THEN NOW NEXT
Peanut Allergies
By Jill Stefancin
Dr. Jaclyn Bjelac was awarded a Catalyst Grant for a novel study that used boiled peanuts to help patients build a tolerance for peanut allergens. | Photo: Annie O'Neill
THEN
Before 1990, food allergies were relatively uncommon. Back then, parents and grandparents fed solid food to babies — well before their first birthday — including foods that today are common causes of allergies, such as peanut. Researchers credit the rise in food allergies to the effects of an indoor lifestyle: decreased physical activity and increased sensitization to indoor allergens, hygiene and diet. Doctors began recommending that parents delay the introduction of peanut to prevent peanut allergies. In fact, in 2000 the American Academy of Pediatrics issued a now-outdated recommendation directing parents to avoid feeding peanuts to children under age 3.
NOW
Today you won’t find a peanut on an airplane or in a school cafeteria. PB&J, a staple of childhood for generations, is virtually unknown by some families. Peanut allergy is a potentially life-threatening condition for which the only approved management is strict avoidance — which can be especially tough for children and their families. Oral immunotherapy, also called desensitization, involves feeding a small, increasing dose of peanut to the allergic person over time, training their immune system to no longer overreact. Unfortunately, this type of therapy often has side effects, including abdominal pain or anaphylaxis, leading to high subject dropout rates in published studies. Funded by a Catalyst Grant, Jaclyn Bjelac, MD, Associate Director of the Food Allergy Center of Excellence (FACE) at Cleveland Clinic, began studying this therapy in children using a peanut product that is boiled rather than roasted. The proteins change when peanut is boiled, decreasing side effects during oral immunotherapy. Very few allergists offer oral immunotherapy because of the risk, logistics and time involved, according to Dr. Bjelac. However, it is effective: 70% to 80% of preschool-age patients can eat full serving sizes of the allergy-inducing food after completing the treatment.
NEXT
A team of physicians and researchers at FACE are working to better understand why the remaining 20% of preschoolers — and 100% of patients over age 5 — don’t achieve the same results. They’re seeking answers to long-unknown questions about our immune system: How does exposure cure allergies in the first place? Why doesn’t it work in all patients under age 4? What role does the immune system play? Why can’t our immune system differentiate something safe, like a peanut, from a dangerous pathogen? Preclinical data from multiple labs has already established ties between immune tolerance and the bacteria that live in our gut microbiome. Researchers are comparing patient data from successful and unsuccessful treatments to understand immune tolerance and the immune system as a whole, with the hope of identifying key factors to make these therapies effective with medication or other interventions.