{"id":19310,"date":"2019-01-23T14:45:31","date_gmt":"2019-01-23T19:45:31","guid":{"rendered":"https:\/\/www.med.unc.edu\/medicine\/?post_type=podcast&#038;p=19310"},"modified":"2023-06-06T13:56:49","modified_gmt":"2023-06-06T17:56:49","slug":"peanut-allergy","status":"publish","type":"episode","link":"https:\/\/www.med.unc.edu\/medicine\/news\/chairs-corner\/podcast\/peanut-allergy\/","title":{"rendered":"Peanut Allergy &#8211; with Dr. Wesley Burks"},"content":{"rendered":"<p class=\"lead\">Dr. Wesley Burks discusses peanut allergy in this second episode of our Conversations on Food Allergy podcast series. Dr. Burks addresses anxieties families have concerning peanut allergy, how to respond to a reaction, and describes the current research and treatments. Dr. Wesley Burks is the Curnen Distinguished Professor in the Department of Pediatrics at UNC and he is the Executive Dean for the School of Medicine. Dr. Burks is a pediatric allergist and immunologist and sees patients at UNC who have food allergies, and is the Executive Director for the UNC Food Allergy Initiative.<\/p>\n<!--[if lt IE 9]><script>document.createElement('audio');<\/script><![endif]-->\n\t<div class=\"wp-playlist wp-audio-playlist wp-playlist-light\">\n\t\t\t<div class=\"wp-playlist-current-item\"><\/div>\n\t\t<audio controls=\"controls\" preload=\"none\" width=\"1118\"\n\t\t\t><\/audio>\n\t<div class=\"wp-playlist-next\"><\/div>\n\t<div class=\"wp-playlist-prev\"><\/div>\n\t<noscript>\n\t<ol>\n\t\t<li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/03\/peanut-allergy.mp3'>Full-Length Track<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/peanut-allergy-rise.mp3'>Rise in Allergic Disease<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/peanut-allergy-immunotherapy.mp3'>Allergy Immunotherapy<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/peanut-allergy-anxiety.mp3'>Dealing with Anxiety about Allergy<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/peanut-allergy-research.mp3'>The Future of Peanut Allergy Research & Treatment<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/peanut-allergy-reaction.mp3'>Responding to a Reaction<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/peanut-allergy-resources.mp3'>More Resources on the Web<\/a><\/li>\t<\/ol>\n\t<\/noscript>\n\t<script type=\"application\/json\" class=\"wp-playlist-script\">{\"type\":\"audio\",\"tracklist\":true,\"tracknumbers\":true,\"images\":true,\"artists\":true,\"tracks\":[{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/03\\\/peanut-allergy.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Full-Length Track\",\"caption\":\"\",\"description\":\"\\\"Peanut Allergy with Dr. Burks - Full-Length\\\" from Peanut Allergy with Dr. Burks by UNC Department of Medicine: Dr. Ron Falk. Released: 2017.\",\"meta\":{\"artist\":\"UNC Department of Medicine: Dr. Ron Falk\",\"album\":\"Peanut Allergy with Dr. Burks\",\"year\":\"2017\",\"length_formatted\":\"25:34\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/peanut-allergy-rise.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Rise in Allergic Disease\",\"caption\":\"\",\"description\":\"\\\"peanut-allergy-rise\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"4:54\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/peanut-allergy-immunotherapy.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Allergy Immunotherapy\",\"caption\":\"\",\"description\":\"\\\"peanut-allergy-immunotherapy\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"7:23\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/peanut-allergy-anxiety.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Dealing with Anxiety about Allergy\",\"caption\":\"\",\"description\":\"\\\"peanut-allergy-anxiety\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"4:59\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/peanut-allergy-research.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"The Future of Peanut Allergy Research & Treatment\",\"caption\":\"\",\"description\":\"\\\"peanut-allergy-research\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"3:54\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/peanut-allergy-reaction.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Responding to a Reaction\",\"caption\":\"\",\"description\":\"\\\"peanut-allergy-reaction\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"2:24\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/peanut-allergy-resources.