New experimental drug offers hope for those with peanut allergies

An immunotherapy drug may allow allergy sufferers lead more normal lives.

ByDr. Johanna Kreafle and Dr. Sumir Shah
November 20, 2018, 4:05 PM

A new experimental drug may help allergy sufferers lead more normal lives. The drug, called AR101, is seeking FDA approval, and a new study has shown the results it produces in kids and teens. It doesn’t cure the peanut allergy, but it allows those who suffer from it to have a less severe reaction.

These allergies are no joke. People with peanut allergies often have to change the way they travel, where they eat and how they live. Exposure -- even in very small amounts -- can lead to skin rashes, trouble breathing or even death.

Historically, once an allergy developed -- often at a young age -- parents had few options except watching over their child, and doctors would advise lifelong avoidance. For many children this meant showing up to birthday parties with their own treats, and taking a slew of medications.

What kind of symptoms and reactions do kids have to foods they’re allergic to?

For some kids, an allergic reaction to a particular food may just be an uncomfortable tingle in the lips and mouth. For others it’s a medical emergency that is severe and even life-threatening. Food allergy symptoms usually take between a few minutes and two hours to develop after eating the offending food. The most common signs and symptoms include:

- Tingling or itching in the mouth

- Hives or itching of the skin

- Swelling of the lips, face, tongue, and throat or other parts of the body

- Nasal congestion

- Difficulty breathing

- Stomach pain, nausea, vomiting

- Dizziness, lightheadedness

Some children develop anaphylaxis, the severe reaction which can be life-threatening and includes a constriction of airways making it difficult to breathe, a severe drop in blood pressure, rapid pulse, dizziness, lightheadedness, or loss of consciousness. People with symptoms of anaphylaxis should use their epinephrine auto-injector if they carry one and go immediately to the ER.

The new study, which used a representative survey of parents of nearly 40,000 U.S. children, found about one in five children who have a food allergy have gone to the ER for food allergy-related symptoms at least once in the previous year. This data is in line with previous research which showed there was nearly a 200 percent increase in food-induced severe allergic reaction ER visits from 2005 to 2014 among 5 to 17-year-olds.

What Are the Treatments We Now Have for Severe Allergic Reactions?

For some people a mild allergic reaction can mean a skin rash and itchiness in the throat. For these people doctors recommend close monitoring of what foods might be causing this, and ingestion of antihistamines like Benadryl and Pepcid.

If you see someone having a severe allergic reaction it is important to act quickly and immediately call 911. At the scene you can use an epinephrine auto-injector and try to keep the person calm.

In the hospital, doctors will often treat the person with antihistamines and steroids through an IV, as well as epinephrine injected directly into the muscle of the thigh or arm to treat the reaction and blunt a possible reoccurrence at 4 - 6 hours after the initial exposure.

What is AR101?

A Cambridge University group showed in 2014 that by using a processed form of peanut flour they could induce a less severe allergic reaction over time in children. Now a new study called the PALISADES trial has presented a new option that is showing promising results – with AR101.

In the study, published in the New England Journal of Medicine, researchers took people who were highly allergic to peanuts, unable to tolerate even half of a peanut without severe symptoms, and gave them either a placebo powder or AR101.

AR101 is oral immunotherapy medication that is derived from peanuts themselves. The researchers exposed the group to small amounts of peanut-derived powder. The goal was not to cure the allergy, but rather to allow minor or accidental exposures to occur without setting off a life-threatening reaction.

After months of ingesting the oral drug, many of the children we able to tolerate the equivalent 2 - 4 peanuts with a minor reaction, or no reaction at all. There were some challenges. Adverse reactions cause by the treatment caused 11 percent of the drug group to drop out and 14 percent of children in the drug group ended up using an epinephrine auto-injector for drug-related reactions. This is not a medication to start at home.

That being said, as almost one in fifty American children are allergic to peanuts, this new drug is likely to have a high demand. But there are questions that still need to be answered. We do not know the long-term effects of ingesting allergens and we do not know how long the dampened immune reaction will last. Yet, most parents would agree that eating a small pill daily to no longer live in fear is a small price to pay. However, it’s unknown how much the drug would cost.

Johanna Kreafle, M.D. is an emergency medicine physician at the Carolinas Medical Center in Charlotte, North Carolina, and a member of the ABC News Medical Unit.

Sumir Shah, M.D. is an emergency medicine physician in New York City, and a member of the ABC News Medical Unit.