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Preventing and Treating Peanut Allergy in 2020
Dr. MaLourdes de Asis discusses Peanut Oral Immunotherapy and ways for preventing and treating Peanut Allergies.
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Learn more about MaLourdes de Asis, MD, MPH
MaLourdes de Asis, MD, MPH
MaLourdes de Asis, MD, MPH, FAAAAI, Section Chief, Allergy and Immunology at Montefiore Nyack Hospital, is a board certified, Fellowship-trained Allergy and Immunology specialist. With a special interest in sinus disease and drug allergy, Dr. de Asis has provided comprehensive allergy, asthma, and immunology care to the Rockland and Bergen County communities for more than 20 years and has extensive experience in chemotherapy, aspirin, food and other drug evaluation and desensitization procedures.Learn more about MaLourdes de Asis, MD, MPH
Transcription:
Preventing and Treating Peanut Allergy in 2020
Bill Klaproth: Better treatments for food allergies are coming, especially for children and adults dealing with peanut allergy. The outlook looks even more promising with the recent approval of peanut oral immunotherapy by the U S food and drug administration. So let's learn more with Dr. MaLouredes de Asis, Section Chief of Allergy and Immunology and the Director of Drug Allergy and Desensitization Program at Montefiore Nyack Hospital. She is optimistic that she will soon be able to offer her patients new treatments that can help them overcome their food allergy, including a wearable patch that delivers small amounts of peanut protein through the skin. This is Health Track. The podcast from Montefiore Nyack Hospital. I'm Bill Klaproth. Dr. de Asis, peanuts are among the most common food allergies affecting an estimated 1.6 million children in the United States. How dangerous is peanut allergy?
Dr. de Asis: Well, peanut allergy, like any food allergy can cause anaphylaxis, which is a severe allergic reaction and that is a life threatening reaction. So people have died from peanut allergy and other food allergies.
Host: So this can be very deadly to a certain portion of the population.
Dr. de Asis: Yes.
Host: And then what are the steps to diagnose a peanut allergy?
Dr. de Asis: Well, you first go by history, so within 15 to 30 minutes, usually the history of eating the peanut, the person gets a rash, hives, swelling, trouble breathing, passes out. Then that's the history. They think that you might be allergic to the peanut. So you have to pick up careful history. And this is a, that just doesn't happen, you know, once and then it doesn't happen again after you eat the peanut. It always happens whenever you are exposed to the peanut. So once the patient comes in, we have that history. We do a skin test where we do a small drop of peanut protein on the skin and we scratch the skin. We wait 15 minutes. So that triggers release of histamine in people who have an allergy. So it can get large, it will look like a hive. And you can also measure. Now we have better ways of measuring the amount of peanut, IgE which is the allergic antibody in the blood.
And we're able to narrowly target, because some people aren't, they may have a positive skin test but they're not anaphylactic to the peanut. So just because you have a positive skin test doesn't mean to will have a physical reaction to the peanut. That's why it's necessary to see a specialist. Because sometimes in the past we've had a general physicians who run a blood test and kids come back, they see the IgE the blood test and they tell them to avoid the peanut and they may not be allergic to the peanut. So we can do more specific blood tests now to identify patients who are high risk for anaphylacting, which is the severe allergic reaction to peanut. And if that test is super positive, like it's very, very high, we don't even bother going to the next step, which is feeding the person peanut and observing them. So yeah, just because you have a blood test that's positive doesn't mean that you will react to peanut.
Host: So that's just the first step in ultimately diagnosing someone with a peanut allergy. So what are the current guidelines for treatment of peanut allergies?
Dr. de Asis: The current methods, which is acceptable is avoidance and carrying an epinephrine auto injector. It's what they call active avoidance. You read labels, you ask people if you eat out, make sure that you are not or the kid isn't exposed to peanut protein. That's currently what's being done has been done for years.
Host: Well, let's talk about some of these newer treatments such as oral immunotherapy, which can reduce allergies to some foods including peanuts. Can you talk about that?