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"More Resources on the Web\",\"caption\":\"\",\"description\":\"\\\"peanut-allergy-resources\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"0:54\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}}]}<\/script>\n<\/div>\n\t\n<div class=\"image-section\">\n<figure class=\"thumbnail wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium\" src=\"https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2018\/12\/peanut-allergy-image2.jpeg\" alt=\"image2\" width=\"300\" height=\"200\" \/><figcaption class=\"caption wp-caption-text\">Dr. Wesley Burks<\/figcaption><\/figure>\n<\/div>\n<div class=\"alert alert-grey\">\u201cYou have to ingest the food to have serious life-threatening reaction\u2014it\u2019s not touching it, it\u2019s not smelling it, it\u2019s not sitting next to somebody in school or a ballgame\u2026That\u2019s not going to cause an allergic reaction\u2014you have to eat the food. That\u2019s the biggest thing for a family to understand.\u201d<br \/>\n&#8211; Dr. Burks on peanut-allergic reactions<\/div>\n<p><b>Ron Falk, MD:<\/b> Hello, and welcome to the Chair\u2019s Corner from the Department of Medicine at the University of North Carolina.<\/p>\n<p>Today\u2019s episode is part of our series focused on food allergy; and we will be discussing peanut allergy.<\/p>\n<p>We welcome Dr. Wesley Burks who is an expert in peanut allergy. Dr. Burks is the Executive Dean for the School of Medicine. He is a pediatric allergist and immunologist and sees patients who have food allergies. We\u2019re really excited that he is here today. Welcome, Wesley Burks.<\/p>\n<p><b>Wesley Burks, MD:<\/b> Thank you, Dr. Falk. It\u2019s nice to be here.<\/p>\n<h3><span class=\"blue\">Rise in Allergic Disease<\/span><\/h3>\n<p><b>Falk:<\/b> There\u2019s a lot of discussion about peanut allergy, and we\u2019re learning more and more about it. Many of our listeners have a relative or a friend who has this allergy. Is peanut allergy really becoming more common, or is it something that\u2019s always been there and we\u2019re just better identifying it?<\/p>\n<p><b>Burks:<\/b> It\u2019s interesting to look at the last four decades of allergy\u2014allergic diseases in general, asthma, allergic rhinitis, atopic dermatitis and food allergy, because they\u2019re all related. What we\u2019re seeing in food allergy is a tripling in the last two decades of the disease; peanut allergy actually parallels that. It\u2019s the third most common allergy as far as foods in the US with milk being the most common and egg second. What you hear in the public is that peanut is often the one that\u2019s associated with life-threatening or life-ending disease, but it\u2019s not the most common food allergy that we see.<\/p>\n<p>If we compare to the 1980\u2019s, again the prevalence is significantly different, with the same way to diagnose them, with doing a food challenge to prove that you\u2019re allergic\u2014so there is a real difference.<\/p>\n<p><b>Falk:<\/b> Why? What\u2019s triggered this?<\/p>\n<p><b>Burks:<\/b> I\u2019ll digress for a second. If you go to a lecture about diabetes, or autoimmune diseases, or allergic diseases, the people presenting those diseases, their first five or six slides are the same. They talk about the environment, they talk about the change in the microbiome, the diesel particulate exhaust, change in other behaviors that we see in the industrialized Western society. All of those diseases I see as immune-related diseases have seen changes in the last couple decades that we don\u2019t see in the non-industrialized societies. Food allergies are just one of those that are much more common now than they were several decades ago.<\/p>\n<p><b>Falk:<\/b> There is this hypothesis, roughly termed <i>\u201cThe Hygiene Hypothesis,\u201d<\/i> that would suggest that in fact we should be exposed as infants to dirt, to the environment, and that the rise in these diseases is that we have avoided our environment and a dirty environment when we were kids.<\/p>\n<p><b>Burks:<\/b> That hypothesis was really put forth in the late 1980\u2019s, and there are some really good studies in Eastern Europe from the late 1990\u2019s, early 2000, in East Germany, taking families that had grown up on a farm. You have to really dissect out what the differences are, but basically the families that had kids that grew up in the farmhouse, with a cow literally in the kitchen, who were exposed to endotoxin and other bacterial contaminants really do have a different prevalence of disease.<\/p>\n<p><b>Falk:<\/b> Much less.<\/p>\n<p><b>Burks:<\/b> Much less. How that relates though, to what we might see here in the inner city which is really not a clean environment but it\u2019s different than a cow in the kitchen in East Germany, we don\u2019t see the decreased prevalence in the inner city. So, it\u2019s not just cleanliness\u2014it\u2019s specific things that are introduced early on in life that really change our immune system, and the hygiene hypothesis is what I alluded to earlier, with the microbiome, diesel particulate exhaust, all those things playing a part. I don\u2019t think there is one reason, I think it\u2019s a combination of them that is ongoing.