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Dr. Jonathan Bell practices peanut oral immunotherapy to tackle dangerous peanut allergies. The patients and parents start the treatment feeling a little uncomfortable but are satisfied with the results, he said. “They all come in nervous on day one, and they all go out with a smile,” Bell said.
If a patient is found to be a good candidate for treatment, Bell books them for a four- to five-hour visit. During the visit, the office administers increasing quantities of peanut flour at specific intervals starting at 0.1 milligram and going up to 6 milligrams.
“Most people are able to tolerate the top dose of 6 milligrams or one step below that, which would be 3 milligrams,” Bell said. “Whatever the highest dose that is tolerated on day one that becomes the starting dose for the protocol.”
On the second day of treatment, the patient is given the starting dose of peanut flour in the office, which is mixed with pudding, yogurt or juice. The office monitors the patient for two hours.
If the patient can handle the dose, the office provides the patient with a pre-measured daily dose of peanut flour, which he or she takes at home.
In case a child has a reaction at home, parents follow safety protocols such as having an EpiPen and quick-onset antihistamines on hand for possible allergic reactions.
Patients come to the office two weeks later — and for subsequent follow-up appointments — for an opportunity to step up their doses. For peanuts, Bell aims for a top dose of 10 peanuts a day or the equivalent amount of peanut butter.
Patients tend to take the treatment well. “Most of the reactions to the peanut oral immunotherapy tend to be very mild,” he said.
The most common reactions include mild itching of the mouth and throat, mild nausea or abdominal cramping, Bell said.
Bell said he didn’t invent the therapy, and he waited many years until he thought the treatment could be done safely before deciding to offer it to his patients.
But peanut oral immunotherapy is the most impactful treatment treatment he has ever offered. “It makes a bigger change in peoples’ lives than anything I've done previously,” Bell said.
While the treatment is available for adults and children, Bell said patients tend to be children. Parents are more interested in seeking treatment for their children than adults are in seeking treatment for themselves, he said.
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