Having a food allergy can make for a cautious existence — carefully reading food labels, being constantly aware of your surroundings and carrying an Epi-pen can all take their toll on a family’s well-being. And the problem isn’t getting any better — the rate of food allergies has been rising rapidly, with peanuts being a prime example. The main strategy for those with a peanut allergy is simple — just stay away from peanuts. But that’s easier said than done. Peanuts appear in many foods and totally avoiding the legume is nerve wracking. So researchers have turned to the peanut itself for a solution. In the mid-2000s, researchers began administering microdoses of peanuts to children with peanut allergies in an attempt to disrupt the process and desensitize the immune system. This treatment, dubbed “peanut immunotherapy,” exposes children to very small but increasing doses of peanut product, sometimes starting with less than a 1/1000th of a peanut. Once inside the body, peanut proteins trigger a cascade of immune activity. In tissues like the gut, the skin, and the respiratory system, the antibody called immunoglobulin E, or IgE, binds to white blood cells called mast cells. The food proteins get noticed by IgE, which activates the mast cells. This leads to reactions throughout the body, from hives on the skin, to stomach pain and throat swelling. Clinical trials of oral immunotherapy in food allergies have shown some promising results. In many studies, after eating slowly increasing quantities of the food for 6 to 12 months, around 70% to 80% of patients could handle higher doses than before. In one company-sponsored clinical trial, a peanut immunotherapy study of almost 500 children and teens put the subjects on a regimen stepping up through 11 dose levels over several months. About 20% on treatment dropped out of the study for various reasons, including side effects. After about a year of treatment, 96% of those who completed the treatment could consume about one peanut with only mild symptoms; 84% could tolerate two; and 63% could tolerate at least three peanuts. The company developing this capsule treatment, and a second that’s created a skin patch, are hoping to have their peanut immunotherapy products on the market as soon as next year. The therapy is not without downsides — in the case of oral immunotherapy, even children who follow the treatment precisely may experience allergic reactions. A stomach virus, physical activity or even a hot shower can provoke allergic reactions after taking a treatment dose — and sometimes the treatment can trigger a reaction for no apparent reason at all. Still, despite the uncertainty, some families with children who have food allergies welcome the respite from everyday anxiety that comes from avoiding hard-to-avoid foods. The new treatments aren’t cures, but with even more food allergy therapies in the pipeline, there’s hope that families dealing with food allergies will eventually be able to breathe a bit easier.