As an internal medicine physician I’ve been trained to react quickly and without emotion to many kinds of potentially life-threatening medical conditions. But this training couldn’t prepare me for the recent terrifying sight of my 13-year-old son swelling up, turning red and vomiting from an exposure to nuts he didn’t realize were in his food.

I overcame my paralyzing fear to get him to the hospital emergency room quickly. I will never forget how rapidly his condition deteriorated and then happily reversed in response to an injection of epinephrine – a powerful hormone also known as adrenaline that is used to treat severe allergic reactions. The hormone was administered with an EpiPen auto-injector in the emergency room.

Food allergies are among the most dangerous allergies, and in the worst cases can be fatal. Peanut allergies are particularly hazardous. As a society, we must learn not only how to recognize and treat them, but also how to prevent them.

Unfortunately, peanut allergies are all too common. An estimated 1 out of 50 children 1 out of 200 adults in the U.S. are allergic to peanuts.

Alarmingly, peanut allergies tripled from 1997 to 2008.

It is difficult to know for certain that the food you eat is free of nuts. As with my son, the reaction can be swift and life-threatening. In fact, a large percentage of the deaths from food allergies have been due to peanuts.

A study published in Perspectives in Public Health in 2016 put it best: “Evidence suggests a combination of strategies, including natural childbirth, breast feeding, increased social exposure through sport, other outdoor activities, less time spent indoors, diet and appropriate antibiotic use, may help restore the microbiome and perhaps reduce risks of allergic disease. Preventive efforts must focus on early life.”

It isn’t just the lack of exposure to early infections, known as the hygiene hypothesis, that can cause allergies. Allergies are caused by a multitude of factors that remove us from the natural order of things.

My son had a series of ear infections as an infant, and I believe it was perpetual use of antibiotics that changed his microbiome and altered his immune response, leading to his serious nut allergies.

The microbiome is the vast army of microorganisms – trillions of bacteria, viruses and fungi – that live in every part of our bodies. When our microbiomes are disrupted – including by antibiotics – our health can sometimes suffer.

And contrary to the common belief that these microorganisms are always invading germs that are harmful to us, in reality some of these tiny living things inhabiting our bodies are essential to our health.

Understanding the complex microbiome in all of us is vital to understand how we can help the many people, including my son, who suffer from peanut allergies.

What can we do?

Several previous studies have provided hope that a mixture of probiotics and small amounts of peanuts given over time can dramatically decrease the severity of a peanut allergy.

The theory is that a slow careful introduction of the offending antigen (the substance causing an allergic reaction) leads to gradual accommodation and diminished response.

Now along comes the final proof – the gold standard – a multicenter double-blinded randomized placebo trial – published this week in the esteemed New England Journal of Medicine.

This study was sponsored by Aimmune Therapeutics, the company that makes the drug AR101, yet represents independent thinking and careful observation. A total of 372 children were studied for six months and received the drug (tiny increments of peanut protein) and another 124 received a placebo.

Dramatically, two-thirds of the children who received the treatment were able to tolerate the equivalent of two peanuts (600 mg). In contrast, only four from the placebo group could tolerate peanuts at the study’s conclusion.

Keep in mind the goal here was to avoid an allergic reaction from accidental exposure, not to be able to chomp a bag of peanuts at a ballgame, and the peanut extract drug accomplished that in a large majority of patients studied.

What was the downside?

The study found that 14 percent of patients receiving the study drug required epinephrine, versus 6 percent with a placebo. This means that the drug is not something you could take by yourself at home, but a treatment that would require careful observation.

Still, this is clearly a highly successful clinical trial, and I predict that the drug will be approved by the Food and Drug Administration and reach the market (with restrictions) soon.

AR101 and other drugs like it will save lives and improve quality of life – the goal of parents, children and physicians everywhere.

I also believe AR101 should probably be coupled with probiotics, to replenish the “good” bacteria that my son and others lost along the way to a deranged immune response, otherwise known as an allergy.

The day is coming soon when a simple drug will be able re-expose our allergic children to some of the essential proteins or microorganisms we did too good a job protecting them from.