<\/p>\n<p><b>Falk:<\/b> Everyone should take their kids, move to a farm, and roll around in the dirt. If you are concentrating on peanut allergy, are there specific risk factors that separate out those people who have peanut allergy from milk allergy?<\/p>\n<p><b>Burks:<\/b> Not really, the risk for allergic disease is inherited\u2014allergic rhinitis, food allergy, atopic dermatitis together. So, if you have a parent that has one of those diseases, the child has a forty percent chance of having one of those diseases. If the mother has asthma, the child might have allergic rhinitis. If you have both parents, or a parent and a sibling, it goes up to about sixty percent plus, and the parent might have asthma and the child might have food allergy. It\u2019s allergic disease to allergic disease, that\u2019s the biggest risk. The only slight risk for peanut allergy is if another family member already has it, then there\u2019s a slight increase, but most of the inheritance is allergic disease to allergic disease.<\/p>\n<p><b>Falk:<\/b> If you\u2019re a parent who has asthma or allergic rhinitis, let alone both, your kid has a much higher chance of having food allergy.<\/p>\n<p><b>Burks:<\/b> Or any of the allergic diseases, including food allergy.<\/p>\n<h3><span class=\"blue\">Allergy Immunotherapy<\/span><\/h3>\n<p><b>Falk:<\/b> There are a number of efforts to try to decrease the possibility of your child having a reaction to a peanut or to milk, and there has been a lot of work which you are doing much of, of immunotherapy or if it isn\u2019t immunotherapy, then tolerance to a food particle. Can you tell us about that?<\/p>\n<p><b>Burks:<\/b> If a family has a child with allergy, specifically peanut allergy, they live in fear that their child will accidentally ingest peanuts at home, in a contaminated food when they go out to eat, at their grandparents\u2019 house, and they have a life-threatening reaction. The chances of that happening are relatively small but they\u2019re unpredictable. So, what the family wants is some protection from an accidental significant reaction.<\/p>\n<p>Studies are done with types of allergy immunotherapy. Immunotherapy has been done for over a decade for allergic rhinitis and asthma, for airborne allergies like grasses and tree pollen, and basically the concept is to give that person back what they\u2019re allergic to in increasingly larger amounts over time to change their immune system.<\/p>\n<p><b>Falk:<\/b> Allergy shots.<\/p>\n<p><b>Burks:<\/b> Right, so those are the injections that people get, you grew up with kids getting shots. The concept of allergy immunotherapy we took to foods to give them what they\u2019re allergic to, to try to raise their tolerance level. As an example, most children who are allergic to peanuts will react to about a third of a peanut, so not very much. If you do a type of immunotherapy, whether it\u2019s oral, or sublingual, or epicutaneous, at 6 months to 12 months into it, they\u2019ll tolerate somewhere between 5 and 20 peanuts before they have a reaction, so their tolerance level goes up, but only while they\u2019re on the therapy.<\/p>\n<p><b>Falk:<\/b> Why can\u2019t you do a peanut allergy shot? Why does it have to be oral?<\/p>\n<p><b>Burks:<\/b> If you look at allergic disease in general, the most likely way you\u2019ll cause a really bad reaction is by giving something IV, and then intramuscular injection is the next way to cause anaphylaxis or a life-threatening allergic reaction. The least likely way to give a reaction is to give it orally, so we\u2019re trying to take the safest way that you can give peanut back to cause the changes in the immune system. People have tried injection with peanut immunotherapy, there were studies in the early 1990\u2019s and there was a patient who died from that. There\u2019s a resurgence now with a modified peanut to try to do that, but just in general whether it\u2019s a drug or a food, if you give something intramuscularly or IV, you increase your chances of having a really bad reaction significantly.<\/p>\n<p><b>Falk:<\/b> So what you\u2019re doing now is literally grinding up peanut and putting it between the cheek and gum?<\/p>\n<p><b>Burks:<\/b> No, we actually buy peanut powder from an international candy company, and the powder has some other things in it. We weigh it out and give it to the patient mixed with food and that\u2019s the dose that they take that day.<\/p>\n<p><b>Falk:<\/b> They drink it?