Dear Dr. Roach: Why can’t people see an allergist to alleviate their peanut allergy? As a child, I was allergic to things like dust, pet hair, and milk, but I did seek treatment. I’m not bothered by any of these now. It seems prudent to desensitize people with life-threatening allergies, such as peanut allergies.
SS
Allergy immunotherapy continues to be a commonly used and effective treatment for many allergies, including environmental allergies, insect venom allergies, and, more recently, food allergies. This treatment can also be used for peanut allergies, but it is not complete. Therefore, it is not used very often.
The goal of immunotherapy is to make the patient tolerant to the allergen that is causing the allergic reaction. This involves giving very small amounts of the allergen, below the level that causes an allergic reaction. If you look very carefully, the amount of allergens increases over time. For allergens such as pollen, it is usually given by subcutaneous injection (or drops under the tongue), while for food allergens it is given orally.
Reactions are common during oral immunotherapy, especially in cases of peanut allergy. Approximately 1 in 1,000 doses required emergency treatment with epinephrine under the supervision of an allergist. Even during home maintenance therapy, reactions occurred 3.5% of the time and required treatment at 0.7% of all doses administered.
Oral immunotherapy is effective in making people tolerant to peanuts, but the effects are short-lived, with only 13% surviving peanut attacks three years after discontinuing maintenance therapy. (His 37% of those who continued maintenance therapy were able to tolerate the peanut challenge.)
It is unlikely to recommend oral immunotherapy to people with peanut allergy until outcomes are significantly improved. However, it is different if you cannot effectively avoid exposure to peanuts and keep having recurring reactions. Patients are still advised to use caution and seek immediate emergency treatment, whether or not they are receiving immunotherapy.
A new treatment for food allergies has been approved by the U.S. Food and Drug Administration. Omalizumab works by blocking the immunoglobulin IgE, which is very important in allergic diseases. This study showed that 47% to 80% of subjects treated with omalizumab (injected every 2 to 4 weeks) for 4 months were able to tolerate standard doses of the food they were allergic to (at least peanuts). it was done. Other he has two foods). However, the effects of treatment are not thought to be sustained after treatment is discontinued and are intended to be used in conjunction with food allergen avoidance to prevent accidental exposure.
In the future, combining this new drug with oral immunotherapy may be more effective than using either alone, and may reduce serious or fatal injuries caused by accidental peanut exposure. It can prevent allergic reactions. Further research on this issue is underway.
Dr. Roach regrets not being able to respond to individual letters, but will incorporate them into his columns whenever possible. Readers can email questions to him at ToYourGoodHealth@med.cornell.edu.