Is there anything new in the nut allergy treatment world?

[Anonymous]

Anonymous wrote:Two of my three children are allergic to tree and peanuts. I assume OIT isn't really feasible when allergic to a variety of nuts? Unfortunately our 5 year old is an unknown because we have been afraid to give him any nuts...need to have him tested.

We haven't tested the two allergic children in 3-4 years, so we should do that again.

I know someone that has completed it for two different tree nuts simultaneously, but not sure how many one person can do at one time.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

4-6m is the recommendation. We also were told to touch our infants with hands after touching peanuts earlier than 4-6m because the skin can increase exposure.

Not everyone is going to develop your allergy. Your 2011 kid probably was never going to develop one. But in kids who might develop an allergy, early exposure has shown a reduction in allergies.

As I understand it, there is a body of research that suggests oral exposure is good, but skin exposure is actually what may lead to the development of allergies (and thus possible the allergy/eczema connection). I would not try early introduction via skin routes.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

4-6m is the recommendation. We also were told to touch our infants with hands after touching peanuts earlier than 4-6m because the skin can increase exposure.

Not everyone is going to develop your allergy. Your 2011 kid probably was never going to develop one. But in kids who might develop an allergy, early exposure has shown a reduction in allergies.

As I understand it, there is a body of research that suggests oral exposure is good, but skin exposure is actually what may lead to the development of allergies (and thus possible the allergy/eczema connection). I would not try early introduction via skin routes.

Yeah, don't do this. I'm a PP with food allergies (and 2 DD's with FA). When she was still a baby, our younger DD's allergist told us to avoid any risk of skin exposure to potential allergens specifically for this reason (she had severe eczema on her face, and he was concerned she may come into contact with potential allergens through that vector before we started oral introduction).

[Anonymous]

OIT response - our son tried OIT with Schreiber as well. Unfortunately he ended up declining EOE and so we had to stop it. I will say Dr Schreiber is fantastic and the protocol is easy to follow. But, likes other said, it’s a commitment and requires no strenuous activities 2 hours (?) after dosing, doing this daily (and having your child deal with eating the peanut flour that, even mixed with applesauce, he hated) and the worry that, with any dose, there could be an ana reaction. And then the lifetime maintenance doses.

Not saying don’t try it, but def be aware of what comes with it.

I’m hopeful that there will be a peanut cure or something mentioned above like Xolair by the time he goes to college and may be less cautious about this.

[Anonymous]

OIT — we started with Schreiber when son was 5. Did multiple nuts at a time. It took ten months, he is now at maintenance for walnut/pecan and cashew/pistachio/hazelnut. We still avoid foods that are made with these nuts but he can eat “may contain” or “cross contaminated.” He had no EoE or anaphylaxis during treatment, which I was concerned about. We did always make sure to coat his gut well with apple sauce (pectin) and rice porridge to make the doses less likely to inflame his system.

We are a pretty routine family in terms of bedtimes etc so it hasn’t been a big deal. We dose before bed. In a few years he will be able to cut down to a dose every few days. He may even get to free eating or be no longer allergic one day.

I think the allergy field is changing fast. We now know that allergies develop through skin and can resolve through the gut. He had eczema as a baby and I believe probably was exposed to this nut dust when his system was flaring, but didn’t have it in his gut to help mitigate that reaction. Schreiber had him do his doses with a specific probiotic. I think in the future we will find out how gut bacteria maybe help regulate these genes or affect protein synthesis. Very exciting times.

Good luck!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

NP. I don’t think it is an absolute, by any means. I developed a peanut and tree nut allergy as a teenager, after having practically lived off of PB&J sandwiches in my childhood. I followed the recommendations for early introduction when my older child was born, but she ended up developing a peanut allergy when she was 3. Younger DD went anaphylactic to her very first intro to eggs. I feel like there’s certainly a genetic component and, while early introduction may help, parents shouldn’t be made to feel like their child’s food allergies are somehow their fault because they didn’t introduce everything early enough.

Exactly! Nobody really knows what causes food allergies, but in the absence of solid knowledge, let's blame the parents for either doing too much, or not doing enough.

[Anonymous]

Anonymous wrote:OIT — we started with Schreiber when son was 5. Did multiple nuts at a time. It took ten months, he is now at maintenance for walnut/pecan and cashew/pistachio/hazelnut. We still avoid foods that are made with these nuts but he can eat “may contain” or “cross contaminated.” He had no EoE or anaphylaxis during treatment, which I was concerned about. We did always make sure to coat his gut well with apple sauce (pectin) and rice porridge to make the doses less likely to inflame his system.

We are a pretty routine family in terms of bedtimes etc so it hasn’t been a big deal. We dose before bed. In a few years he will be able to cut down to a dose every few days. He may even get to free eating or be no longer allergic one day.

I think the allergy field is changing fast. We now know that allergies develop through skin and can resolve through the gut. He had eczema as a baby and I believe probably was exposed to this nut dust when his system was flaring, but didn’t have it in his gut to help mitigate that reaction. Schreiber had him do his doses with a specific probiotic. I think in the future we will find out how gut bacteria maybe help regulate these genes or affect protein synthesis. Very exciting times.

Good luck!

Do you happen to recall the probiotic? I've added a daily yogurt drink as part of DD's diet.

[Anonymous]

We went to Dr Agrawal at Freedom Allergy in Atlanta after being unable to find a local doctor to treat our child's rare food allergies. He is incredibly caring and thorough and changed our lives. It is a big decision to travel for treatment, but I have zero regrets.

[Anonymous]

[twitter]

Anonymous wrote:

Anonymous wrote:OIT — we started with Schreiber when son was 5. Did multiple nuts at a time. It took ten months, he is now at maintenance for walnut/pecan and cashew/pistachio/hazelnut. We still avoid foods that are made with these nuts but he can eat “may contain” or “cross contaminated.” He had no EoE or anaphylaxis during treatment, which I was concerned about. We did always make sure to coat his gut well with apple sauce (pectin) and rice porridge to make the doses less likely to inflame his system.

We are a pretty routine family in terms of bedtimes etc so it hasn’t been a big deal. We dose before bed. In a few years he will be able to cut down to a dose every few days. He may even get to free eating or be no longer allergic one day.

I think the allergy field is changing fast. We now know that allergies develop through skin and can resolve through the gut. He had eczema as a baby and I believe probably was exposed to this nut dust when his system was flaring, but didn’t have it in his gut to help mitigate that reaction. Schreiber had him do his doses with a specific probiotic. I think in the future we will find out how gut bacteria maybe help regulate these genes or affect protein synthesis. Very exciting times.

Good luck!

Do you happen to recall the probiotic? I've added a daily yogurt drink as part of DD's diet.

Fellow OIT mom here. We use Natures Way Primadophilus from Whole Foods. But our allergist also recommended Culturelle.

[Anonymous]

Anonymous wrote: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.

This is so exciting -- I'm a 40-something woman who has landed in the ER dozens upon dozens of times due to anaphylactic reactions to tree nuts. The idea of being able to avoid an ambulance ride when I encounter cross-contamination is mind-boggling and so exciting to think of. Thanks for sharing your insight on what may be around the corner for food allergy sufferers!