<\/p>\n<p><b>Burks:<\/b> They put it in a food, in applesauce or ice cream or something soft, and eat the food. The amount that they put out and the regulations for it are not different than you might expect for a drug, because we\u2019re giving them something to change the immune system, so the regulatory hurdles that we face as far as how to give the peanut product\u2014we don\u2019t just buy a product off the shelf and give that to them. We have to make sure it doesn\u2019t have bacterial contamination, we have to make sure it has all the peanut proteins in it, all the things that you might do if you\u2019re giving someone a drug like amoxicillin\u2014it\u2019s the same process, it just happens to be a food.<\/p>\n<p><b>Falk:<\/b> How successful is it?<\/p>\n<p><b>Burks:<\/b> There are different types of immunotherapy\u2014there\u2019s oral, sublingual\u2014liquid concentrated peanut, and there\u2019s a company that has an epicutaneous one which is a patch. The main ones we\u2019re studying here are oral and sublingual. The oral\u2014about fifteen percent of children cannot tolerate it because they have such significant GI symptoms in the first few weeks when they start it. If they\u2019re in the 80 plus percent of those who can tolerate it, most all of them will get to that tolerance level in six months where they can tolerate it quite easily.<\/p>\n<p>The sublingual is to take peanut and put it in liquid. That liquid concentrate is taken with a dropper and put under the tongue\u2014four, five, six drops put underneath the tongue. They try to hold it for a couple of minutes and then they swallow it. That\u2019s a traditional form of allergy immunology that\u2019s used for grass and tree pollen and other things, it\u2019s been done for a long time. There are products approved in the US for sublingual therapy for grass, weed and timothy grass, and that changes your immune system like it does for oral and epicutaneous. It has fewer side effects than oral and it\u2019s more effective than epicutaneous, so it\u2019s kind of a midpoint between those two types of treatments. All of them, the effect begins to go away once you stop the treatment. If you were treated for five years, unless you continue to expose them to peanut in some way, it begins to wear off. It doesn\u2019t wear off as fast as people thought. Dr. Kim and others have done studies that have shown the decay in that protection, and it\u2019s longer than people thought, but it will dissipate over time unless you continue to allow them to, what I think of as \u201csee the peanut\u201d in some way.<\/p>\n<p>We\u2019re not asking them to ingest peanuts, but it gives them a level of protection that they\u2019re not going to eat six peanuts.<\/p>\n<p><b>Falk:<\/b> Because that\u2019s the fear\u2014the fear is that you go to somebody\u2019s house and they have peanuts and some way or another, unbeknownst to the individual they\u2019re eating peanuts. It\u2019s not an effort to allow someone to eat peanuts again or for the first time, it\u2019s an effort to protect them of a catastrophic adverse moment.<\/p>\n<p><b>Burks:<\/b> Yes. One of the interesting things that I\u2019ve learned personally is that a lot of us started doing this, we did it to make the disease go away. That\u2019s what you want to do, you give them a treatment and make it go away. What we quickly realized, literally the first year, the parents really didn\u2019t care about that\u2014all they wanted was that protection, and they\u2019ll do a lot to raise that threshold so their child won\u2019t have an accidental reaction. They didn\u2019t really care that their child couldn\u2019t have peanut butter and jelly sandwiches, but they did care that there was that threshold, so it really changed our approach. Those are really different goals.<\/p>\n<h3><span class=\"blue\">Dealing with Anxiety About Allergy<\/span><\/h3>\n<p><b>Falk:<\/b> Right. If you\u2019re a parent listening to this discussion, and you have not had the opportunity of immunotherapy, and you\u2019re reasonably concerned that your child has a peanut allergy, what do you do to make sure to the best of your ability that you can protect your child? You can\u2019t keep them in a bubble.<\/p>\n<p><b>Burks:<\/b> I think that what I talk about with a family\u2014if their child is two or three or maybe seven or eight, ten or eleven, or high school or college, each discussion in that age range, and depending on the child and what they can tolerate. I had discussions in clinic this week with two young adolescents, at that point they can really begin to know and own the disease. When they\u2019re going out to eat, they can say <i>\u201cI\u2019m allergic,\u201d<\/i> and they can help, and the more they can do that, the more comfortable they are and their parents are.