For kids who’ve already developed a peanut allergy, though, a similar but more controversial treatment is up for approval by the Food and Drug Administration. The agency is holding a hearing today with the pharmaceutical company and its advocates, expected to inform a final ruling in coming months.
There is currently no “treatment” for a peanut allergy. As it is, patients are told to avoid peanuts. They are prescribed a syringe full of epinephrine (trade name: EpiPen) and taught to inject themselves if needed. Despite much advancement in medical science and technology over the decades, nothing has given families peace of mind that the allergy itself could be treated, or at least tempered. Until now. The new approach involves trying to reprogram the immune system by giving a person … peanuts.
This might sound dangerous, because it is.
Known as oral immunotherapy, the idea is that by exposing a person to tiny amounts of peanut, that person will slowly become able to tolerate it. Immunotherapy is common practice in the form of allergy shots for things such as pollen: You inject bits of the protein and watch as the immune system gets more tolerant and the person becomes less wheezy.
But oral immunotherapy with peanuts is considered experimental, and no professional organization recommends that parents give any peanuts to an allergic person. Even though some practitioners have concocted homespun protocols, most doctors feel unsafe overseeing any such attempts. Given the potential for a fatal reaction, some believe that no one should yet be trying out the approach outside of a research setting.
In the late 1990s, there was an attempt to treat peanut allergies with a similar shot—an injection of liquid peanut extract. A patient died of anaphylaxis during a clinical trial (reportedly due to a labeling error). The incident shut down the trial and cast a chill over the field for a while. Then, in the 2000s, a group of scientists at Duke University rekindled the idea and chose the oral route. They published proof-of-concept studies in which allergic mice were safely given microscopic amounts of crushed peanut and their allergies waned.
Excited by the prospect of extending this to humans, the influencers of the food-allergy world convened in Boston in 2011 to try to move the concept forward. Food Allergy Research & Education, or FARE, a nonprofit advocacy and lobbying group that’s partly funded by the pharmaceutical industry, held a retreat that included patient advocates, the researchers from Duke and elsewhere, regulators, and industries. The group agreed that in order to study oral immunotherapy safely, scientists needed a standardized product that would allow everyone to know exactly how much peanut was being given.
“The problem was that this wasn’t exactly a product that a typical drug company would make,” says Brian Vickery, an allergist involved in the proof-of-concept studies. Nor was the product a food, exactly. “And there was nothing to be licensed—it was peanut flour, you know?”