Peanut allergy advance: Oral therapy for allergy desensitization deemed safe for preschool-aged kids

18 Apr 2019 --- Oral immunotherapy (OIT) is a safe method for treating peanut allergies in children as young as nine-months to five-years of age, according to a new study led by scientists and pediatric allergists at the University of British Columbia and BC Children’s Hospital, Canada. The study examined the cases of 270 children from across Canada who were given OIT for peanut allergies between April 2017 and November 2018, finding that the majority were able to build tolerance to the allergen. Data from the research was published this week in the Journal of Allergy and Clinical Immunology: In Practice.

OIT is a treatment protocol in which a patient consumes small amounts of an allergenic food, such as peanuts, with the dose gradually increased to a determined maximum amount over a given time. The objective of the treatment is to reach desensitization, whereby a patient can ingest more of the allergenic food without triggering an adverse reaction – protecting them in the event of accidental exposure. Patients must continue to routinely consume a determined amount of the allergen to maintain this tolerance.

“Although there have been many clinical trials of peanut oral immunotherapy in older children, and one trial in preschoolers, there has been a lack of real-world data due to safety concerns of offering this treatment to preschoolers outside of a research setting,” says Lianne Soller, the study’s lead author and Allergy Research Manager at BC Children’s Hospital. “But our findings confirm in a real-world setting that this treatment is not only safe but is well-tolerated in a large group of preschool-aged children.”

Peanut-allergic children gradually build-up tolerance 
With the goal of reaching the maintenance stage, children were seen by a pediatric allergist in a community or hospital clinic approximately every two weeks, where they were fed a peanut dose that gradually increased at 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 over eight to 11 clinic visits.

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 also provided with 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 a severe cold or flu.

Majority of children reached maintenance stage
While findings of the study might do well in relieving parental anxieties, the overall success rate of the practice was not the primary focus. “The goal of this study was to look at safety of OIT, and we have not yet looked at the likelihood of re-developing the allergy,” Soller tells NutritionInsight. “If the patient decides to stop taking the dose, there is a possibility that the allergy comes back, but we currently do not know how likely that is. That is one of the future goals of our study.”

Still, the research builds a compelling case. The study found that 243 children (90 percent) reached the maintenance stage successfully, while 27 children (10 percent) dropped out. Reasons for dropping out were listed as repeated allergic reactions, the child refusing to consume the daily dose and parental anxiety. It took an average duration of 22 weeks of oral immunotherapy for patients to reach the maintenance stage.

Although nearly 68 percent of preschoolers experienced at least one allergic reaction during the build-up phase, the researchers found the majority of reactions were mild (36.3 percent) or moderate (31.1 percent). Only 0.4 per cent of children experienced a severe reaction and 11 children (4 percent) received epinephrine.

“We were impressed that among over 40,000 doses of peanut that were administered, only 12 resulted in reactions requiring epinephrine,” says Dr. Edmond Chan, the study's Senior Author. 

Rethinking home-administered oral immunotherapy
Dr. Chan, a pediatric allergist, Head of the division of Allergy and Immunology at UBC and a clinical investigator at the BC Children's Hospital, says he hopes the findings provide guidance to health-care practitioners treating preschool children in their clinics.

 “Many allergists do not believe OIT should be offered outside of research settings, and have not routinely offered it as a therapy for peanut allergy in their clinics due to safety concerns,” he says. “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.”

The industry shifts to accommodate consumers with allergies
The plight of eating out for people with allergies has come to the fore in recent times. Headline-grabbing incidents have drawn attention to the risk many people with allergies face and has, arguably, renewed attention on this space. Research from the UK Food Standards Agency (FSA), in partnership with Allergy UK (AUK) and the Anaphylaxis Campaign (AC), last year also noted that over half of young people with a food allergy or intolerance have avoided eating out in the last six months due to their condition. This highlights the shift needed in the industry to cater to such consumers.

“Free-from” foods have gone far beyond the niche in recent years and this dynamic has not really slowed. Innova Market Insights reports a 16 percent CAGR in food & beverage launches with a free-from claim in recent years (Global, 2013-2017). These products accounted for 24 percent of food & beverage launches reported in 2017. NPD growth in the free-from space was clear at the International Food & Drink Event (IFE) show in London, March 17-20, where the “free-from” movement was on full display. 

By Benjamin Ferrer