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Peanut Allergy: Is There a Cure

Peanut allergies are very common, making a cure for this allergy very desirable. Dr. Jay Lieberman, Associate Professor at University of Tennessee Health Science Center, discusses peanut allergies.
Peanut Allergy: Is There a Cure
Featured Speaker:
Jay Lieberman, MD
Jay Lieberman, MD is an Associate Professor, The University of Tennessee Health Science Center. 

Learn more about Jay Lieberman, MD
Peanut Allergy: Is There a Cure

Bill Klaproth (Host):  Peanut allergy is one of the most common food allergies found in children. So, what is the future of peanut allergy treatment and are we getting closer to a cure? Let’s find out with Dr. Jay Lieberman, Associate Professor at the University of Tennessee Health Science Center. This is the Peds Pod by Le Bonheur Children’s Hospital. I’m Bill Klaproth. Dr. Lieberman what is the root cause of peanut allergy and do we know why some kids are more susceptible than others?

Jay Lieberman, MD (Guest):  I would say no one knows the root cause and there clearly is not one single cause. We like to say it’s a multifactorial disease. So, there’s a genetic component, an environmental component and possibly a component of when these foods are introduced into the diet that can play a role into why some kids get peanut allergy and others don’t.

Host:  So, it seems like more and more children have peanut allergies than in past generations. Do you know why that is?

Dr. Lieberman:  Yeah, there’s no single cause for that either but there’s a lot of theories out there. For example, number one is something called the hygiene hypothesis which just in brief terms states that as we become a more hygienic society and we have less infectious disease whether that be parasitic or bacterial diseases; our immune system may shift a little bit to develop more allergies in general, not just peanut allergy. And with peanut allergy, it does seem that perhaps some guidelines of when foods are introduced may have played a role in it meaning delaying introduction in kids especially those who are prone to develop peanut allergy may not have been the best idea and maybe getting it in early may be a better idea.

Host:  So, exposing the kids early to potential peanut allergy may in fact help them develop their immune system to fight off peanut allergies as they grow. Is that right?

Dr. Lieberman:  So, not necessarily specifically to peanuts but studies have definitely shown that allergic disease in general meaning developing allergic antibodies to dust mite or peanut may be more apt to happen in patients who are not exposed to certain early infectious agents.

Host:  Got you. All right so, what is the scientific reason for a peanut allergy reaction? What exactly happens in the body?

Dr. Lieberman:  Yeah so, if you have developed an allergic antibody to peanut and then you are exposed to peanut, what will happen is the body will sense the peanut protein no matter where in the body that that’s occurring so, there is allergic cells called mast cells that sit everywhere in our body and if the peanut allergen contacts an allergic antibody or an IGE antibody on those mast cells or basophils; it will cause those cells to react and when they do that, they release contents. And the contents of mast cells and basophils lead to the symptoms that you see in kids. So, leads to sneezing, runny nose, if it’s in the nasal epithelium, if it’s in the – near the blood vessels, it will lead to vasodilation and drop in blood pressure. If it’s in the lungs, it will lead to cough and wheeze and bronchoconstriction.

Host:  So, out of all the children you see for food allergy, how common is the peanut allergy and how fatal can it be?

Dr. Lieberman:  Best estimates for peanut allergy in the United States are somewhere between one and two percent of the population with higher numbers in children and adolescents than the adult population currently. And that obviously has to do with an increased incidence that we are seeing. How fatal is peanut allergy? It’s hard to estimate. I will say it’s very important to understand that death due to food allergy, although tragic, is very rare overall but does occur. And we know that peanut allergy when you look at cohort populations of food allergy related deaths; peanut is a very common trigger in those cohorts. So, we do feel that peanut seems to be a common trigger amongst fatal food anaphylaxis.

Host:  So, what are the current treatments available for peanut allergy?

