Oral immunotherapy safe for children allergic to peanuts

A recent study has claimed that oral immunotherapy given as routine is safe for preschoolers allergic to peanuts.

Oral immunotherapy (OIT) is a treatment protocol in which a patient consumes small amounts of the allergenic food.

Although there have been many clinical trials of peanut oral immunotherapy in older children and one trial in pre-schoolers, there has been a lack of real-world data due to safety concerns of offering this treatment to preschoolers outside of a research setting, said the lead author of the study.

Children were seen by a pediatric allergist every 2 weeks, where they were fed a peanut dose that gradually increases in every visit.

Parents also gave children the same daily dose at home, between clinic visits, until they reached a maintenance dose of 300 mg of peanut protein.

Symptoms and treatment of allergic reactions at clinic visits and at home, including epinephrine use, were recorded in the patient's medical chart.

Parents were given instructions on how to manage at home-allergic reactions, when to administer epinephrine, and when to hold off on an OIT dose, such as during severe cold or flu.

The goal of our project was to confirm the safety of preschool peanut OIT in a much larger sample pf patients in the real world said  the senior author.

The researchers found that 243 children (90 %) reached the maintenance stage successfully, while 27 children or 10 % , dropped out.

It tool an average duration of 22 weeks or OIT for patients to reach the maintenance stage.

Many allergists do not believe OIT should be offered outside of research settings and have not routinely offered it as therapy for peanut allergy in their clinics due to safety concerns. We hope that our data demonstrates that the treatment is safe in preschoolers, and could be offered to families of preschool children with peanut allergy who ask for it. There appears to be a big difference in outcomes in preschoolers compared to older  children, he said.

The group now hopes to investigate the long-term safety and efficacy of peanut OIT desensitisation and sustained unresponsiveness for patients who choose to stop daily peanut OIT.

He hopes the findings provide guidance to health-care practitioners treating preschool children in their clinics said the researcher.

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Eating Peanuts After Immunotherapy May Prolong Allergy Treatment Benefits

Eating few peanuts after completing oral immunotherapy (OIT) or sublingual immunotherapy (SLIT) for peanut  allergy may provide continued protection against accidental exposures to the allergen, says a latest study. Asthma and Immunology (AAAAI) conference in San Francisco. Conducted by a group of researchers led by Edwin Kim, the study followed 55 people who completed OIT or SLIT peanut immunotherapy trials at UNC-Chapel Hill and were desensitised to between 300mg and 5,000mg of peanuts.

It is interesting to note that desensitisation increases the amount of peanut it takes to cause an allergic reaction, decreasing the likelihood of a severe reaction caused by accidental peanut exposure. Speaking about it, he said, "They don't necessarily want to eat large amounts of their allergen, they just want a level of reassurance that if a restaurant cook makes a mistake or a food label is wrong, they won't have a severe allergic reaction."

After the participants completed their immunotherapy trial, they were encouraged to introduce foods containing peanuts into their diets with a goal of about 300 mg of peanut each day.  They were also asked how much they ate, how often they ate it and how they felt afterward for follow-up.
A great number of participants continued to eat peanuts daily for up to eight years after completing immunotherapy.

Among those still eating peanuts, the median amount of daily consumption was 600 mg. No reactions from accidental ingestion were reported for the 55 participants, but ten people reported allergic reactions to the daily peanut foods they introduced into their diet.

Scientists said that majority of reactions happened to be mild and were easily treated with antihistamines. But three reactions required epinephrine and two required EMS. Although these significant reactions were not so frequent, one must not forget to seek expert opinion on the amount of peanuts that you can take.

The study was observational in nature. More longitudinal studies were required to make concrete conclusions, but researchers are hopeful that these findings could be used to study other types of food allergies too.

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Oral immunotherapy effective for peanut-allergic kids

Low-dose and high-dose of oral immunotherapy (OIT) is safe and equally effective at suppressing allergic immune responses to peanut in children, suggests a study.
Peanut OIT involves eating small, gradually increasing amounts of peanut protein daily.
Previous studies showed that peanut OIT in older children can offer some protection against potentially life-threatening anaphylaxis caused by peanut exposure. 


This study, conducted by Wesley Burks, researcher at the University of North Carolina in the US, assessed whether giving OIT to younger children whose duration of peanut allergy was short could alter the course of the allergy and allow safe introduction of peanut into the diet.

The study team enrolled 40 peanut-allergic children aged nine to 36 months. They randomly assigned participants to either high-dose peanut OIT with a target daily dose of 3,000 milligrams peanut protein or a low-dose regimen with a target dose of 300 milligrams.
Nearly all participants experienced some side effects, such as abdominal pain, but these were generally mild, and required little or no treatment. 

 After receiving OIT for 29 months on average, participants avoided peanut completely for four weeks before attempting to reintroduce it into their diets.

Nearly 80 per cent of peanut-allergic preschool children successfully incorporated peanut-containing foods into their diets after receiving peanut OIT.

In comparison to those peanut-allergic children who had avoided the therapy showed that OIT-treated children were more likely to successfully incorporate peanut into their diets, said the paper published in the Journal of Allergy and Clinical Immunology. 

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