However, hope may be on the horizon as a potentially life-changing trial has shown that two-thirds of adults with severe peanut allergies can be desensitised through supervised daily exposure: a treatment otherwise known as oral immunotherapy (OIT).
In the past, OIT has already proved to be effective in children. It involves consuming small, but gradually escalating amounts of the allergen under medical supervision. OIT belongs to a broader category of treatments aimed not only at managing, but reducing or even eliminating the burden of allergies. Rather than meticulously avoiding allergens and carrying around epinephrine, Prof. Robert Wood of Johns Hopkins University says: “Now we have options”.
The urgency of allergy research stems from rising food allergy cases. In fact, UK hospital admissions for food anaphylaxis have tripled between 1998 and 2018. Less extreme allergies are also becoming more common. Experts suggest several culprits contributing to this: weaning practices, overly sterile environments, and reduced contact with dirt and animals. Efforts to protect children from allergens have actually made them more vulnerable.
Whilst OIT is not a new concept (the first successful report dates all the way back to 1908), researchers have only fine-tuned dosing protocols over the past decade. The approval of ‘Palforzia’, a pharmaceutical-grade peanut protein, can be a form of regulated treatment. Yet, the process involves fortnightly dose escalation and rigorous monitoring. But the biggest problem is that although patients build a tolerance, they’re not cured. Daily exposure may increase tolerance slightly, but it won’t necessarily stop people from having allergic reactions. For those with multiple allergies, this isn’t a viable solution.
In a landmark study last year, Prof. Wood and his team found that the asthma drug ‘Omalizumab’, which targets IgE antibodies, can actually be repurposed to desensitise patients to peanuts, cashews, walnuts, hazelnuts, milk, wheat, and eggs by essentially clearing problematic antibodies.
Potent IgE antibodies have apparently evolved to fight parasites, but now mistakenly attack certain food proteins. They bind to our immune cells more tightly than other antibodies.
The treatment isn’t cheap though, as fortnightly injections may cost between $30,000-$60,000 a year. Still, for those allergic to staple ingredients like milk or wheat, this could be life-altering.
Currently, OIT remains the only approved treatment and the most advanced in development despite its risk of severe reactions. Other innovations continue to be developed, such as a vaccine for peanut allergies or a ‘peanut patch’ that has shown some promising results over the past three years.