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Giving peanut extract under the tongue may be an even safer way to treat peanut allergies, doctors say

By Heather Simonsen, KSL TV | Posted - Jan 19th, 2019 @ 1:55pm


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SALT LAKE CITY — 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,” he said.

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.”

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

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 than oral immunotherapy, or OIT. Peanut extract is absorbed under the tongue, rather than swallowed.

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. Photo: KSL TV

Dr. Aaron Kobernick, assistant professor of Allergy and Immunology at the 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.”

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 Food and Drug Administration.

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,’” James said.

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

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

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Heather Simonsen

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