Is there anything new in the nut allergy treatment world?

[Anonymous]

I have a 15 year old who is allergic to peanuts. She was food-challenged by Dr. Wood at Hopkins when she was 6 and she failed. Since then we have just been doing the obvious avoid/carry epi pen thing. After a few years of going to our local allergist and basically being told the same thing, we honestly just stopped going and our pediatrician fills our epi pen prescriptions and writes our allergy action plans.

I've been thinking lately that I should probably take her back to see her local allergist or even Hopkins but I'm not sure if there is any point. I don't want to get her hopes up or put her through new testing if there is little point to it.

Thoughts?

(PS - this poor kid, who is absolutely wonderful by the way, also has dental issues despite excellent care, and back problems so that's the other reason I try to avoid unnecessary appointments for her.)

[Anonymous]

There is oral immunotherapy
You’d have to talk to your doctor to see if your child would be a candidate

[Anonymous]

Dupixent is a miracle drug. Twice monthly injections. Look into it.

[Anonymous]

Yes!! Xolair - our allergist said we can expect FDA approval in Q1 or Q2 of 2024. It’s a once-monthly injection that substantially reduces risk of a severe reaction. There’s another one in clinical trials now that has an even more dramatic effect. And what’s really cool is that a PN-allergic kid could take it during risky times, e.g., high school, college, but wouldn’t need to as a responsible adult with their own kitchen.

This allergist (Mark Scarupa at Institute for Asthma and Allergy) is also not high on OIT, for various reasons. But he was positively giddy about these options. It felt like a bit of relief for my 10yo PN-allergic DS.

[Anonymous]

My friend has been taking her severely food allergic son (multiple anaphylactic allergies) to the Food Allergy Institute in Long Beach CA. They use a treatment called TIP. It’s a pain because they have to travel there multiple times a year but she did a lot of research before deciding it was worth it. The goal is to not just reduce the risk of anaphylaxis upon accidental exposure but to actually be able to eat the foods.

[Anonymous]

Anonymous wrote:Yes!! Xolair - our allergist said we can expect FDA approval in Q1 or Q2 of 2024. It’s a once-monthly injection that substantially reduces risk of a severe reaction. There’s another one in clinical trials now that has an even more dramatic effect. And what’s really cool is that a PN-allergic kid could take it during risky times, e.g., high school, college, but wouldn’t need to as a responsible adult with their own kitchen.

This allergist (Mark Scarupa at Institute for Asthma and Allergy) is also not high on OIT, for various reasons. But he was positively giddy about these options. It felt like a bit of relief for my 10yo PN-allergic DS.

Interesting. DS sees Dr Scarupa for peanut allergies and at his last visit in August, right before he left for college, Dr Scarupa didn’t even mention this.

[Anonymous]

Hi OP, I work in food allergy. I can tell you we are all eager for the announcement of Xolair, which could before the end of the year, with a Q1/Q2 FDA approval.

It's important to differentiate Xolair is not being considered a cure for food allergy, but a medicine that takes away the risk of anaphylaxis on accidental exposure. Still lots of questions to be answered- monotherapy vs with OIT, can it help get to sustained unresponsiveness with the right pt (either bite proof or "free eating"), will it be needed for life or a period of time? Lots to consider, and pt age and acuity will factor in, but a potent new tool.

Dupixent trials have been less promising for food allergy, though a wonderful biologic for eczema, asthma and may still have use. I share the reservations about OIT. In application, there are many hurdles of which families often aren't aware. A pt and family will want to be fully informed and make a shared decision with an allergist.

And since I'm here, please help get this message out, EARLY INTRODUCTION IS ESSENTIAL. All the top allergens into the diet in age-appropriate forms when your child is ready for solids at 4-6 MONTHS OF AGE. Yes, that early. If there is any hesitation (bc of eczema, sibling/family history, etc), get to an allergist for support, but don't unilaterally take it out of your child's diet. We now know this has the possibility to potentiate an allergy and there is for many a window on immune plasticity.

Thanks for indulging the PSA, best of luck OP.

[Anonymous]

Anonymous wrote:Hi OP, I work in food allergy.

