Giving Peanut Extract Under The Tongue May Be An Even Safer Way To Treat Peanut Allergies, Doctors Say

Jan 17, 2019, 9:46 AM | Updated: Jan 19, 2019, 7:35 pm

If you know or love a child with a peanut allergy, you’re aware of how difficult their lives can be. They miss out on parties and activities, and often live with fear. A Cedar City family’s immunotherapy treatment is life-changing.

James Blodgett made a gift for his allergist. “It’s got a square base. We sort of used a pencil and poked holes in it, baked it,” said Blodgett, who is 9 and lives in Cedar City.

He has a peanut allergy so severe, any contact with peanuts was life-threatening. “The life of daily fear,” said Diana Blodgett, James’ mother.

James agrees: “Most entirely difficult.” At home in Cedar City, life was a series of precautions. “When I was walking to the peanut-free table at school, I had to look out for what I was walking past, too.”

Diana Blodgett said, “No parent should have to watch their child start to have their throat close off and their eyes widen in panic.”

James Blodgett, 9, of Cedar City made his doctor, Rafael Firszt, a sculpture of a peanut to thank him for successfully treating his severe peanut allergy.

One in 50 kids has a peanut allergy. Immunotherapy research and treatment has surged the past 10 years. It slowly builds up the body’s tolerance to peanuts, under the careful care of a physician.

For a year, the family drove 16,170 miles to his doctor in Salt Lake City and back. They traveled to the Tanner clinic in Murray every Monday where they gave him micrograms of diluted peanut extract under his tongue. Then, they increased his dose over time.

“The 50 to 100 patients that have been recorded in publications have never had evidence of an anaphylactic event,” said Dr. Rafael Firszt, an allergist with the Tanner Clinic.

Applying doses under the tongue is called sublingual immunotherapy or SLIT. Firszt says it’s a good option for patients who’ve had severe reactions in the past. “If a parent was really nervous about doing oral immunotherapy, this might be a nice option to potentially bridge to oral immunotherapy,” Firszt said.

SLIT desensitizes the body more slowly that oral immunotherapy, or OIT. Peanut extract is absorbed under the tongue, rather than swallowed.

Dr. Aaron Kobernick, Assistant Professor of Allergy and Immunology, University of Utah, said, “It seems to be a little bit more safe. We see fewer systemic reactions. Again, really small numbers in these studies so we don’t know.”

Dr. Aaron Kobernick, University of Utah Health, says sublingual immunotherapy or SLIT, which is absorbed under the tongue, is safer but also slightly less effective than oral immunotherapy, or OIT, that’s swallowed.

But SLIT can be a bridge to OIT, which is what James did. After finishing SLIT, he took the treatment orally.

“There are essentially two phases to the desensitization,” Kobernick said. First, the child swallows small amounts of peanut powder diluted in Kool-Aid. Once that’s tolerated, they sprinkle it on

their food. Doctors report severe reactions requiring epinephrine 5 to 10 percent of the time. But it has proven so successful it will likely soon gain approval by the FDA.

And it worked for James. He went trick-or-treating care-free this year. “It was great,” he said. When he learned the theme for his school art contest was heroes, “I was like, ‘Dr. Firszt.’”

And that brings us back to the gift, a sculpture of a peanut, which James gave to Firszt.

Diana Blodgett said, “He can participate more fully in life. It was 100 percent worth it.”

James Blodgett, age 9, on the day he graduated from the peanut allergy immunotherapy treatment program at the Tanner Clinic in Murray, Utah. Before, he and his parents lived a life a daily fear. His reactions to the smallest exposure to peanuts were severe and life threatening.

Both SLIT and OIT require difficult time and lifestyle commitments under the care of an allergist.

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Giving Peanut Extract Under The Tongue May Be An Even Safer Way To Treat Peanut Allergies, Doctors Say