Over the past several years as a result of careful studies the attitude towards peanut introduction has changed. We know that a positive blood RAST or skin test for peanut alone without a history of a reaction to peanut does not make the diagnosis of peanut allergy and many patients with low level of reactions can be introduced to peanut in the form of an open challenge in the allergist’s office. If this challenge is negative kids are encouraged to ingest peanut regularly several times a week. We also have learned that exposure to peanut dust or peanut containing creams will make patients much more reactive on oral challenge.
Peanut desensitization has been attempted over the past 15 years. The initial attempts at peanut desensitization in patients who are allergic on challenge were associated with several life threatening reactions. Recent studies with oral desensitization has been more successful demonstrating that following a slow oral tolerance protocol patients were able to tolerate limited amounts of peanut protein. This approach is not felt to be ready for prime time however and does not render the patient ‘cured’ of their allergy. The most promising approach being studied is using genetically engineered peanut protein that has been rendered non allergic but still stimulates the immune system.