to a “more normal life where they don’t have to be paranoid about trace amounts of food.”
“Some patients can have quite a lot of anxiety around eating out … I would say, on average, it does have a big impact on quality of life,” said Kim.
OIT can have positive outcomes
That’s why Kim believes OIT should be offered to patients.
“The science behind it is very good … but, of course, we want to warn people about the potential side effects. You could extrapolate that to any medical therapy that we have,” he said.
“If we use a blood thinner to treat blood clots, there’s an increased risk of bleeding for those patients, but the benefit is that they won’t have life-threatening problems with blood clots.”
Kim believes that Chu’s findings were to be expected.
“(During OIT) we’re giving children the food they’re allergic to,” Kim said. “We warn all patients that there is an increased risk of systemic side effects and milder effects as well.”
Despite these side effects, Kim thinks OIT still helps people with severe peanut allergies lead more normal lives.
More research is needed
The outcomes of OIT treatment can be unpredictable, which worries doctors like Dr. Elana Lavine, a pediatric allergist and immunologist at Humber River Hospital.
“I have been avidly following the oral immunotherapy research and I would hope to be able to provide this service to my own patients in the future, but I’m still working on concerns regarding the pragmatics of how to operate in a safe way,” said Lavine.
Her concerns are mostly about how to provide patients with around-the-clock care in case of an anaphylactic reaction — which can happen, since they’re consuming their allergens on a regular basis.
“The real-life application of this therapy does carry certain risks,” said Lavine. “Parents and patients would have to be given appropriate informed consent before they began this process.”
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There’s also the chance that OIT could have a negative impact on your quality of life, as it can come with several side effects.
“The most common side effects seem to be discomfort associated with ingesting the food that you’re allergic to,” said Lavine.
This can include but is not limited to stomachaches, abdominal pain and problems with the esophagus. There’s also, of course, the risk of have an anaphylactic reaction.
Add peanuts to your child’s diet as soon as possible
One way you can reduce your child’s risk of developing a severe peanut allergy is to introduce peanuts at a young age — ideally, between four and six months of age.
For this preventative measure to be effective, your baby should be ingesting peanuts regularly.
This is the official stance of the Canadian Pediatric Society, and it’s one both Kim and Lavine wholeheartedly endorse.
“That’s absolutely something I recommend to all of my patients, and it’s not altered at all by the recent publications about oral immunotherapy,” said Lavine.