It’s the strangest thing to watch your peanut-allergic child eat, well, peanuts. We’ve known he was allergic to the stuff since he was a tot. A sliver of peanut butter on toast brought him out in hives. Sharing a toy with a peanut-guzzling buddy gave him a rash on his hand. Hugging a pal who’d just eaten Crunchy Nut Cornflakes set his chubby young cheeks ablaze. Poor lad, we thought. It’s not fair. A peanut allergy is for life, right?
Well, often it is. Only one in five kids diagnosed with a peanut allergy will outgrow it, and usually that happens by the age of four. For a parent of a five year old with a persistent allergy, that’s frightening and dispiriting. Even though severe reactions are rare, for worried parents it’s tough to see the tragic stories shared online and in the media. Currently, one in fifty children have a peanut allergy, and the numbers are rising: 21 per cent more children have a peanut allergy now than in 2010.
But, there is a glint of hope. Peanut oral immunotherapy is arriving. It’s not a cure but does offer “bite-proof protection”, when it works. Professor Adam Fox, of the ‘Allergy London’ clinic, is offering it to young patients. He is a medical director at Guy’s and St Thomas’ and is also President of the British Society for Allergy and Clinical Immunology. So it’s fair to say that, when it comes to food allergies, he knows his onions.
My son, a longstanding patient of the clinic, met the criteria for the treatment. And now, having spent five months zipping back and forth to the Hertfordshire clinic, he can tolerate the equivalent of 1.5 peanuts every day. Given where we started, I find this astonishing.
The treatment is based on a large and peer-reviewed Canadian study, published in 2019, which proved its safety and effectiveness. Nine in ten of the 270 pre-school children who took part achieved the 300mg maintenance dose. Ten percent dropped out, either due to repeated allergic reactions, refusing to eat the dose or parental anxiety. While mild reactions are common, severe ones are rare in this treatment, and with this age group. Of the 41,000 doses in the Canadian study, only 0.029% required treatment with adrenaline.
We entered into it tentatively, firing questions at the ever-patient Professor Fox. What are the risks? Should we act now, or wait? Would he outgrow it anyway? What if he reacts? Professor Fox’s evidence-based approach is always hugely reassuring, and we decided to go for it.
The first dose is a really tiny amount of the peanut protein. Returning to the clinic every few weeks, depending on how well the treatment is going, the daily dose gradually increases to 320mg, the equivalent of 1.5 peanuts. And then it stays at that level for the foreseeable future.
Outside of the clinic, we repeated the dose at home daily following the clinic team’s strict ‘Golden Rules’ (and were drilled on our knowledge of these at each clinic visit). My son had various mild reactions requiring antihistamine throughout the process, tending to react several days after a dose increase, presumably as his body caught up with what was happening.
But we were well briefed on how to respond to a reaction, with the clinic nurse re-teaching us how to use an adrenaline pen before any peanut doses were given. In between visits, the team responded promptly to our emails. Sometimes they advised us to temporarily decrease the dose or to delay the next increase.
One unexpected benefit is that now that our son has experienced several small and well-controlled allergic reactions, he knows how to spot and describe them. I’m more hopeful than ever that if he accidentally ate something containing an allergen, he’d realise quickly and tell us.
So, while immunotherapy isn’t a cure, and while it probably isn’t for the faint-hearted, I find it massively reassuring to have got to this stage of the process and know that our son is at a lower risk of accidental exposure. Can he hug that peanut-loving pal now without getting a rash? Antihistamine-at-the-ready: maybe, just maybe, he can.