And since I'm here, please help get this message out, EARLY INTRODUCTION IS ESSENTIAL. All the top allergens into the diet in age-appropriate forms when your child is ready for solids at 4-6 MONTHS OF AGE. Yes, that early. If there is any hesitation (bc of eczema, sibling/family history, etc), get to an allergist for support, but don't unilaterally take it out of your child's diet. We now know this has the possibility to potentiate an allergy and there is for many a window on immune plasticity.

Thanks for indulging the PSA, best of luck OP.

UGH this is SUCH BS. Look, early introduction works for kids who don’t have food allergies because they DON’T HAVE FOOD ALLERGIES. Statistically speaking very few kids have food allergies but those who do, it is NOT because their parents didn’t introduce the food early enough. It is simply luck of the genetic draw.

While we are at it, let us set aside the myth that farm kids are hardier when it comes to asthma. Every farming community has kids with severe asthma. Yes, in a family of farmers there can be a few family members who get severe respiratory troubles with the harvest season. There is nothing inherently alllergy protective about being raised on a farm, again—it is just genetics.

[Anonymous]

Can someone share concerns with oit?

[Anonymous]

Anonymous wrote:Can someone share concerns with oit?

Hi, my daughter is almost done with her first year of OIT for cashew at Schreiber allergy. She is a few weeks away from maintenance, which basically is for life, unless we decide to stop or switch gear. My daughter is 10 and while it has been a bumpy road, she appreciates the freedom it gives her. She is more confident about making decisions about what she can eat, and much less worried about a severe reaction. Also Schreiber allergy is wonderful, the best allergist we have seen (and we’ve seen Wood and Scarupa, among others).
The negatives are that it can be time consuming to do the daily dosing, with the two hour rest period. She usually works on homework though, so that helps. In addition, as I mentioned above, we don’t really have an end point, so she will likely have to dose every day for the future unless her numbers say otherwise. The first year can be pricey but insurance covered most for us. Overall it’s been a very positive experience and we don’t worry about her as much.
Happy to answer any additional questions!

[Anonymous]

Anonymous wrote:

Anonymous wrote:Hi OP, I work in food allergy.

And since I'm here, please help get this message out, EARLY INTRODUCTION IS ESSENTIAL. All the top allergens into the diet in age-appropriate forms when your child is ready for solids at 4-6 MONTHS OF AGE. Yes, that early. If there is any hesitation (bc of eczema, sibling/family history, etc), get to an allergist for support, but don't unilaterally take it out of your child's diet. We now know this has the possibility to potentiate an allergy and there is for many a window on immune plasticity.

Thanks for indulging the PSA, best of luck OP.

UGH this is SUCH BS. Look, early introduction works for kids who don’t have food allergies because they DON’T HAVE FOOD ALLERGIES. Statistically speaking very few kids have food allergies but those who do, it is NOT because their parents didn’t introduce the food early enough. It is simply luck of the genetic draw.

While we are at it, let us set aside the myth that farm kids are hardier when it comes to asthma. Every farming community has kids with severe asthma. Yes, in a family of farmers there can be a few family members who get severe respiratory troubles with the harvest season. There is nothing inherently alllergy protective about being raised on a farm, again—it is just genetics.

It’s kinda harsh to say the PPs theory is BS. Calm down. Nobody really knows. Some doctors recommend early introduction and others don’t. So the only truth is that nobody knows. I’ve heard that early introduction can help determine if there is an allergy, and lead to earlier treatment options. I believe OIT can have better outcomes for younger patients. I get that we are all sensitive about why this happened to our kids, but there is nothing conclusive to say it’s anything other than bad luck.

[Anonymous]

We did OIT and once we got to the maintenance phase my daughter completely loathed eating the maintenance dose (one peanut m&m a day). It was a constant battle. I didn’t see that coming but it makes sense. Her body hates peanuts and the taste as a defense mechanism. She could tolerate eating it with no allergic reaction she just hated the taste and begged not to do it. It was pretty hard to picture keeping it up for the rest of her life.

I think it’s worth trying though. The OIT is a massive commitment. Not an easy path.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Hi OP, I work in food allergy.

