Hard Cases: The Challenges of Treating Peanut Allergies with No Options

This article is part of LinkedIn's Hard Cases series, where doctors and medical professionals share the toughest challenges they've faced in their careers. You can read more about it here and follow along using hashtag #HardCases.

?Packing an EpiPen in your child’s backpack before heading to school. Asking if that cookie dough touched anything recently cooked with peanuts. These are the everyday concerns racing through the mind of someone living with a peanut allergic child. Yet, for my patients – some of the 1.6 million people allergic to peanuts in the U.S. – after I stress the seriousness of their condition, I have to tell them there aren’t any approved treatments. In fact, my peers and I must tell our patients and their parents the best approach to avoiding fatal moments is to avoid any contact with peanuts.

Although fatal events are rare, even people who have known about their allergy their entire lives, who understand the potentially fatal outcome of a reaction, are subject to an accidental exposure. According to published studies, food allergies result in as many as 400,000 visits to U.S. emergency rooms each year.

That’s what we saw last summer when a 19-year-old man in Pennsylvania died after eating a festive dinner with friends at a restaurant. He knew he had an allergy, he even had emergency medicine with him. But avoidance and epinephrine weren’t enough to save his life. That’s where my role is challenging. As a board-certified allergist and immunologist, I’m trained to help manage food allergies without any approved treatment options, but we are moving in the right direction with the potential benefits of oral immunotherapies (OIT).

Last week, a meta-analysis garnered headlines because the authors concluded that patients should avoid peanuts because OIT was associated with higher risk of serious adverse events and allergic reactions, such as vomiting and swelling. Yet, what was sorely missed is what needs to stay at the center of our practice: giving patients an option. The treatment may still be viable for parents and children who feel avoidance is not an adequate option for a life-threatening condition.

Before a potential FDA-approved therapy was even on the horizon, my biggest challenge was giving parents the confidence that avoidance alone would work. Particularly in those patients with a severe enough allergy that they react from merely touching a table that wasn’t properly cleaned after someone ate peanuts on it. How can you tell those patients to trust their lives to avoidance? Now, we are just on the cusp of instilling that confidence.

Those who do not have food allergies, and even some that do, frequently underestimate how rapidly a person can go into anaphylaxis – even from just touching peanut dust. Anaphylaxis is a rapidly progressing reaction that usually involves a skin reaction such as acute redness, itching, or hives plus a secondary reaction such as trouble breathing, swelling, or vomiting. If that happens, it’s a serious medical emergency that requires fast administration of a rescue drug, epinephrine, and immediate medical attention.

Ultimately, we must have better ways to reduce the risk of severe food allergies and we must have an empathetic society in order to improve the lives and experiences of food allergic people. I am hopeful that soon we will have desensitizing treatments for peanuts – much like the shots that we’ve given to reduce seasonal allergy reactions for years. Even if we cannot completely eliminate the reactions, if we can prevent the most dangerous ones, we will save lives.