“Moving toward a cure”: US allergist sheds light on treatment for peanut allergies in children

25 Aug 2021 --- A treatment program designed for peanut-allergic preschoolers and babies has proven effective at helping children overcome their life-threatening food allergies, according to an allergist from Cleveland Clinic in the US.

Sandra Hong, director of the Food Allergy Center of Excellence at Cleveland Clinic, explains that a food allergy is a condition where the body’s immune system identifies a food, such as peanuts, as harmful. The immune system then launches into attack mode and releases antibodies to combat the threat. The reaction can lead to hives, vomiting or – in worst-case scenarios – constriction of airways and even death.

While data is not available on prevalence worldwide, in the US, more than 1 million children live with a peanut allergy and the knowledge that one bite of the food could be deadly. 

Of the children in the Cleveland Clinic program, more than 80 percent now possess “bite-proof” tolerance or are building up to that level, says Hong (pictured).“For us to be able to help someone move past that – it’s the most rewarding part of our careers,” says Hong.

Treatment program touted as life-changing
That optimism reflects the findings so far from an Early Peanut Oral ImmunoTherapy (EPOIT) treatment program developed at Cleveland Clinic.

Hong describes the program as life-changing – and perhaps life-saving.

In the program, children aged four and younger who are allergic to peanuts built a tolerance to peanuts by ingesting minuscule amounts of the food in a step-by-step, allergist-supervised process. Doses are increased gradually over many months.

This approach represents a reversal from clinical guidelines shared by allergists a decade ago. Looking at the older approach, Hong explains that as food allergy numbers began spiking in the US in the 1990s, doctors recommended that allergenic foods such as milk, eggs and peanuts be removed from children’s diets with a high risk of allergies.

That thinking began to change, though, as research showed that eliminating specific foods did not slow the development of food allergies.

Then came the Learning Early About Peanut (LEAP) allergy study in 2015. The study found that the development of peanut allergies decreased in at-risk children with an early introduction of the food.

“It was completely the opposite of what we had believed,” notes Hong.

Next steps in allergy treatments
Ongoing treatment programs aim to refine the treatment process that grew from the LEAP study, says Hong. More than 50 children with an identified peanut allergy are in the program.

The minimal goal is to help these children achieve at least “bite-proof” tolerance to peanuts, meaning they can consume nearly two peanut kernels without a reaction, says Hong. That protects against an accidental nibble of a food with peanuts leading to a health emergency.

“Many participants, however, see their immune system response change so much that they can eat peanut products,” says Hong. 

The key is the age of the participants, as reactions to food allergens typically are less severe in early childhood. “Their immune system is so malleable, so flexible, that they can tolerate it,” she notes. “There is this narrow window where we can do this.”

The series of peanut doses given to participants involve tiny amounts of food. In the initial treatment cycle, for example, the daily dose is 8 mg of peanut protein.A food allergy is a condition where the body’s immune system identifies food such as peanuts as harmful.

Small increases follow every two weeks if there are no setbacks, says Hong. The process takes at least four to six months, with maintenance dosing then continuing for at least a year.

Every uptick in peanut butter dosage takes place in an allergist’s office in case there’s a reaction. “This is not something you do at home,” she stresses. The child is monitored for an hour after the higher dose.

The future outlook
Of the children in the Cleveland Clinic program, more than 80 percent now possess “bite-proof” tolerance or are building up to that level.

Currently, one in five children with a peanut allergy outgrows the condition before adulthood. Hong says advances in treatment could reverse those numbers, with as many as four in five children “leaving their peanut worries behind.”

Dr. Hong believes the number of children with severe peanut allergies will soon begin to decline. “We’re moving toward a cure,” she continues, “And a lot less worry for families.”

In March, NutritionInsight reported that allergy guidelines encouraging infant peanut consumption might have reduced the risk of infant peanut allergies by up to 16 percent in Australia, according to a study by Murdoch Children’s Research Institute (MCRI), Australia. 

Dietary guidelines for parents in Australia were adjusted in 2016 to suggest that feeding infants peanuts at an early stage of life, before the age of 12 months, could help cultivate defense against peanut allergy development.

Edited by Elizabeth Green