Allergy expert says expect cure for peanut allergy in five years

May 5 2008

The announcement by an American expert that within the next five years some form of immunotherapy will be available to treat peanut allergy, will bring relief to many concerned parents.

Allergies to peanuts has become increasingly common but the reasons for the rise in prevalence remains unclear with experts suggesting a number of possibilities.

Among them is the hygiene hypothesis, which suggest that not enough exposure to infectious agents in early childhood can increase susceptibility to allergic disease, also suggested is that the presence of peanuts in the mother's diet before birth could be risk factor for developing the allergy - none however have been proven.

The problem has become a major health concern worldwide, particularly in developed countries, and affects around 1% of children under the age of five years - research in the U.S. shows that peanut allergy prevalence in young children doubled from 0.4% in 1997 to 0.8% in 2002.

The allergy occurs because the immunoglobulin E part of the immune system connects with antibodies which causes the release of inflammatory molecules such as histamines when peanuts are ingested and reactions can range from a minor irritation to a life-threatening, whole-body allergic response called anaphylaxis.

Initial reactions usually involve the skin, approximately half involve the respiratory tract, and a third the gastrointestinal tract and children are usually diagnosed by about 14 months of age.

Symptoms occur after the first known peanut ingestion in 75% of those children eating peanuts for the first time.

Professor Wesley Burks, from Duke University Medical Center, in Durham, North Carolina says because of the potentially severe health consequences of peanut allergy, those suspected of having had an allergic reaction to peanuts deserve a thorough evaluation.

Professor Burks says all patients with peanut allergy should be given an emergency management plan, as well as epinephrine and antihistamines available at all times.

He says patients and their families should be taught to recognise early allergic reactions to peanuts and how to implement appropriate peanut-avoidance strategies and it is vital that severe, or potentially severe, reactions be treated promptly with the drugs.

Professor Burks believes patients who have had such a reaction should be kept under observation in a hospital emergency department or equivalent for up to four hours because of the possible development of the late-phase allergic response.

A number of approaches are currently being examined to reduce the impact of the condition such as the development of transgenic plants to produce hypoallergenic peanuts, but Professor Burks says as several peanut proteins are involved in the allergic response, the resulting product could be a peanut which is no longer a peanut.

Professor Burks says future treatments are all focused around curbing the immune response or inducing the immune system to tolerate a specific food allergen, possibly by introducing engineered peanut proteins as immunotherapy, where the food is ingested in increasingly larger amounts on a regular basis.

Professor Burks who is a food allergy expert, believes in the next five years that there will be some type of immunotherapy available for peanut allergenic individuals.

Professor Burks comments are published in the Lancet.