By Megan Tseng
Pop quiz: what affects 1 in every 200 adults, 1 in every 50 children, and roughly 5 million people overall?
Answer: the peanut allergy.
The prevalence of this disease may come as a surprise. “Peanut allergy” sure does sound a bit juvenile, but as all allergic people know, it is anything but. In light of this, an unexpected treatment has recently joined the fight.
In children, #peanutallergies are among the most common food allergies.
The allergic reaction is caused by certain proteins in peanuts. When these allergens enter the body of someone allergic, they are recognized by dendritic cells in the immune system, and trigger an immune response. These dendritic cells signal several other types of immune cells, which begin to produce signaling chemicals called cytokines. Eventually, cytokines signal the release of IgE, an antibody. Antibodies usually facilitate the destruction of dangerous pathogens; however, they can be harmful in the context of an allergic reaction. IgE triggers the production of inflammatory chemicals, causing many of the severe symptoms associated with peanut allergies, including anaphylaxis.
Until recently, there was no treatment for people allergic to peanuts. They simply steered clear of peanut-containing foods. Since blood pressure plummets during an anaphylactic reaction, epinephrine was used to constrict the blood vessels and thereby save lives in case of an emergency.
On January 31 of 2020, the United States Food and Drug Administration approved Palforzia, the first-ever peanut allergy drug. As a form of oral immunotherapy, or OIT for short, Palforzia is different from other common medications. It contains purified peanut powder, and gradually increases in dosage until it reaches a routine daily dose.
Palforzia, a drug developed by the biopharmaceutical company Aimmune Therapeutics, utilizes OIT in treating peanut allergies.
The basis for this treatment method came about from a two-phase OIT study conducted at Stanford University, which enlisted subjects with confirmed peanut allergy. In the first phase, 95 participants were given peanut powder OIT daily in increasing doses, and 25 participants were given a placebo. After 24 months’ time, the participants were “tested” for peanut tolerance. A shocking 83% of peanut powder OIT subjects passed, while only 4% of placebo subjects passed. The OIT subjects who passed continued on to the second phase of the research, during which some of them were given steady daily doses of peanut powder, and others were given placebos. After a year, the participants were tested again, and the success rate of peanut OIT subjects was 24% higher than that of placebo subjects. From this data, the creators of Palforzia at Aimmune Therapeutics were able to understand the two essential steps of reducing the severity of peanut allergy: gradual desensitization, followed by routine maintenance.
Look at this way; in peanut-allergic people, the immune system has a “peanut-phobia.” When an immune cell encounters a peanut particle, it gets scared and mobilizes the entire immune system to attack it, creating more serious problems for the body than a simple peanut invasion. Palforzia counters this reaction by slowly teaching the immune system that peanuts are not dangerous. The initial doses introduce miniscule amounts of peanut to the immune system. After a while, the immune system “gets used to it,” and the dosage increases. By the time the Palforzia reaches its highest dosage, the immune system has essentially “conquered” its fear of peanuts, and will not panic in the case of a small peanut encounter. This process utilizes desensitization; the body’s responsiveness to peanut stimuli is gradually diminished. After this obstacle has been overcome, Palforzia is taken in regular daily doses to make sure the immune system doesn’t return to its original “peanut-phobic” state. This maintains the hard-earned results of the desensitization process in the first part of the Palforzia treatment.
It is important to keep in mind that Palforzia is a dangerous #medication. Since it uses an allergen to treat an allergy, it can cause anaphylaxis and other allergy symptoms in those who are allergic.
However, Palforzia only desensitizes you to small amounts of peanut; you’ll be okay if you sit next to a friend eating peanuts, or accidentally ingest a bit of it, but you’ll still have an allergic reaction if you swallow the whole bag.
Palforzia increases the tolerance of peanuts until it is no longer a major threat in daily life.
So unfortunately, chomping PB & J sandwiches is still out of the question-- but at least, we can say goodbye to peanut-free lunch tables.
"The Current State of Oral Immunotherapy (OIT) for the Treatment of Food Allergy." American Academy of Allergy, Asthma & Immunology, 4 Feb. 2020, www.aaaai.org/conditions-and-treatments/library/allergy-library/oit.
"Few people with peanut allergy tolerate peanut after stopping oral immunotherapy." National Institutes of Health, 13 Sept. 2019, www.nih.gov/news-events/news-releases/few-people-peanut-allergy-tolerate-peanut-after-stopping-oral-immunotherapy.
Miller, Sara G. "How Do EpiPens Work?" Live Science, 24 Aug. 2016, www.livescience.com/55872-how-do-epipens-work.html.
The PALISADE Group of Clinical Investigators. "AR101 Oral Immunotherapy for Peanut Allergy." The New England Journal of Medicine, Massachusetts Medical Society, 22 Nov. 2018, www.nejm.org/doi/full/10.1056/NEJMoa1812856.
Sanders, Laura. "The FDA has approved the first drug to treat peanut allergies." Science News, 4 Feb. 2020, www.sciencenews.org/article/fda-first-drug-peanut-allergies.