Experimental treatment fights food allergies with hair of the dog

Experimental treatment fights food allergies with hair of the dog

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CHAMPAIGN — Starting with a tiny dose of peanut powder he got in a doctor's office, 11-year-old Kyan Pope has been gradually kicking one of his food allergies to the curb.

Diagnosed as a toddler with both peanut and sesame-seed allergies, the Champaign boy has been undergoing a nonstandard treatment called oral immunotherapy for his peanut allergy in St. Louis since this past November.

His parents, Mandy and Matt, are so happy with the results so far, they plan to start Kyan on oral immunotherapy for sesame seeds as soon as he graduates from peanut-allergy treatments, Mandy Pope said.

Oral immunotherapy works by retraining the immune system with, at first, miniscule amounts of a food, and gradually ramping up the doses.

It isn't billed as an allergy cure, though. The goal is to reduce the risk of anaphylaxis, a severe and potentially life-threatening allergic reaction, due to accidental exposure to foods people are allergic to, according to Dr. Josie Vitale, the Popes' allergy specialist at the Allergy, Asthma & Sinus Care Center in St. Louis.

"We have to start with small doses," she said.

It's a treatment that also comes with some risk — for example, anaphylaxis — so it's important to know this is nothing to try on your own at home, without careful medical supervision, Vitale said.

Finding oral immunotherapy is the first challenge, since this treatment isn't widely available outside clinical trials.

Mandy Pope said the biggest hurdle for her and her husband was getting past the fear of their son starting treatments in which he would be eating a food that has been dangerous to him.

"We didn't sleep the night before," she recalled.

Peanuts are among the eight foods most commonly responsible for the most serious allergic reactions. Most people who have a peanut allergy have it for life, though about 20 percent of kids do outgrow it by the time they become adults, according to the Food Allergy Research and Education.

Kyan Pope's first serious allergic reaction happened when he was 2, his mom said. She had offered him a taste of hummus, which commonly includes tahini, a sesame-seed paste. As soon as the hummus touched his tongue, he had a violent reaction with welts and swelling, and he began clawing at his face, Pope said.

She gave him Benadryl and took him right to the doctor, and realized later she should have taken him right to the emergency room.

Kyan's allergies to peanuts and sesame seeds were found in subsequent testing, Pope said, and since then, she and her husband have carefully taught Kyan to avoid the foods that could hurt him.

Even parental diligence isn't 100 percent foolproof, however. Kyan later had another allergic reaction after someone brought a Snickers bar to his sister's nut-free preschool, she said.

"It happens all the time," Pope said. "If you don't live it, you don't think."

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Over the course of his treatments, Kyan has steadily consumed higher amounts of peanut in powdered form without issues, she said, and "he just updosed to two full peanuts."

If all continues to go well, Kyan will finish active treatments April 28 — a day on which he's set to undergo a challenge to eat 24 peanuts in one sitting in the doctor's office. Then he'll graduate to a maintenance plan of eating eight peanuts a day at home, Pope said.

Vitale said the standard treatment for food allergies remains avoiding the foods to which people are allergic, but oral immunotherapy is an option that has been undergoing trials with some clear research to date showing it to be beneficial.

Even after successful oral immunotherapy, she said, patients still need to carry EpiPens, an emergency injectable treatment for anaphylaxis.

Generally, she and her colleagues are encouraged and excited about the results since they began offering this treatment, Vitale said.

She and other doctors at her clinic are happy to consult with families to see which patients are candidates, she said, "but we are not recommending this as a treatment for everyone."

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Carle nurse practitioner Amy Jessup said parents frequently ask about this treatment option locally and are referred to clinical trials. With results announced Feb. 20 for one oral immunotherapy trial, however, it could make its way to the mainstream as soon as next year, she said.

The phase 3 PALISADE (Peanut Allergy oral Immunotherapy Study of AR101 for Desensitization in children and adults) trial found 67 percent of AR101 patients ages 4-17 tolerated at least a 600 mg dose of peanut protein in the exit food challenge, compared to 4 percent of patients who got the placebo, according to the product developer, Aimmune Therapeutics. Aimmune said it plans to file for FDA approval for AR101 by the end of the year.

Pope said she and her husband hope the treatments Kyan has been getting will get him to the point at which he can eat freely. That would also mean she and her husband will worry a lot less about him later, when he'll no longer be living at home.

"I think college was our deep dark fear," Mandy Pope said. "The death rate increases when they get into their teens and 20s because they think they can take more risk. And also, Mom isn't there."

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