How to Control Peanut Allergy in Children

As a cure, new treatment is promising but not ready for prime time; 4 ways to manage food allergies now

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A peanut allergy is terrifying: Eating even a tiny bit of peanut can spark a fatal reaction, and up until now, the only way to avoid that fate was to never eat the legumes, which lurk in thousands of processed foods. Of the 150 deaths each year from food allergies, half are caused by peanuts, and most of those deaths happen in teenagers and young adults. That's why two new reports on an experimental treatment for peanut allergy are good news. They offer the possibility that some kids will be able to "outgrow" peanut allergy, as well as dangerous allergies to such foods as eggs, milk, tree nuts, and shellfish.

Ryan Cassada can now eat peanut M&Ms and peanut butter cookies, thanks to being one of the 33 children to try the experimental therapy. Ryan's parents signed him up for the study at Duke University Medical Center when he was 2½. "I was a little bit nervous about it," says Ryan's mother, Rhonda Cassada, because the treatment involved feeding peanuts to Ryan daily. "We decided if we could give our child a chance of getting over this allergy, it could potentially save his life one day."

At first, Ryan was fed trace amounts of peanut at the hospital. Doctors closely monitored him so they could administer drugs at the first sign of a reaction. All he got was a stomachache, so the Cassadas were sent home to Hillsborough, N.C., with instructions to give him measured amounts of peanut flour daily. Rhonda hid it in chocolate pudding and blueberry muffins and gradually increased the dose in keeping with doctors' recommendations.

After 2½ years, Ryan is one of five children in the study who can eat M&Ms and other foods with peanuts without having a reaction. Four children quit the study because they continued to have allergic reactions; the others haven't had allergic reactions to the therapy but are not eating peanuts in food. A second, smaller study gave peanut powder to 12 children and a placebo to 6 others. After 10 months, all the children were fed peanuts under medical supervision. The placebo group had allergic reactions after eating a peanut and a half, while the children in the treatment group ate 15 peanuts on average without symptoms.

Ryan now eats peanut products daily to maintain his tolerance. While his mother can't get him to eat a PB&J, he happily downs peanut butter cookies and other peanutty treats. "Daily is the goal," Rhonda says.

Caution. Do not try this at home, says Wesley Burks, chief of the division of pediatric allergy and immunology at Duke and a director of the studies, which are conducted at Duke and Arkansas Children's Hospital. It will take two to three more years before the technique is tested enough to be used outside of an experiment. But, he says, the evidence that tolerance can be developed by feeding a child the allergy-causing food, much as it can be instilled by giving people shots of an allergen, generated hope that allergies to peanuts, tree nuts, eggs, shellfish, and other foods will soon be much less frightening and managing them much less of a family burden.

That's all very nice, but what's a parent to do till then? I talked with Burks recently about the options parents have in managing a child's food allergies and how to keep kids safe. Here's his advice:

1. Know the symptoms of food allergies: hives; wheezing, or other breathing problems, and stomachaches or vomiting. If it's a food allergy, these symptoms start within a minute of eating the food.

2. If you think your child has had an allergic reaction to food, take her or him to the doctor for blood tests to make sure it really is a food allergy. It's easy to confuse plain old stomachaches with a food allergy.

3. If your child is diagnosed with a food allergy, learn from other parents how to manage the allergy without turning family life upside down. The Food Allergy and Anaphylaxis Network is a great source for ideas on managing food allergies. The Food and Drug Administration is considering revamping food labels, which should make them more helpful than those annoyingly vague "may contain nuts" labels.

4. Exposing children to peanuts and other foods in the first year of life might reduce the risk of developing allergies, some research suggests. Studies are underway in England to see if that's really so.

"I help a family make the appropriate diagnosis," Burks says, and if the child is allergic to peanuts, he helps the family avoid it. "I wouldn't do immunotherapy yet." In other words: Keep reading those food labels, but figure it's not unreasonable to think that there may soon be more formerly allergic kids like Ryan Cassada who are happily snacking on peanut butter cookies.