Dr. Lieberman:  Well by current guidelines, there’s no recommended treatment. It’s avoidance and having emergency therapy available, specifically in the form of epinephrine. However, there’s a lot of studies and research that have looked at immunotherapy such as delivering the peanut into the body whether that be orally or sublingually or through a patch on the skin to slowly introduce peanut into the body in somebody who is allergic to try to make the body not allergic anymore.

Host:  So, I know Le Bonheur’s doing research on this. Can you tell us about the recent study that took place at Le Bonheur?

Dr. Lieberman:  Yeah so, Le Bonheur was one site in the largest peanut oral immunotherapy trial to date. And oral immunotherapy is taking peanut allergic patients and giving them small amounts of peanut protein in the form of a powder in this study and increasing that amount every two weeks in the patients until they are eating approximately a peanut’s worth. And what happens is over time, you can slowly increase that dose in the patient to where they are tolerating it and tolerating an amount that they otherwise wouldn’t have tolerated prior to it. And in some patients, even though they get to a point where they are eating essentially a peanut’s worth every day; they can actually, if you challenge them at the end of the study, let’s say six months or twelve months later; they can eat upwards of 10 to 15 peanuts whereas before they couldn’t eat one.

Host:  So, because of this promising outcome, do you think this research will affect peanut allergy treatment?

Dr. Lieberman:  I think we all believe that. So, the product that was being studied at Le Bonheur went before the FDA recently and the advisory committee at the FDA voted to pass it on and the community is now very hopeful that the FDA will approve that product sometime within the next six months.

Host:  So, you mentioned immunotherapy earlier. What are immunotherapy drugs and how do they work?

Dr. Lieberman:  Sure so, immunotherapy just in general means any therapy or treatment that you are doing that you are either suppressing or activating the immune system to achieve the desired outcome. So, for peanut immunotherapy, what that means is we are going to shift the body’s immune response to peanut by introducing it some way into the body. And so it works just like you could think of allergy shots for patients who have rhinitis, nasal allergies and asthma in which you are introducing the pollen or dust allergens slowly via a shot. We do the same idea with peanut immunotherapy in some other form. We don’t use subcutaneous or shots because it lead to some reactions in the past. But it has been successfully done with peanut for example by doing it sublingually, orally or epicutaneous near the skin.

Host:  So, you are basically putting the immune system to work for you in combatting the peanut allergy.

Dr. Lieberman:  Exactly and shifting the immune response so that instead of the allergic antibody being produced to peanut every time, maybe producing another type of antibody and so you shift that immune response away from an allergic phenotype.

Host:  So, is this something that will be available to us shortly to help kids or people with peanut allergy?

Dr. Lieberman:  Absolutely. The hope is that within the next year would have at least one or two products available that a prescriber – a physician could prescribe to a patient with peanut allergy as a hopeful form or treatment.

Host:  So, it sounds like we’re getting a handle on this. What’s your thoughts on the future of peanut allergy treatment as we move forward?

Dr. Lieberman:  There’s a lot of new therapies being investigated beyond just the oral immunotherapy and the patch immunotherapy that we’ve discussed. There is some modified allergen therapies. There’s people looking at adding on a biologic medicine with one of the immunotherapies to either improve the efficacy of the immunotherapy or make it more safe. So, there’s a lot on the horizon and it’s a good time to be a part of the food allergy community because for so long we haven’t had anything to treat these patients with and hopefully soon, we’ll have more than one option.

Host:  So, it sounds like really good news on the horizon for peanut allergy sufferers then.

Dr. Lieberman:  Absolutely. Better time than any time in the past 30 years for sure.

Host:  Great news. Well Dr. Lieberman, thank you so much for your time today. We really appreciate it.

Dr. Lieberman:  No problem. It was a pleasure.

Host:  That’s Dr. Jay Lieberman, Associate Professor University of Tennessee Health Science Center. And to learn more please visit and be sure to subscribe to the Peds Pod in Apple Podcasts, Google Play or wherever you listen to your podcasts. You can also check out to view our full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children’s Hospital. Thanks for listening.