Dr. de Asis: Well, currently the only FDA product for food allergy is for peanut, which is called alforgia. Now when it was under studied was called AR101. So it's peanut flour, which is carefully measured and packaged in small capsules. And the idea is you slowly introduce small increasing amounts of peanut to the patient so that they develop a tolerance to the peanut. It is not a cure for peanut allergy. However, after six months of the treatment, the person can tolerate small amounts of peanut, like two peanuts. You won't react if you accidentally, like you eat something and you didn't know that there was some peanut in it and normally you would have a reaction. But with this treatment you won't.
Host: Well even building up a small tolerance is a win as if you accidentally eat some peanuts, you know you're not going to have that severe allergic reaction. So tell us more about this process of immunotherapy.
Dr. de Asis: It's a six month process and it's kind of involved. The patient needs to come to the allergist office every two weeks to get updosed and they have to take the drug at home every day. They have to be careful, they have to take it on a full stomach. They can't shower, take a hot shower or exercise for like two to four hours after they take the drug. It's not this easy as you just take the drug and you know you're on your merry way every two weeks. You have to be in the office like an hour or two and then at home, you have to be careful and there are side effects. Most of the adverse reactions are abdominal. So you can get an upset stomach. You can get cramping and, and some people, you know, you are giving people something that they're allergic to. They can anaphylax the, it doesn't mean that you don't carry it. You still avoid the peanut even though you're taking the drug and you still have to carry your EpiPen. The FDA has mandated that the company are required to do a [inaudible 06:33] program which is like they have to enroll patients and we have to follow them throughout treatment for drug safety. So it's just a good thing.
Host: Well, I know oral immunotherapy is a game changer for a lot of people and something that looks to be even more promising is the possibility of this wearable patch that delivers small amounts of peanut protein through the skin. Can you explain that to us?
Dr. de Asis: Yes. So same idea. You will be exposed to small increasing amounts of peanut protein every day. And it will protect you from a small accidental exposures to peanut. It will be giving you less protein because it's administered through the skin. And I believe you have to change the patch every day. And it doesn't give you as much protection as the oral immunotherapy, but it still gives you some protection. So that has to be FDA approved. And because it's, it doesn't give you as much peanut protein, there's less side effects with a patch. You don't, you're not swallowing it, so you won't get, there's less abdominal problems.
Host: Well, we're very excited about the possibility of the patch coming to the market. And as we wrap up, Dr. de Asis, How do we prevent peanut allergies as a young child starts out?
Dr. de Asis: Yeah. So the American Academy of Pediatrics and the Allergy Societies have issued recommendations which have come out since 2017. So they have three groups of kids. So the high risk group are the kids, the children who are two to four months or younger, less than a year of age, who have severe eczema or have an egg allergy. They have found that these children are likely to develop peanut allergy and that, if you give them, if they don't react, if they safely can ingest peanuts without reacting physically, that actually prevents peanut allergy. So these kids, the ones who have severe eczema or and or egg allergy need to see an allergies to get skin tested and to be given the peanut in the office. And if they pass the test where they don't react to the peanut, they should be given the peanut several times a week to prevent them from developing a peanut allergy.
And the second group are the children who have mild to moderate eczema. And those children also should see an allergist get skin tested and determine if they can, they can actually have the peanut at home. They may not have to have the skin testing done, and they should start eating that when their pediatrician and the family decides it's appropriate for them to start having peanut butter. Obviously at that age they can't have whole peanuts because they might choke. And then the third group are the low risk children who don't have eczema or a mild eczema and they don't have any egg allergy. If they have like a different food allergy, may be, you still want to see the allergies just to get that checked out and they can also advise better. But those children around six months of age should start eating peanuts because we mentioned this because previously to 2017 the recommendations were to avoid peanuts until they were like three years old and they found that that does not prevent peanut allergy. The earlier, if you can introduce peanut earlier into the diet, that actually prevents peanut allergy from developing.
Host: So as always, check with your pediatrician first. But I think that's great advice and thank you for bringing that up. We appreciate it, Dr. de Asis. This has really been informative and helpful. Thank you so much for your time today.