And since I'm here, please help get this message out, EARLY INTRODUCTION IS ESSENTIAL. All the top allergens into the diet in age-appropriate forms when your child is ready for solids at 4-6 MONTHS OF AGE. Yes, that early. If there is any hesitation (bc of eczema, sibling/family history, etc), get to an allergist for support, but don't unilaterally take it out of your child's diet. We now know this has the possibility to potentiate an allergy and there is for many a window on immune plasticity.

Thanks for indulging the PSA, best of luck OP.

UGH this is SUCH BS. Look, early introduction works for kids who don’t have food allergies because they DON’T HAVE FOOD ALLERGIES. Statistically speaking very few kids have food allergies but those who do, it is NOT because their parents didn’t introduce the food early enough. It is simply luck of the genetic draw.

While we are at it, let us set aside the myth that farm kids are hardier when it comes to asthma. Every farming community has kids with severe asthma. Yes, in a family of farmers there can be a few family members who get severe respiratory troubles with the harvest season. There is nothing inherently alllergy protective about being raised on a farm, again—it is just genetics.

This is a really harsh response. There was a well known study that came out in 2015 that showed scientific evidence that introduction of peanuts at 4-6 months reduced the risk of kids developing peanut allergies. I get it - my daughter was born in 2014 and I wish I would have known this before she developed her own peanut she developed her peanut allergy. Allergies aren’t the fault of any parent doing the best they can with available evidence, and there’s absolutely a major genetic component to it. But when my younger DS was born, I spent a lot of time with my DD’s allergist going over the evidence, and I was absolutely convinced that it made sense to introduce common allergens to him at 4 months.

https://www.foodallergy.org/resources/learning-early-about-peanut-allergy-leap

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Hi OP, I work in food allergy.

And since I'm here, please help get this message out, EARLY INTRODUCTION IS ESSENTIAL. All the top allergens into the diet in age-appropriate forms when your child is ready for solids at 4-6 MONTHS OF AGE. Yes, that early. If there is any hesitation (bc of eczema, sibling/family history, etc), get to an allergist for support, but don't unilaterally take it out of your child's diet. We now know this has the possibility to potentiate an allergy and there is for many a window on immune plasticity.

Thanks for indulging the PSA, best of luck OP.

UGH this is SUCH BS. Look, early introduction works for kids who don’t have food allergies because they DON’T HAVE FOOD ALLERGIES. Statistically speaking very few kids have food allergies but those who do, it is NOT because their parents didn’t introduce the food early enough. It is simply luck of the genetic draw.

While we are at it, let us set aside the myth that farm kids are hardier when it comes to asthma. Every farming community has kids with severe asthma. Yes, in a family of farmers there can be a few family members who get severe respiratory troubles with the harvest season. There is nothing inherently alllergy protective about being raised on a farm, again—it is just genetics.

This is a really harsh response. There was a well known study that came out in 2015 that showed scientific evidence that introduction of peanuts at 4-6 months reduced the risk of kids developing peanut allergies. I get it - my daughter was born in 2014 and I wish I would have known this before she developed her own peanut she developed her peanut allergy. Allergies aren’t the fault of any parent doing the best they can with available evidence, and there’s absolutely a major genetic component to it. But when my younger DS was born, I spent a lot of time with my DD’s allergist going over the evidence, and I was absolutely convinced that it made sense to introduce common allergens to him at 4 months.

https://www.foodallergy.org/resources/learning-early-about-peanut-allergy-leap

I have a peanut allergic kid born 2008, and I gave peanuts to her at 15 months (per the ped) and I have a kid with no allergies born 2011 that didn’t get nuts until age 3 (per our allergist.) So, I’m skeptical.

[Anonymous]

We looked into OIT for my high schooler but there was just no way to even make it work with academics, sports, etc. because he would need to go out to the allergies so often. Even thought it would be life changing to pass, there was also the reality of needing to do well in school, keep up with sport (being recruited), etc. It was a bummer. Also the doctor acknowledged that it would not be good for an egg allergy (too many fails) and my son's peanut allergy was so high that OIT might not work either. With lower chance of success, we had to chose not to pursue OIT.

I am hopeful for the medication route!