<\/p>\n<p>The big thing to understand in this for a family is that you have to ingest the food to have serious life-threatening reaction\u2014it\u2019s not touching it, it\u2019s not smelling it, it\u2019s not sitting next to somebody in school or a ballgame, the child that is peanut-allergic doesn\u2019t like to smell it. They intuitively know, <i>\u201cThat makes me feel bad.\u201d<\/i> It\u2019s not going to cause an allergic reaction\u2014you have to eat the food. It may only be a quarter or a third or a hundredth of a peanut\u2014it may not take a lot but you have to eat it before you\u2019re going to have a life-threatening reaction. That\u2019s the biggest thing for a family to understand.<\/p>\n<p><b>Falk:<\/b> The worry of a parents might also be, <i>\u201cI have a child with a food allergy, a peanut allergy.\u201d <\/i>What are the chances of another child, a sibling now being at risk. One hundred percent, five percent?<\/p>\n<p><b>Burks:<\/b> No, less than the majority of them are at risk. You can tell relatively early in life if the sibling has allergic rhinitis, other allergic disease. They\u2019re more likely to have peanut allergy. If the first couple years of life they have no atopic dermatitis, they don\u2019t have any allergic symptoms, the likelihood of peanut allergy is small.<\/p>\n<p><b>Falk:<\/b> Do you introduce peanuts to a sibling slowly, just to make sure this isn\u2019t a problem? Are there guidelines?<\/p>\n<p><b>Burks:<\/b> There are guidelines. This is a fascinating history that I\u2019ve seen in my lifetime. When I grew up, in the field the advice and guidelines based on animal studies told us as pediatricians to help people avoid the food\u2014so avoid milk for a year, eggs for two years, peanuts and tree nuts for three years. I was around when people developed the guidelines. People did that for a few decades and this change in prevalence happened, and people began to study that and the opposite of introducing allergenic foods in the first four to six months of life. A landmark study was done about three years ago in London, and the international guidelines have changed.<\/p>\n<p>If you have a child who is not allergic to anything else, no allergic family history, give them peanut butter\u2014not peanuts\u2014at four to six months. If you have a child from a family that has allergic disease, unless they\u2019re not having allergic dermatitis or another risk factor, give them peanut butter at four to six months. The last one would be if you have a family that has another peanut allergic child, and they have allergic dermatitis, they can be tested with either a skin test or blood test. If it\u2019s negative, give them peanut butter. All three of them, once you introduce peanut in their diet, they\u2019re not going to develop peanut allergy later on.<\/p>\n<p><b>Falk:<\/b> And it doesn\u2019t make any kind of difference what kind of peanut butter it is?<\/p>\n<p><b>Burks:<\/b> No. The interesting thing about that is, there are differences in peanut oils. This may be more than you want to know at this point, but it does make a difference to families. Chick-fil-A, one of our favorite places to eat, uses peanut oil to cook in, so for a family that is acquainted with peanuts, this peanut oil is actually heat-processed so all the protein\u2019s gone and you can\u2019t have a reaction unless the protein is there. If you go to Carrboro, to the health food store, and they make peanut butter by grinding up peanuts with a mortar and pestle, then the protein will leech into the oil\u2014that\u2019s cold pressed. That peanut oil does have protein in it. It\u2019s important for families to understand that.<\/p>\n<p><b>Falk:<\/b> So the cold-pressed variety, that is a risk?<\/p>\n<p><b>Burks:<\/b> It has protein in it and you can react to it.<\/p>\n<p><b>Falk:<\/b> So heat killed or cold pressed are very different. That\u2019s an interesting difference.<\/p>\n<h3><span class=\"blue\">The Future of Peanut Allergy Research &amp; Treatment<\/span><\/h3>\n<p><b>Falk:<\/b> Where\u2019s the research headed?<\/p>\n<p><b>Burks:<\/b> Three big things. One would be a treatment that would give families the comfort level that their child has some protection from an accidental reaction, because that\u2019s really their main anxiety about all of this. A treatment that has fewer side effects than what we have now, and a treatment that you can continue to expose them to the treatment bur it\u2019s not really a daily treatment like it is right now\u2014so the first part is trying to change the treatment from where we are right now.<\/p>\n<p>The second part would be how we understand the mechanism of the treatment that would allow us to do something different, a generation or two generations from now. Any study you do, as you well know, if you design it appropriately, whatever answer you get is really good because it informs your next study. If it\u2019s a result that\u2019s not as positive as you want, if you do the right mechanistic study or laboratory study with it, you can do something better the next time.