Oral immunotherapy for peanut allergy: Is it time?
What is oral immunotherapy and is it a potentially safe and effective treatment for peanut allergy in young children?
A recent study in the Journal of Allergy and Clinical Immunology showed promising results for the use of oral immunotherapy (OIT) as a potentially safe and effective treatment for peanut allergy in young children.
The goal of OIT is to make the immune system less reactive to a food allergen by eating small, gradually increasing amounts of the food over time. In this study, patients ate peanut flour mixed into soft foods such as apple sauce or pudding, every day for between 2 and 6 years (average 2.5 years). Once treatment was completed, peanut was avoided for four weeks. An oral challenge to peanut was then tried to see if there would be a reaction.
Approximately 80 percent of the children passed the challenge, and were advised to incorporate peanut into their diet going forward. The children will be followed over time to make sure they continue without symptoms when eating peanut in the future. Although not the first study to report the use of OIT for peanut allergy, the new study found a higher success rate than those completed previously.
Although the study's results are encouraging, more research is necessary to confirm the findings. Some important points to consider regarding the investigation:
Only 32 children completed treatment.
The study began with 40 infants and toddlers, but three stopped participating because they had adverse reactions during treatment, three did not qualify for treatment, and two others withdrew during therapy.
Children with a history of life-threatening peanut allergy, severe eczema, or severe asthma were excluded.
Almost all children experienced acute symptoms during treatment, including abdominal pain, vomiting, hives, congestion, and sneezing.
About half of the children required antihistamines for acute symptoms, and 1 child required an injection of epinephrine for a more serious reaction.
Children with higher blood testing levels for peanut allergy required longer treatment and were less likely to successfully incorporate peanut into their diet.
Most of the children could eat peanut a month after therapy was completed, but it is possible the treatment could wear off over time.
We cannot generalize the results of this one study to the larger population of children with peanut allergy because the number of patients in the study was small and children with life-threatening peanut allergy could not participate for safety reasons. At this time, OIT for food allergies should only be completed in allergist-supervised settings. As this study points out though, investigators are making great strides toward developing alternative treatment options for food allergy.
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