Peanut Allergy: Advances in Treatment Over the coming year, the peanut allergy space will likely transform from relying on strict avoidance as a long-term management option to introducing multiple available therapies. These advances will inevitably come with challenges to managing care.
Christopher Parrish, M.D., FAAAAI, FACAAI Assistant Professor of Pediatrics and Internal Medicine UT Southwestern Medical Center
Maryam Tabatabai, Pharm.D. Senior Director, Drug Information Magellan Health Services
An allergy is when the immune system reacts in a potentially harmful way to a normally harmless substance. In the U.S., 1 in 13 children has food allergies, and an estimated 40% of those with food allergies are allergic to more than one food.1 Peanut allergy is among the most common food allergies in the U.S., impacting 2.5% of children and 1.2% of the overall population.2, 3 Moreover, peanut allergy is the leading cause of food-allergy-related deaths in children.4 The prevalence of the allergy more than tripled from 1997 to 2008, and, according to a 2017 study, it has increased by 21% since 2010.5, 6 Thus, although the allergy resolves in an estimated 20% of children, it is conceivable that the number of adults living with the allergy will increase in the decades to come. After the publication of a landmark study showing that early introduction of peanut may reduce the risk of developing peanut allergy in high-risk infants,7 the National Institute of Allergy and Infectious Diseases (NIAID) published an addendum to its guidelines detailing when to introduce children to peanut-containing foods. The NIAID recommended adding peanut protein to the diet of infants with severe eczema, egg allergy, or both at age 4 to 6 months; of infants with mild to moderate eczema at 6 months; and of infants with none of those conditions at any time appropriate for the family.8 In 2019, the American Academy of Pediatrics updated its guidelines to recommend introducing allergenic foods, including peanut protein, into babies’ diets at as early as 4 to 6 months of age, in an effort to reduce the risk of developing food allergies.9 This is contrary to prior recommendations of avoiding allergens. Peanut is the food allergen most commonly associated with anaphylaxis, which occurs when the patient ingests the peanut protein.1 Symptoms of food allergy vary. Skin symptoms such as hives or swelling are most common. Anaphylaxis is a severe, potentially fatal, systemic (whole-body) reaction that may include skin symptoms and/or some combination of wheezing, shortness of breath, repetitive cough, throat swelling, vomiting, stomach cramps, diarrhea, dizziness, confusion, and other symptoms. According a 2012 survey, annual costs associated with food allergies in U.S. children totaled $24.8 billion, with $4.3 billion in direct medical costs.10 The majority of these medical costs are tied to emergency
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