Dr. de Asis: Thank you.
Host: That's Dr. MaLourdes de Asis and for more information or to schedule an appointment call (845) 353-9600, that's (845) 353-9600. And for more information, please visit RBallergy.com that's the letter R the letter B, allergy.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Health Track, the podcast from Montefiore Nyack Hospital. I'm Bill Klaproth. Thanks for listening.
Preventing and Treating Peanut Allergy in 2020
Bill Klaproth: Better treatments for food allergies are coming, especially for children and adults dealing with peanut allergy. The outlook looks even more promising with the recent approval of peanut oral immunotherapy by the U S food and drug administration. So let's learn more with Dr. MaLouredes de Asis, Section Chief of Allergy and Immunology and the Director of Drug Allergy and Desensitization Program at Montefiore Nyack Hospital. She is optimistic that she will soon be able to offer her patients new treatments that can help them overcome their food allergy, including a wearable patch that delivers small amounts of peanut protein through the skin. This is Health Track. The podcast from Montefiore Nyack Hospital. I'm Bill Klaproth. Dr. de Asis, peanuts are among the most common food allergies affecting an estimated 1.6 million children in the United States. How dangerous is peanut allergy?
Dr. de Asis: Well, peanut allergy, like any food allergy can cause anaphylaxis, which is a severe allergic reaction and that is a life threatening reaction. So people have died from peanut allergy and other food allergies.
Host: So this can be very deadly to a certain portion of the population.
Dr. de Asis: Yes.
Host: And then what are the steps to diagnose a peanut allergy?
Dr. de Asis: Well, you first go by history, so within 15 to 30 minutes, usually the history of eating the peanut, the person gets a rash, hives, swelling, trouble breathing, passes out. Then that's the history. They think that you might be allergic to the peanut. So you have to pick up careful history. And this is a, that just doesn't happen, you know, once and then it doesn't happen again after you eat the peanut. It always happens whenever you are exposed to the peanut. So once the patient comes in, we have that history. We do a skin test where we do a small drop of peanut protein on the skin and we scratch the skin. We wait 15 minutes. So that triggers release of histamine in people who have an allergy. So it can get large, it will look like a hive. And you can also measure. Now we have better ways of measuring the amount of peanut, IgE which is the allergic antibody in the blood.
And we're able to narrowly target, because some people aren't, they may have a positive skin test but they're not anaphylactic to the peanut. So just because you have a positive skin test doesn't mean to will have a physical reaction to the peanut. That's why it's necessary to see a specialist. Because sometimes in the past we've had a general physicians who run a blood test and kids come back, they see the IgE the blood test and they tell them to avoid the peanut and they may not be allergic to the peanut. So we can do more specific blood tests now to identify patients who are high risk for anaphylacting, which is the severe allergic reaction to peanut. And if that test is super positive, like it's very, very high, we don't even bother going to the next step, which is feeding the person peanut and observing them. So yeah, just because you have a blood test that's positive doesn't mean that you will react to peanut.
Host: So that's just the first step in ultimately diagnosing someone with a peanut allergy. So what are the current guidelines for treatment of peanut allergies?
Dr. de Asis: The current methods, which is acceptable is avoidance and carrying an epinephrine auto injector. It's what they call active avoidance. You read labels, you ask people if you eat out, make sure that you are not or the kid isn't exposed to peanut protein. That's currently what's being done has been done for years.
Host: Well, let's talk about some of these newer treatments such as oral immunotherapy, which can reduce allergies to some foods including peanuts. Can you talk about that?
Dr. de Asis: Well, currently the only FDA product for food allergy is for peanut, which is called alforgia. Now when it was under studied was called AR101. So it's peanut flour, which is carefully measured and packaged in small capsules. And the idea is you slowly introduce small increasing amounts of peanut to the patient so that they develop a tolerance to the peanut. It is not a cure for peanut allergy. However, after six months of the treatment, the person can tolerate small amounts of peanut, like two peanuts. You won't react if you accidentally, like you eat something and you didn't know that there was some peanut in it and normally you would have a reaction. But with this treatment you won't.