<\/p>\n<p>The third area would be, <i>\u201cHow do you identify a peanut-allergic patient that really is at risk for life-threatening disease?\u201d<\/i> Not everybody is. It\u2019s a really small percentage of children who have that, and right now we can\u2019t tell that person from the next one. Everybody lives in fear of a severe, accidental reaction. Even in all of the peanut-allergic kids, particularly those in the first few years of school, is really, really small.<\/p>\n<p>It\u2019s interesting to think back a few decades about therapy with families and the dichotomy of what they want and what we thought they would want. I think that most families now understand it as a situation of equipoise. We have some treatments that will become available in the next three or four years, therapy is in Phase III studies, the epicutaneous we talked about is in Phase III and will likely be approved. If you are a child of a five-year-old who has peanut allergy, your child goes a year and a half before they have an accidental reaction, they don\u2019t have symptoms every day, but you live in fear every day that they\u2019re going to, if you put both of those treatments with side effects and you have to do something every day, if you\u2019re giving them oral immunotherapy and they\u2019re having hives or wheezing and you\u2019re giving that protection from an event that doesn\u2019t happen very much. You have to think about, what\u2019s really your goal out of thinking that they need treatment. It\u2019s an important thing to think about, as treatments are approved, it will be an individual parent-family discussion. What are they most concerned about and what\u2019s the most likelihood, treatment or not treatment that will address those concerns?<\/p>\n<p><b>Falk:<\/b> Is there any research, other than the study in eastern Europe with the cow in the kitchen, is there an effort to determine what you need to expose your infant to, to decrease the possibility of allergic symptoms?<\/p>\n<p><b>Burks:<\/b> There are relatively good studies throughout the world. There are some better ones being done in the US, in rural Wisconsin, some in Australia\u2014to try to identify the factors that might play a part in decreasing the likelihood of that child developing allergic disease. They really take decades to play out, because you need to look at the outcome and it\u2019s not a year or two-year outcome.<\/p>\n<p><b>Falk:<\/b> So for now, everyone should bring a cow into their kitchen..<\/p>\n<p><b>Burks:<\/b> Right. For the kids.<\/p>\n<h3><span class=\"blue\">Responding to a Reaction<\/span><\/h3>\n<p><b><\/b><b>Falk: <\/b>If you\u2019re<b> <\/b>watching your child have a food allergy,<b> <\/b>in this case a peanut allergy, what should you do?<\/p>\n<p><b>Burks: <\/b>The types of symptoms that a child will have from a peanut allergy reaction are skin, GI and respiratory. The skin symptoms are hives, itchy rash. GI symptoms are vomiting, really severe abdominal pain, and respiratory symptoms are, <i>\u201cmy throat feels funny,\u201d <\/i>or start to wheeze, cough will be part of that\u2014that\u2019s the constellation of symptoms. Each of us that take care of food-allergy patients\u2014peanut are a little bit different, but it\u2019s a general category\u2014if you eat something and you feel like it has peanuts in it and they have a hive or two on their face, they\u2019ll take the antihistamine. If they have symptoms really from their chin, throat down, <i>\u201cmy throat hurts,\u201d<\/i> or they start wheezing, coughing, hives all over, start to have vomiting, they need to take their epinephrine and seek medical care right away and not wait at home for it.<\/p>\n<p>There are some that might suggest if the child eats something and you know it has peanuts in it, give the epinephrine right away. I wouldn\u2019t do that. I think if you wait to see because you might suspect that it\u2019s there but it isn\u2019t. If you have symptoms from your chin, throat down, that can be life-threatening so take the epinephrine and antihistamines and go see the doctor.<\/p>\n<p><b>Falk:<\/b> It\u2019s an EpiPen or an injectable form of epinephrine and an antihistamine like Benadryl for example. But the other message is not, if you have two systems, skin and respiratory, skin and GI, you probably need to take the epinephrine and go to the emergency room.<\/p>\n<p><b>Burks:<\/b> Yes. It\u2019s interesting that most of us feel like the skin symptoms are a harbinger of something bad, but then probably 75-80% of the life-ending reactions do not have skin symptoms, they\u2019re respiratory symptoms which is why the adult who will have a life-threatening reaction is basically an asthma reaction.