Cynthia Nirenblatt remembers giving her son Daniel a peanut butter and honey sandwich after his 1-year-old wellness visit.
“And he screamed like I had just poured shards of glass down his throat," the Mount Pleasant mother said.
He eventually started throwing up his entire stomach and broke out in hives. His screams were so intense that she said it damaged her husband's eardrum.
"All I could think was 'Who screams over this?'" she said.
Nirenblatt, like many others, found out the hard way that her son would have to navigate life with a severe peanut allergy, the most common food allergy among children, according to the American Journal of Managed Care.
A food allergy is an uncomfortable and often dangerous immune response to certain foods. Reactions can range from mild breakouts from eating the food to anaphylactic shock from just touching it. In Daniel's case, his reactions lean more toward the anaphylactic range.
Currently, there are no U.S. Food and Drug Administration-approved treatments for peanut allergies. But that may be changing soon. An advisory committee for the FDA recently voted to approve a peanut powder treatment called Palforzia that will be used to help reduce peanut allergy reactions for patients between the ages of 4 and 17.
While the committee's approval doesn't mean that patients can start requesting the treatment just yet, experts note it is likely the FDA will officially approve the treatment early next year.
“We’ve been following along for years," said Dr. Jeffrey Dietrich, a board certified specialist in adult and pediatric allergy, asthma and immunology for Charleston Allergy & Asthma.
A 2018 study by the American Journal of Managed Care noted that the prevalence of peanut allergies in the United States has increased significantly over time. Between 1997 and 2008 the prevalence tripled. And between 2010 and 2018 it increased by more than 20 percent.
Nearly 3 percent of children have a food allergy. Among those with food allergies, around 25 percent have a peanut allergy.
Dietrich describes the new treatment as more of a standardized process than what is seen now. In the past, the only treatment for a long time was to just avoid peanuts. Physicians would simply give a patient an EpiPen (epinephrine), Dietrich explained.
Eventually, experts came up with a method to slowly introduce peanuts to people with allergies. An oral food challenge with peanuts involves patients being given tiny amounts of peanut dust and water to slowly desensitize them, Dietrich said.
The process includes patients going into their allergist's office about every two weeks and getting a higher dose of peanut powder each time they go in. That way, they are observed in the office in case of an allergic reaction.
“So it requires a lot of visits," Dietrich said.
If they pass, they can eventually start eating one to two peanuts every day at home to continue the process. With the new treatment, Dietrich explained that patients will be given a standardized amount of peanut powder.
“So we know exactly how much peanut," he said.
In the Allergenic Products Committee Meeting briefing documents on the new treatment, it explains that the endpoint of the treatment is to get participants to at least tolerate 600 milligrams of peanut protein.
By comparison, one peanut contains around 180 to 200 grams of protein. While oral food challenges and Palforzia have been shown to be effective with some with patients, completing the treatment does not mean people can run off and eat a jar of peanut butter.
“Unfortunately, it has not been shown to be curative," he said.
Patients also would have to continuously take the treatment daily. Otherwise, over time, the protection would go away. And not everyone has the correct blood-test levels to go through with the treatment.
If the immunoglobulin E, an antibody made by the immune system, levels aren't high enough, then a patient can't go through with it.
“We’ve been told not quite yet for him," Cynthia said about Daniel.
Before giving Daniel the peanut butter and honey sandwich years ago, she said she would notice anytime she breastfed him after eating peanut butter he would have somewhat similar reactions.
But the sandwich was the wake-up call. After getting an allergy test, they learned that his allergies included peanuts, eggs, shellfish and tree nuts. Now 14, peanuts are still just as dangerous for Daniel as they were then.
When he would go trick-or-treating, Cynthia would ask to exchange his candy for Canadian candy that she knew for certain lacked peanut butter. Every time she goes to the grocery store, she has to always read labels, not only to make sure items don't have peanuts in them but to make sure they were not made in a factory that has peanuts.
“You have to really label check everything," said Charleston mother Inda Humes.
For Humes, it's much of the same. Three out of five of her children have a peanut allergy. Luckily for her, their allergic reactions aren't as intense as Daniel's.
But she and Nirenblatt both have trouble getting people to understand that it's not just the eating of peanuts that causes reactions. If someone makes a food item in a kitchen around peanuts, there is a chance it can cause an allergic reaction in their children.
That's partly why the new treatment is a ray of hope for the two mothers. Not necessarily because they think it would work on their children, but because it means there are people out there taking the common allergy seriously.
Fewer than 1 percent of people who have experienced an anaphylactic reaction have died from the reaction. One day, the two mothers hope that the allergy doesn't have to be on the forefront of their minds.
They especially want this for their children, who won't always have parents to rely on.
“His goal is to travel the world," Nirenblatt said about her son Daniel. "My fear is him traveling the world."