Kevin Dooms, MD, FAAAI
Swedish Allergy/Immunology
A new study published in the New England Journal of Medicine suggests a potential treatment for children 4-17 years old who are highly allergic to peanut.
Study results were announced November 18, 2018, at the annual meeting of the American College of Allergy, Asthma, and Immunology (ACAAI) in Seattle.
The proposed treatment is called oral immunotherapy, or “OIT”. During OIT, patients gradually ingest small amounts of peanut over the course of 6 months. If patients tolerate the treatment and become “desensitized” to peanut, then they continue eating the equivalent of two whole peanuts every day.
A majority of children (67%) reached the goal of the treatment: to decrease the risk of a serious or life-threatening reaction from accidental peanut ingestion. A few adults (18 years or older) were included in the study, though they did not appear to respond to the treatment.
Study authors emphasize that oral immunotherapy is not a cure for peanut allergy. Almost all the patients in the study (99%) experienced some kind of side effect, ranging from chronic stomach discomfort to worsening of eczema, asthma, or other allergic conditions. Some patients (20%) could not tolerate the side effects from OIT and had to stop the treatment. A small number of patients (14%) experienced unpredictable and serious allergic reactions from OIT and needed to be treated urgently with epinephrine.
Patients who are successful with OIT will likely need to continue indefinitely, possibly for life. Once patients stop taking OIT, they will likely go back to being allergic again.
Even with its limitations, this study may give hope to patients with peanut allergy. Experts estimate 1 in 50 children has a peanut allergy. Peanut allergies can be associated with severe or life-threatening allergic reactions, though it can be difficult to predict when or how a reaction may occur. Experts estimate the risk of fatality from food allergy to be 1 in 1,000,000. If approved by the FDA in the next 1-2 years, peanut OIT could significantly improve patient quality of life by decreasing the anxiety and risk associated with accidental severe reactions.
There are currently no FDA-approved treatments for food allergy. Research currently is underway for other types of desensitization therapies (e.g. a patch on the skin) and for different kinds of foods (e.g. milk, egg, and tree nuts). Experts discourage patients and families from attempting “do it yourself” food allergy treatment at home.
The OIT study took place in multiple centers across several different countries. There is also potential for bias: the study was sponsored by Aimmune Therapeutics, a company that hopes to sell a peanut OIT product in the future. Most researchers in the study have financial relationships with Aimmune Therapeutics. So far, we do not know the cost of the product or whether it will be covered by insurance.
Overall, food allergy experts are cautiously optimistic about the findings in this new study on peanut oral immunotherapy. If approved by the FDA, patients will need to have an informed discussion with their allergist regarding OIT, making an honest assessment about potential risks and benefits. Ultimately, it may be peanut-allergic patients themselves who decide whether or not OIT is a successful treatment option.