<\/p>\n<p><b>Falk:<\/b> So respiratory symptoms alone, skin symptoms or not, time to take the epinephrine and go to the emergency room.<\/p>\n<h3><span class=\"blue\">More Resources on the Web<\/span><\/h3>\n<p>&nbsp;<\/p>\n<p><b>Falk:<\/b> If you were to give advice for a trustworthy source of information on the web, any thoughts?<\/p>\n<p><b>Burks:<\/b> If you Google peanut allergy, you\u2019ll get a million hits. For a family that has not been seen and given good information, then it will be really scary for them and they\u2019ll get a lot of misinformation. There are two sites that I would recommend. One from a lay organization called FARE, Food Allergy Research and Education and that web site is foodallergy.org. Then the UNC web site for the Food Allergy Initiative. Those are both good. The FARE site has everything from how to diagnose, to recipes for families. The UNC web site is about the studies being done here and other places.<\/p>\n<p><b>Falk:<\/b> Thank you, Dr. Burks, for this wonderful amount of information.<\/p>\n<p><b>Burks:<\/b> Thank you, it\u2019s good to talk to you.<\/p>\n<p><b>Falk:<\/b> Thanks so much to our listeners for tuning in. If you enjoy this series, you can <a href=\"https:\/\/itunes.apple.com\/us\/podcast\/unc-department-of-medicine-chairs-corner\/id1076686662?mt=2\" target=\"_blank\" rel=\"noopener noreferrer\">subscribe to the Chair\u2019s Corner on iTunes<\/a> or <a href=\"https:\/\/www.facebook.com\/UNCDeptMedicine\" target=\"_blank\" rel=\"noopener noreferrer\">like the UNC Department of Medicine on FaceBook<\/a>. In our next episode, we will welcome Dr. Scott Commins and have a discussion on meat allergy or alpha-gal allergy. Thanks so much.<\/p>\n<div class=\"alert alert-blue width:100% \">\n<p><strong>Visit these sites for information on peanut allergy.<\/strong><\/p>\n<ul>\n<li><a class=\"external-link\" title=\"\" href=\"http:\/\/www.aaaai.org\" target=\"_blank\" rel=\"noopener noreferrer\">American Academy of Allergy, Asthma &amp; Immunology<\/a><\/li>\n<li><a class=\"external-link\" title=\"\" href=\"http:\/\/www.foodallergy.org\" target=\"_blank\" rel=\"noopener noreferrer\">Food Allergy Research and Education (FARE)<\/a><\/li>\n<li><a class=\"external-link\" title=\"\" href=\"\/pediatrics\/specialties\/air\/food-allergy\" target=\"_blank\" rel=\"noopener noreferrer\">UNC Food Allergy Initiative<\/a><\/li>\n<li><a class=\"external-link\" title=\"\" href=\"http:\/\/www.med.unc.edu\/www\/about\/administration\/office-of-the-dean\/school-leadership\/bios\/a-wesley-burks-m-d\" target=\"_blank\" rel=\"noopener noreferrer\">UNC School of Medicine bio for Dr. Wesley Burks<\/a><\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<p>\/\/ <\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dr. Wesley Burks discusses peanut allergy in this second episode of our Conversations on Food Allergy podcast series. Dr. Burks addresses anxieties families have concerning peanut allergy, how to respond to a reaction, and describes the current research and treatments. Dr. Wesley Burks is the Curnen Distinguished Professor in the Department of Pediatrics at UNC and he is the Executive Dean for the School of Medicine. Dr. Burks is a pediatric allergist and immunologist and sees patients at UNC who have food allergies, and is the Executive Director for the UNC Food Allergy Initiative.<\/p>\n","protected":false},"featured_media":6006,"menu_order":0,"template":"","meta":{"_acf_changed":false,"layout":"","cellInformation":"","apiCallInformation":"","_links_to":"","_links_to_target":""},"podcast-category":[635,639],"class_list":["post-19310","episode","type-episode","status-publish","has-post-thumbnail","hentry","podcast-category-podcast-food-allergy-series","podcast-category-podcast","odd"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Peanut Allergy - with Dr. Wesley Burks | Department of Medicine<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.med.unc.edu\/medicine\/news\/\/news\/chairs-corner\/podcast\/peanut-allergy\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Peanut Allergy - with Dr. Wesley Burks | Department of Medicine\" \/>\n<meta property=\"og:description\" content=\"Dr. Wesley Burks discusses peanut allergy in this second episode of our Conversations on Food Allergy podcast series. Dr. Burks addresses anxieties families have concerning peanut allergy, how to respond to a reaction, and describes the current research and treatments. Dr. Wesley Burks is the Curnen Distinguished Professor in the Department of Pediatrics at UNC and he is the Executive Dean for the School of Medicine. 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