A nut a day keeps the doctor away

Tessa sat on a second-floor hospital bed at El Camino Hospital eating a cup of applesauce, as her mother and two nurses stood by, waiting for an allergic reaction. The applesauce contains only a placebo this time — oat flour — but if it had peanut, sesame or egg in it, the nurses would need to be ready to jump in and save Tessa’s life.

That’s because Tessa, along with millions of other children in the United States, suffers from severe food allergies. In an effort to help kids overcome such allergies, the Sean N. Parker Center for Allergy Research is running 11 groundbreaking clinical trials to desensitize kids like Tessa to the foods that could kill them.

In a process called oral immunotherapy, kids eat very small doses of the food they’re allergic to, like peanuts, and slowly work up the dosage without triggering an allergic response. By the end of the trial, kids can eat up to eight peanuts without any reaction.

People from all over the world are drawn to the allergy research center, where most of the breakthrough clinical trials in oral immunotherapy take place. There is no known cure for food allergies, but research shows kids can be desensitized and no longer run the risk of a severe allergic reaction — the next best thing for parents looking to keep their kids safe. Over 1,000 people are on the waiting list to get into the clinical trials, according to Whitney Block, research nurse practitioner at the Lucile Packard Children’s Hospital.

Tessa’s mother, Robyn Bash, flew to Mountain View from her home in Maryland in hopes that Tessa and her other daughter, Rebecca, will be eligible for the clinical trial. Tessa is allergic to peanuts, sesame and eggs, and Rebecca is allergic to hazelnuts and cashews.

“We’re excited and hopeful to be even considered,” Bash said.

Allergic reactions can be deadly, and Bash’s daughters run the risk of going into anaphylactic shock when exposed to those foods. Anaphylaxis is a violent, whole-body response that causes swelling so severe it can prevent a person from breathing.

Bash said both kids have experienced anaphylactic shock multiple times — a terrifying experience that caused the girls’ lips and face to swell up to three times the normal size. EpiPens, a portable shot of adrenaline commonly used to treat anaphylactic shock, is the family’s lifeline for dealing with the allergic reaction, Bash said, and she has them ready at all times.

“We have EpiPens everywhere,” she said.

The allergies add another level of difficulty in their day-to-day lives, Bash said, as she and her husband have to closely watch everything Tessa and Rebecca eat, and prepare all of their meals. Any hint of nuts in the food, she said, can trigger Tessa’s strong reaction to peanuts and put her in another life-threatening situation.

But supervision can go only so far, and Bash said she has concerns as her kids get older and spend more time away from home. She said seemingly low-risk activities, such as playing on a playground, can pose a threat because there’s always that slim chance someone left a piece of food around.

Across the hallway from Tessa and Rebecca, 7-year-old Audrey was successfully consuming her 75 milligrams of peanut without an allergic response. Not long ago, she couldn’t handle 6 milligrams without stomach pain as she worked up her tolerance. Despite the improvement, upping the dosage still puts her mother, Katherine Hochstetler, on edge.

“It’s scary building up an immunity, especially since she’s spending more time out of the home,” Hochstetler said.

Through oral immunotherapy, kids with a peanut allergy can reach a point where they can eat 2 grams of peanuts, or about eight peanuts, without any problems.

It takes about six months of steadily increasing dosage amounts to get there, and upping the amount too fast triggers allergic responses. A new trial could bring that time down to eight to 10 weeks by doing the desensitizing regimen while injecting patients with Xolair, a medication to suppress allergic reactions.

Block said kids like to set goals for themselves along the way to claim victory over their allergies by doing things they couldn’t do without being desensitized.

“They have things like ‘I want to eat a Reese’s Peanut Butter Cup,’ or ‘I want to go to a sleep-away camp,'” Block said.

A growing issue

Food allergies have become a top health issue as rates of the condition in children continues to increase. About one in 12 people under age 21 have a doctor-diagnosed food allergy in the U.S., and that rate just about doubles every decade, according to the Stanford School of Medicine. Of those kids, one in four will experience a near-fatal anaphylactic shock.

Not all food allergies are the same. Kids react to different food allergies with different levels of severity, but peanut, cashew and wheat allergies generally cause some of the worst reactions, according to Whitney Block, a research nurse practitioner with Lucile Packard. Other food allergies may not be as bad, but the foods themselves are more pervasive and hard to take out of the household environment completely, such as eggs and milk.

She said the one upside to wheat allergies, lately, is the recent gluten-free diet trend that has many companies producing more options for people who can’t eat wheat products. Even Girl Scout cookies are on board, adding two new flavors of gluten-free cookies. But with food allergies, everything is a dietary minefield. The gluten-free cookies contain peanuts, milk, eggs and soy.

There’s no real scientific consensus on what is causing the rate of food allergies to increase, according to Block, but there are a lot of theories. One of them is the “hygiene hypothesis,” which states that modern hygiene and excessive cleanliness interferes with the development of the human immune system, causing the body to develop allergic reactions to food, according to the Food and Drug Allergy Care Center at the University of California, Los Angeles.

Block said other theories point to hormones present in food as the culprit, but the reality is that the cause of the increase in food allergy cases largely remains a mystery.

Schools no longer treat individual food allergy cases as anomalies, and have policies and guidelines for how to avoid accidental exposure to food allergens. At Oak Knoll Elementary in Menlo Park, where Audrey goes to school, there is a “peanut-free” table during lunch, and a special form parents can fill out so school staff members can identify symptoms of an allergic reaction.

Bash said she went out of her way to talk to the teachers and make sure Rebecca’s allergies were well known by the school when she started kindergarten last year. She said the teachers are trained to use EpiPens, and she made it clear to teachers they shouldn’t hesitate to give her child a shot of adrenaline even if it turns out to be a false alarm.

How long does it last?

The question parents often ask Block is whether their kids have to continue eating 2 grams of the foods they’re allergic to for the rest of their lives. She said more research is still needed for a concrete answer on how dependent kids will be on their daily dosage of peanuts, milk, or other foods, but some studies show there is some flexibility.

It turns out that after eating eight peanuts a day for long enough, kids have been able to stop eating peanuts for a brief period of time, then resume eating peanuts again without any problems. How long kids can stay desensitized to allergies without their fix still needs to be figured out.

Block said it’s possible that one nut a day could be enough to maintain tolerance to a food allergy, and kids could eat it daily like a pill or vitamin.

There is nothing keeping some kids from going over two grams as well. One trial showed that nine kids who built their way up to 2 grams could eventually handle 4 grams without any problems, according to Block, meaning accidental ingestion of peanuts and other allergen foods shouldn’t be a problem.