The fear was so great that the woman reached deep into her pockets: a 27-year-old bought peanuts on a plane at the beginning of August for 168 euros – the entire range on board the Eurowings plane. But the woman didn’t want to eat the peanuts on her flight from Düsseldorf to London; she just wanted to prevent a passenger near her from tearing open a bag because she has a severe allergy to peanuts.
Even if, according to the American Academy of Allergy, Asthma & Immunology, the woman’s concern was probably unfounded because peanut dust is not transmitted through the air: In fact, peanut allergy is one of the most dangerous food allergies. Even tiny amounts of peanut protein can cause severe reactions in those affected – from hives to shortness of breath to anaphylactic shock, which can be fatal. Many of those affected and their relatives are therefore in a constant state of alarm. Because traces of peanuts are found in many foods, carry an adrenaline pen with you for emergency treatment.
Erika von Mutius is therefore happy that she can now offer help to affected children and young people: a drug called Palforzia has been approved throughout Europe for hyposensitization for children between the ages of four and 17 for two years, and the allergology team at the Haunerschen Children’s Hospital in Munich has already used it for a few treated young people. And now researchers report in the New England Journal of Medicine that the same principle can also help small children between the ages of one and three: In the study, 146 children between the ages of one and three were treated. 98 of them regularly took tiny amounts of pure, pharmaceutically tested peanut powder, like that found in Palforzia, and 48 others took a placebo. After a year they were given larger quantities of peanuts. And although everyone had reacted violently to less than 300 milligrams of peanut protein before starting treatment, 74 percent of those treated now tolerated more than 600 milligrams and had at best mild allergic symptoms. The success rate corresponds to that of older children.
Erika von Mutius and her team at Haunerschen Children’s Hospital have had good experiences with immunotherapy for four to 17 year olds. “If you can get children to no longer react to traces of peanuts, that’s a huge step forward for families,” says the allergist. However, the therapy must be planned with care: “It’s not something you can just do in a pediatrician’s office,” emphasizes von Mutius. “Some of the children react violently.”
As with other hyposensitizations, which are intended to train the immune system to relax towards the allergy trigger, the treatment of peanut allergy begins with very small doses and the dose is increased over weeks in order to get the immune cells used to the allergen that they would otherwise be exposed to fight violently. In the case of peanut allergies, tiny doses are used because of the particularly strong reactions: “We start with mini-doses,” says von Mutius. “We are extremely careful.”
Just in case, the doctors are prepared for the worst. During the treatment, the child sits in a hospital bed, an infusion and medication are ready. The parents are often afraid, says Mutius, as they have usually had bad experiences with peanuts. “But they are also extremely motivated because the success rate is quite high and because, unlike other allergies, a peanut allergy rarely progresses.” There is correspondingly great interest and the waiting list for treatment at the Hauner Children’s Hospital is long. Von Mutius welcomes the fact that he will probably soon be able to treat smaller children as well. “There is hope that worsening of the allergy can be counteracted by starting immunotherapy so early,” she says.
However, the treatment is not free of side effects: Many children show allergic reactions during the therapy and suffer from stomach ache or nausea. Some doctors are therefore hoping for immunotherapy with patches, which could have fewer side effects. Here too, researchers recently reported successes in small children – with success rates similar to those of the oral therapy that has now been successfully tested.