Dr. Wesley Burks is leading the charge in a possible revolution in the world of food allergies from his lab in the Medical Sciences Research Building.
Burks, chief of the division of allergy and immunology in the department of pediatrics at Duke University Medical Center, is conducting studies in oral and sublingual immunotherapy that have made it possible for some children with once-fatal peanut allergies to safely consume peanut products. His subjects receive low doses of peanut daily—increasing from minute to larger doses over a period of years—that desensitize their immune systems to the consumption of peanuts. Some patients can tolerate between 10 and 20 peanuts after several months of treatment, Burks said.
“It’s a level of protection you’re affording them that they didn’t have before,” he said. “Before the study they all had reactions to literally less than one-sixth of a peanut.”
Burks said there are two concrete goals in the peanut allergy testing: desensitization and, in the long term, complete immunization. Participants can receive either oral immunotherapy, in which they swallow a powder with a carefully measured dose of peanut product, or sublingual treatment, in which the subject holds the powder below the tongue before swallowing, Burks said.
He noted, however, that currently patients’ tolerance is not a complete solution for the allergy, because the tolerance is not necessarily permanent.
“It’s still a study,” Burks said. “There are lots of things that we have to learn about it, the good and the allergic side effects. We really need to do that before it becomes the standard of care.”
Cautious optimism
Freshman Shannon Kalsow lives with a hypersensitive peanut allergy that she says her allergist described as a 10 out of 10 in severity.
“If I smell it, I feel uncomfortable. If I touch it, I’ll get hives up my arm. Eating it is fatal,” she said.
Kalsow recently took the first steps toward participating in one of Burks’ studies, but said she feels uneasy about the process because her allergist at home warned against going “anywhere near treatment.” Still, the opportunity to build up a tolerance for peanuts is appealing.
“I do have complete faith in Dr. Burks,” Kalsow said. “He’s doing a lot of good for a lot of people who just want to go to dinner with their family and not have to worry what the tiramisu was made next to.”
Kalsow has not decided whether or not to participate in the study but said she is strongly considering it.
Providing peace of mind
Some patients have already experienced some relief through the study. After a four-year pilot study that concluded in January, 12-year-old J.P. Hainline can eat up to eight peanut M&Ms whenever he wants. His mother, Janie Hainline, called the oral immunotherapy “life changing.”
J.P. grew up with a fatal peanut allergy discovered when he was 18 months old when he let out a strange cry after biting into a peanut butter cracker.
“He couldn’t talk because his throat was so swollen, and he began vomiting and breaking out in hives,” Janie Hainline said.
When Janie Hainline heard of Burks’ research, she thought it seemed reasonable and practical.
After her son graduated from the pilot study, Janie Hainline, formerly an intensive care nurse, began working in Burks’ office as a clinical research nurse.
J.P. still carries an EpiPen, but no longer constantly fears having a fatal reaction. Janie Hainline said her son can now do everything the other kids on his soccer team can, adding that the peace of mind is “worth its weight in gold.”
Broader implications
Burks has worked with a team of researchers for 20 years, starting in Arkansas before moving to Duke.
“In the U.S. there are about 3 million people with a peanut allergy,” he said. “We just saw, really, an unmet medical need, particularly for children that needed some type of proactive treatment.”
Before any therapy was available, Burks said all he could do was explain how to avoid peanuts and limit the effects of a reaction when it occurs.
This therapy offers hope of a more lasting immunity, and should the work with peanut allergies succeed, it could have major implications for the field at large.
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