Understanding allergic diseases and how they are managed is becoming increasingly complex. Recent research is chipping away at age old practices that for decades were thought to be sound allergy advice.

The first oxymoron:

For decades allergists  have told patients to remove their furry pets from the home but recent scientific research suggests some kids who grow up with dogs and cats, and have exposure to more germs are actually  at lower risk of developing asthma and allergy later in life (Hygiene Hypothesis). Despite these findings, allergists still advise people to remove pets from the home (at least restrict them from the bedroom) if they are allergic to them.

What is the latest oxymoron?

Over the past two decades there have been many attempts to solve the peanut allergy problem. Treatment with peanut vaccines failed because of side effects. Sublingual (under the tongue) allergy therapy to date, has failed to yield promising results. But some doctors have found that giving small increasing amounts of peanut to children who are peanut allergic may effectively desensitize them. Allergy specialists at Duke University and Arkansas Children's Hospital reported on 33 peanut allergic children, 9 of whom have been tolerating peanuts for more than 2 ½ years since starting the study.

This is amazing news because once peanut allergy is established strict avoidance has always been recommended. This report sounds exciting but DO NOT TRY THIS AT HOME!

Here are some reasons to exercise extreme caution in interpreting this research:

• 1) Some children and adults may be highly sensitive to peanut and accordingly require only a trace amount to trigger a severe life threatening allergic reaction (anaphylaxis). Many peanut allergic children with a history of severe allergic reactions (throat closure or shock) may not qualify for this treatment.

• 2) The current studies using the oral ingestion method to desensitize involve too few people. More studies are needed to support these early findings before considering it as a new treatment.

• 3) It is too early to know if the tolerance to peanuts is longstanding. About 20% of children may lose their hypersensitivity over time. Researchers need to show if this percentage is higher for the children in their study.

• 4) Maintaining tolerance, once achieved, will require a period of continued peanut consumption on an established schedule. If a child or adult fails to do this a severe allergic reaction may occur. How reliable is your teenager?

• 5) Some children who achieved tolerance in the study were able to go off the daily peanut doses and continue to eat peanuts when desirable. Past research has shown some people who grow out of peanut allergy (remember about 20% chance of this) re-sensitize and become allergic again. This could be a problem for someone, who after successful desensitization has been given the green light to eat peanuts indefinitely.

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