Treatment offered at a new Food Allergy Clinic desensitizes patients to peanuts
Colin Labrie was 11 months old when he took his first – and last - bite of a peanut butter sandwich. His faced ballooned and his eyes swelled shut. Every day since then has been one of constant vigilance and worry. The possibility of a life-threatening reaction, even death, is never far from their thoughts, say parents Mike and Kathy.
Now 12, Colin has become an expert at looking after himself – being on the alert, reading ingredients, and keeping one of an armory of Epipens nearby. Most recently he and his parents took a bold, new step so they could worry less.
Colin is patient of a new Food Allergy Clinic at St. Joseph’s Hospital in London, where allergists are tackling the growing incidence of peanut allergies with a leading-edge approach that’s allowing children and adults with the allergy to no longer live in fear of accidental exposure and a reaction. At the clinic, patients diagnosed with a peanut allergy who fit the criteria are offered oral immunotherapy during which a very small amount of peanut is introduced and then gradually increased to desensitize the patient to the allergen. The allergists start with 1/500 of a peanut in the form of peanut flour. If all goes well in the hospital, the patient continues to eat that amount for a month before returning to the hospital to have the amount increased.
Oral immunotherapy for peanut allergy is done at St. Joseph’s Hospital under very strict and careful supervision of allergy specialists, explains Dr. Harold Kim, Medical Director of the Allergy and Immunology Program at St. Joseph’s – the only program in Southwestern Ontario providing the therapy using a protocol that is carefully controlled and monitored.
“The goal is to make it safe for people to live in our society where there is significant risk of accidental exposure to small amount of peanut,” says Dr. Kim. “It’s about improving quality of life. Patients are excited to try this.”
It takes about one year for a patient to be able to eat one full peanut, which they will continue to eat daily thereafter to maintain immunity. While the treatment isn’t a cure, research shows it allows those with the allergy to tolerate exposure to peanuts without overreacting to them, explains Dr. Kim. He cautions, however, that the therapy is not available to patients who have had a severe, life-threatening reaction.
Colin began the treatment about 10 months ago and is now up to 150 mg of peanut flour – the equivalent of one-third a peanut.
Patients with any kind of food allergy can be referred to St. Joseph’s Food Allergy Clinic where the allergy can be definitively diagnosed using the latest, evidence-based approaches, including food challenges where the person is exposed to the food and monitored.
In the last five years, research into the growing prevalence and incidence of food allergies is revolutionizing the approach to prevention, diagnosis and treatment, says Dr. Kim. For example, where the advice was to avoid feeding a child peanuts until age three or four, the thinking now is to expose children at low risk of the allergy (those without a family history, eczema or egg allergy) to peanuts by six months of age to prevent the allergy from developing. For children at higher risk, testing by an allergist is recommended as soon as possible so treatment can be considered.
“Peanut allergies impact one to two per cent of the population,” says Dr. Kim. “If things work out like we think they will based on the research in prevention and treatment, peanut allergies should decrease.”