Dr. Martin Bluth explores why peanut allergies have become more common in our society and new therapies on the horizon.
By Dr. Martin H. Bluth
When I was growing up during the ’70s we had the typical bumps, bruises, colds, sprains, strains and the occasional stomach-related concerns. The idea of a food allergy was a rather foreign concept, and specific food allergies were not well defined.
Fast forward 40-plus years, and we’re bombarded with information for people with allergies as well as people who should be careful not to trigger those around them with allergies.
Peanut allergies represent a particular concern: Unlike other food allergies that can cause gastric upset and other symptoms, those with severe peanut allergies can die from breathing in the air next to someone eating peanuts.
According to a Blue Cross Blue Shield study of 9.6 million children under 18, food allergy emergency room visits increased over 150% among children from 2010 to 2016. Furthermore, food allergy diagnosis has been increasing steadily. The American College of Allergy, Asthma and Immunology reports nearly 2.5 percent of U.S. children, or 1.2 million kids, may have an allergy to peanuts, and peanut allergies among children have increased over 20% since 2010.
How did we get to this point? There are various reasons. They range from changes in the food we eat (like consuming processed foods), to the pesticides we use — much of which relates to increasing efficiency in the food supply and production, while reducing risks of contamination by infectious agents, crop blight or other threats.
Another concept relates to the age when we introduce foods like peanuts into our diet. This idea is known as “leaky gut,” where select foods introduced at an early age may cross through a porous (“leaky”) intestinal tract. This can trigger the immune system to view such foods as foreign and promote an immune response when we eat such foods, causing a host of negative gastrointestinal responses. Once the gut has matured, then it will be safe to eat those foods.
Yet recent guidelines from the National Institute of Allergy and Infectious Diseases have turned this idea 180 degrees by recommending the introduction of peanut-containing foods as early as 4-6 months for some high-risk infants who have already started solid foods. These new guidelines are in line with certain countries like Israel that have been introducing peanuts at an early age with a low incidence of allergies.
There is also the controversial “hygiene hypothesis,” which suggests that continuous antibacterial exposure from pumps, soaps, sprays and the like have negatively affected our normal gut bacteria’s ability to control our immune system and keep us in check with our environment. As a result of the increase in allergies, one camp of medical experts have recommended exposing kids to a more natural environment by participating in activities like playing in the dirt. This re-establishes the balance we used to have with our gut microbiome, helps regulate our immune system and reduces the possibility for allergies.
It is important to note that there is a difference between peanuts, which are legumes and grow in the ground, and tree nuts that grow on a tree such as walnut, almond, hazelnut, cashew, pistachio and Brazil nuts. You can technically be allergic to one and not the other, but some people’s bodies get confused and “cross react,” which means they can have allergy symptoms. Safe alternatives include seed or seed butters such as sunflower, pumpkin, hemp or chia.
In addition to conventional therapies such as food avoidance, epinephrine (EpiPen) injections, steroids and antihistamines, there are some remarkable new interventions making headlines.
These include immunotherapies where patients are exposed to increased concentrations of peanut proteins through injection, ingestion or skin patch, as a means to improve their tolerance to them. Examples include the new ingestible treatments Viaskin Peanut developed by DBV Technologies and AR101 developed by Aimmune Therapeutics.
Another immunotherapy-based approach with variable but encouraging results includes removing the offending immunoglobulin that binds the peanut protein by neutralizing its effects with a different immunoglobulin so that the life-threatening cascade of anaphylaxis is reduced.
These therapies are at various stages of adaptation into the mainstream medical marketplace and offer exciting and effective interventions for those who suffer from life-threatening peanut allergies.
You can visit the Food Allergy and Asthma Network and Food Allergy Research and Education websites for the latest information.
Dr. Martin H. Bluth is the founder of Bluth Bio Industries, professor of pathology at Wayne State University School of Medicine, laboratory director for Accutox Medical Diagnostic and medical director for Kids Kicking Cancer. Visit bluthbio.com for more information.