The tricky science behind eliminating peanut allergies

Allergies are seemingly on the rise with more and more children carrying EpiPens as a potential life-saver against a fatal reaction.

Peanut allergies are the most common with approximately 1 in 50 children and around 1 in 200 adults in the UK suffering from them. They occur when an individual’s immune system mistakenly identifies the peanut protein as something harmful.

There have been several studies investigating whether children will outgrow peanut and tree nut allergies, with “figures ranging between 10 and 20% outgrowing the allergy”, said Anaphylaxis UK.

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But why are allergies increasingly common, and what can science do to alleviate them?

Why are allergies on the rise?

“I never had a kid in my class with a food allergy or sensitivity,” said Anat Binur, founder of Ukko, a company committed to solving food allergies and sensitivities. “And now I’m almost never ever on a call, in an elevator, with my neighbours, or anywhere else without someone having it in their life.”

One of the most popular theories as to why allergies are on the rise is the “hygiene hypothesis”. Based on the fact that children in developed countries have more allergies than those in developing countries, the hygiene theory suggests children who grow up in sanitised environments are not afforded the chance for their immune system to develop sufficiently.

“This lack of exposure then leads our immune system to not get accustomed or to learn and modulate itself towards allergens,” explained Binur. Processed food has also been blamed because it “messes with our microbiome and sometimes makes it more susceptible to allergy”.

What’s being done to try to manage the rise?

In 2020, food giant Nestle agreed a $2.6bn deal to buy Aimmune Therapeutics, the biopharmaceutical company that made Palforzia, a peanut allergy drug. However, just two years later Nestle was wiping its hands of the company.

Palforzia is not a cure for peanut allergies but it does “lessen the reaction”, said The Daily Upside. “Clinical trials found that two-thirds of patients who took the medication could safely handle 600mg of peanut powder – roughly two whole peanuts.”

Despite the fact that the drug works, Nestle found it an ineffective business proposition. “In addition to blaming COVID-19 for disrupting Palforzia’s rollout,” The Daily Upside continued, “the treatment came with fixed costs that were hard to justify”.

While Nestle wasn’t prepared to pay for all the data that had to be collected and submitted to the US Food and Drug Administration, above all, despite allergies being on the rise, there simply wasn’t enough demand for the drug. Less than 2% of Americans have a peanut allergy compared with around 1.1% of the global population, but far fewer were prepared “to visit an allergist every two weeks for four to five months, which includes an extra hour for observation just in case they go into shock” as the medicine required, said The Daily Upside.

What next?

Earlier this month, researchers at the University of Notre Dame and the Indiana University School of Medicine “successfully prevented potentially life-threatening allergic responses to peanuts” by developing an “allergen-specific inhibitor”, said Notre Dame News. So far, the scientists have only tested the drug on mice, but the results have proven positive.

“Our approach is unique because our inhibitor starts working before the allergen has a chance to trigger an allergic reaction,” said Başar Bilgiçer, professor of chemical and biomolecular engineering at the University of Notre Dame. Not only does a single dose of the drug provide “protection against peanut allergic reaction for over two weeks”, but when administered after the onset of symptoms, “the inhibitor stopped the progression of the allergic reaction in its tracks”.

The researchers published their results in the Science Translational Medicine journal where they stated: “Although there are treatments for symptoms in patients with allergies resulting from allergen exposure, there are few preventive therapies other than strict dietary avoidance or oral immunotherapy, neither of which are successful in all patients.” The abstract went on to conclude: “Together, these findings suggest that cHBI [inhibitor] has the potential to be an effective preventative for peanut-specific allergic responses in patients.”

The findings mark a big step forward in the race to treat and even cure allergy sufferers. Any substantial success would definitely save lives and as Nestle identified two years ago, a successful drug could also mean bumper profits for whoever gets their hands on the patent.