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Of all food allergies, which affect between 5% and 8% of US children, peanut allergy is the one most likely to cause anaphylaxis, a serious type of allergic reaction. For a child with a peanut allergy, eating one peanut can literally be fatal.
“When you have an allergy,” says Andrew MacGinnitie, MD, PhD, clinical director of the division of immunology at Boston Children’s Hospital, “your body sees the thing you are allergic to as dangerous. So your immune system tries to protect you by causing hives, vomiting, and other symptoms.”
The body does this by releasing histamine and other chemicals that are designed to help your body get rid of whatever is causing the allergic reaction. Hives increase blood flow to an area so that your immune system can get to work. Sneezing helps you get rid of pollen or cat hair in your nose. And vomiting helps get rid of whatever is in your stomach. The problem is that when the reaction is severe, with an outpouring of more of these chemicals than is needed, it can lead to trouble breathing and a dangerous drop in blood pressure. If untreated, this can lead to death.
“What we’d like to do,” says MacGinnitie, “is re-educate your immune system so that it doesn’t see peanuts as dangerous. For patients with severe environmental allergies, or severe allergies to insect stings, we can give a series of shots that decrease the symptoms. However, when this was tried to treat peanut allergies, it was too dangerous.”
Instead, a different approach — feeding children who have peanut allergies small amounts of peanut to build tolerance — shows promise. In a series of studies, including one published in The Lancet in September 2019, researchers found that when they gave people with peanut allergies small yet gradually increasing amounts of peanut flour every day, 85% of them were ultimately able to eat 300 mg of peanut protein. That’s about the equivalent of one peanut.
That may not seem like much, but it’s a big deal, says MacGinnitie. “Kids with peanut allergy typically don’t want to eat lots of peanut. They just want to be protected so that accidental small exposures — like eating a donut from Dunkin’ that was next to one with peanuts — won’t trigger severe reactions.”
This research led to FDA approval of a new medication to treat peanut allergy. It is called Palforzia, and is made from peanut flour. It is approved for children ages 4 to 17. After an initial dose, 11 increasing doses are given over several months. The first time a higher dose is given it’s done in a healthcare setting, but the other doses at that level are given at home, one dose daily. When a patient can tolerate all the dosage levels, they take a dose of 300 mg peanut protein every day at home as a maintenance treatment.
That’s one of the downsides: this treatment is not a cure. When people stop taking the peanut flour, the vast majority of them lose protection.
There are other downsides too, says MacGinnitie. “About 20% to 25% of kids have anaphylaxis during the protocol. That’s about three times more than would have it if they just stayed away from peanuts.” This alone may keep many families away. He also points out that about 10% drop out because of chronic gastrointestinal complaints during treatment, such as stomachaches, vomiting, or diarrhea.
There are other treatments on the way, such as a patch with peanut protein that has fewer side effects, although it may not work as well as oral treatment.
If your child has a peanut allergy, talk with your doctor. Definitely don’t try eating peanut flour without talking to your doctor! Every patient and every situation is different. Working with your doctor, you can figure what’s best for your child and your family.
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The post Peanut allergy: A new medicine for children may offer protection appeared first on Harvard Health Blog.
Balance is a skill you don’t think about until you really need it — like when you lose your footing and have to perform an exotic improv dance to keep from hitting the ground. But don’t wait until your sense of balance fails before you give it proper attention. As we age, balance can sharply decline, often with little warning. An exercise program called BEEP can help.
While keeping proper balance may seem simple, it involves a complex system with many moveable parts. Whenever you move, your eyes and brain process information about your surroundings. Your feet detect changes in the terrain. Your arms swing to keep you stable, and your lower-body muscles and joints generate rapid power so you can move forward, stop, and change directions.
Unfortunately, this system works less effectively over time. The sensation of our bodies moving through space is not as crisp, and information travels more slowly between the body and brain. Muscles become weaker, and joints lose flexibility.
Any breakdown in your balance system increases your risk of falls, which can cause hip fractures, broken bones, and head injuries.
“Doing more balance exercises and activities can keep your sense of balance in good shape, but you also want to focus on multifaceted movements that work on all the elements of your balance system,” says Dr. Brad Manor, associate director of the Mobility and Falls Translational Research Center with Harvard-affiliated Hebrew SeniorLife.
There are many kinds of balance exercises. Science has not tapped any specific ones as the best; however, some have stood out in many balance-related studies.
For instance, a 2016 study in the journal Gerontology and Geriatric Medicine found that a specific Balance-Enhancing Exercise Program (called BEEP for short) improved balance skills among adults ages 60 to 80. Study participants did better on both solid and uneven surfaces, and increased their walking speed and overall confidence.
The BEEP program focused on three exercises: squats, heel and calf raises, and one-legged standing. “These types of exercises increase both the physical and cognition skills needed for better balance,” says Dr. Manor. “Plus, they mimic movements of everyday life.”
He recommends adding these to your regular workouts or doing them daily on their own.
Squats. Stand with your feet shoulder-width apart. Bend your knees and imagine you are sitting down on a stool. Lower down until your thighs are parallel to the ground, or as far as is comfortable. Keep your weight on your heels. Extend your arms forward or place your hands on a chair, counter, or table for stability. Pause for a second or two, then rise back to the starting position. Do this up to 10 times.
Heel and calf raises. Stand with your arms crossed over your chest and lift your heels, so you rise up on your toes. Hold this position for up to 10 seconds, or as long as possible, and then lower your heels. Do this five to 10 times. If you need support, hold on to a door frame, a table, or another sturdy object. You also can place your hands flat on a wall.
One-legged standing. Stand tall and place your hands on your hips or hold on to a table or chair for stability. Then raise one leg, so your foot is about six to 12 inches above the floor. Keep your gaze straight ahead. Hold for 20 to 30 seconds. Repeat on the other leg. Go back and forth three to five times.
You also can perform these exercises with your eyes closed to work on coordination and concentration. Another option is to “distract” yourself by doing unrelated cognitive tasks — count backward, name words that begin with the same letter, or make a mental supermarket list.
“Balance is definitely a use-it-or-lose-it skill,” says Dr. Manor. “But if you work on your balance continuously, you are almost guaranteed to see improvements.”
The post The BEEP program: Keep your balance appeared first on Harvard Health Blog.