New Therapy May Benefit Some Kids With Peanut Allergies

Peanut allergies are among the nine most common food allergies, affecting approximately 1%-2% of the U.S. population, causing mild responses like nausea and stomach cramps to severe anaphylaxis, which can be life-threatening.

Traditionally, these allergies are managed through strict avoidance to prevent severe reactions. But, new research suggests that gradually exposing kids with high-threshold peanut allergies to peanut butter may build their tolerance and reduce the severity of their reactions.

What the Researchers Learned About Peanut Allergies

Kids with a high-threshold allergy can typically tolerate a larger amount of peanut before experiencing a reaction, while kids with a low threshold have a high sensitivity and can experience a reaction even with trace amounts.

“Most studies have focused on those who react to tiny amounts,” says Scott H. Sicherer, MD, professor of pediatrics, director of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai, and one of the researchers on the study. “We hoped that focusing on the group with the higher threshold and doing oral immunotherapy using a simple regimen under strict allergist guidance could be helpful.”

Prior studies that led to the Food and Drug Administration’s (FDA) approval of oral peanut immunotherapy (Palforzia) have focused on people who react to small amounts of food allergens, such as half a peanut or less. According to Sicherer and his team, an estimated 800,000 children in the U.S. with high threshold peanut allergy could benefit from the treatment strategy examined in this study.  

“About half of the population of people with peanut allergy [can] eat about a half of a peanut kernel without a reaction but have reactions to larger amounts, possibly severe reactions,” he says.

The goal, according to Sicherer, was to see if a different, less expensive approach to peanut oral immunotherapy would work. They randomized 73 children between the ages of 4 and 14—38 to the peanut ingestion (or oral immunotherapy) group and 35 to continued avoidance of peanuts.

The children in the peanut ingestion group began with a minimum daily dose of 1/8 teaspoon of peanut butter. The researchers gradually increased the dosage every eight weeks over 18 months, ending at 1 tablespoon of peanut butter or an equivalent amount of a different peanut product.

“We found that our regimen in this special group…resulted in most of the children being able to ingest a meal-size amount of peanut while taking their daily therapeutic dose of peanut oral immunotherapy,” says Sicherer. “When we had them avoid the daily dose for eight weeks, most could still eat the full serving.”

How This Therapy Can Help

According to Lisa Sammon, DO, a pediatric allergist and director of Allergy and Immunology at Akron Children’s Hospital, who is not affiliated with the study, this research confirms several observations she has witnessed with her patients over the years.

“Many peanut-allergic children can actually tolerate higher amounts with regular and sustained introduction in the home setting,” says Sammon. “The key is recognizing that a significant portion of peanut-allergic children may not be highly sensitized and would benefit from guided introduction and escalation of peanut. Most study participants tolerated [more than] 9 grams of peanut protein or the equivalent of 3 tablespoons of peanut butter.”

Eventually, this regimen could help kids with high-threshold peanut allergies to eat meal-size amounts of peanut butter like other foods in their diet, says Sicherer. “However, we would not call this a ‘cure.’ We only tested those who had success with a two-month time off treatment and not everyone held this high threshold to eat full amounts. Longer times off any peanut may result in more loss of protection.”

Finding Out If This Therapy Is Right For Your Child

Sicherer cautions that these findings are not something parents should try at home due to the risks of severe reaction involved. Some of the children had allergic reactions and one was treated with epinephrine for a reaction related to the treatment, he says. Nonetheless, this study has many allergists excited about what it could mean for their practices and patients.

“This can change our practice,” says Mahboobeh Mahdavinia, MD, PhD, director of allergy and immunology at UTHealth Houston. “The initial challenge and escalation of doses can be done in allergist offices and continue to be done at home under guidance.”

If you think your child could benefit from a peanut regimen like the one in the study, Sammon recommends looking for an allergist with an established oral immunotherapy program. Clinicians should be specifically trained and experienced in peanut introduction methods and know how to manage potential complications.

“The recent study findings further emphasize the need to utilize shared medical decision-making with families to discuss that much more options exist for patients with peanut allergy than in prior years,” says Sammon.

What This Study May Mean Long-Term for Peanut Allergies

While these results are promising, Sammon notes food allergy management is not a one-size-fits-all approach. “Individuals can vary in their levels of reaction threshold and yet others will still prefer avoidance regardless of reaction risk.”

Due to these individual factors, Sammon says allergists cannot guarantee that such treatment approaches will be long-term, but families should discuss treatment goals with allergists, as they can help to set expectations.

Sicherer says ideally more studies would validate the safety and efficacy that his team found. “But allergists may wish to pursue this if they and their patients are comfortable—which will require shared decision-making conversations and caution.”