Host: Well even building up a small tolerance is a win as if you accidentally eat some peanuts, you know you're not going to have that severe allergic reaction. So tell us more about this process of immunotherapy.
Dr. de Asis: It's a six month process and it's kind of involved. The patient needs to come to the allergist office every two weeks to get updosed and they have to take the drug at home every day. They have to be careful, they have to take it on a full stomach. They can't shower, take a hot shower or exercise for like two to four hours after they take the drug. It's not this easy as you just take the drug and you know you're on your merry way every two weeks. You have to be in the office like an hour or two and then at home, you have to be careful and there are side effects. Most of the adverse reactions are abdominal. So you can get an upset stomach. You can get cramping and, and some people, you know, you are giving people something that they're allergic to. They can anaphylax the, it doesn't mean that you don't carry it. You still avoid the peanut even though you're taking the drug and you still have to carry your EpiPen. The FDA has mandated that the company are required to do a [inaudible 06:33] program which is like they have to enroll patients and we have to follow them throughout treatment for drug safety. So it's just a good thing.
Host: Well, I know oral immunotherapy is a game changer for a lot of people and something that looks to be even more promising is the possibility of this wearable patch that delivers small amounts of peanut protein through the skin. Can you explain that to us?
Dr. de Asis: Yes. So same idea. You will be exposed to small increasing amounts of peanut protein every day. And it will protect you from a small accidental exposures to peanut. It will be giving you less protein because it's administered through the skin. And I believe you have to change the patch every day. And it doesn't give you as much protection as the oral immunotherapy, but it still gives you some protection. So that has to be FDA approved. And because it's, it doesn't give you as much peanut protein, there's less side effects with a patch. You don't, you're not swallowing it, so you won't get, there's less abdominal problems.
Host: Well, we're very excited about the possibility of the patch coming to the market. And as we wrap up, Dr. de Asis, How do we prevent peanut allergies as a young child starts out?
Dr. de Asis: Yeah. So the American Academy of Pediatrics and the Allergy Societies have issued recommendations which have come out since 2017. So they have three groups of kids. So the high risk group are the kids, the children who are two to four months or younger, less than a year of age, who have severe eczema or have an egg allergy. They have found that these children are likely to develop peanut allergy and that, if you give them, if they don't react, if they safely can ingest peanuts without reacting physically, that actually prevents peanut allergy. So these kids, the ones who have severe eczema or and or egg allergy need to see an allergies to get skin tested and to be given the peanut in the office. And if they pass the test where they don't react to the peanut, they should be given the peanut several times a week to prevent them from developing a peanut allergy.
And the second group are the children who have mild to moderate eczema. And those children also should see an allergist get skin tested and determine if they can, they can actually have the peanut at home. They may not have to have the skin testing done, and they should start eating that when their pediatrician and the family decides it's appropriate for them to start having peanut butter. Obviously at that age they can't have whole peanuts because they might choke. And then the third group are the low risk children who don't have eczema or a mild eczema and they don't have any egg allergy. If they have like a different food allergy, may be, you still want to see the allergies just to get that checked out and they can also advise better. But those children around six months of age should start eating peanuts because we mentioned this because previously to 2017 the recommendations were to avoid peanuts until they were like three years old and they found that that does not prevent peanut allergy. The earlier, if you can introduce peanut earlier into the diet, that actually prevents peanut allergy from developing.
Host: So as always, check with your pediatrician first. But I think that's great advice and thank you for bringing that up. We appreciate it, Dr. de Asis. This has really been informative and helpful. Thank you so much for your time today.
Dr. de Asis: Thank you.
Host: That's Dr. MaLourdes de Asis and for more information or to schedule an appointment call (845) 353-9600, that's (845) 353-9600. And for more information, please visit RBallergy.com that's the letter R the letter B, allergy.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Health Track, the podcast from Montefiore Nyack Hospital. I'm Bill Klaproth. Thanks for listening.