Children May Overcome Peanut Allergy with Oral Immunotherapy

Around 2% of children in the U.S. suffer from a peanut allergy. But a new study suggests that young kids may be able to overcome their allergy by ingesting small amounts of peanut protein powder. The oral immunotherapy induced remission of the allergy in one in five children, according to a new study funded by the National Institutes of Health (NIH).

Hope for the Future

Having a peanut allergy can be fatal. The most severe allergic reaction is anaphylaxis, a sudden and potentially deadly condition that requires immediate medical attention and treatment. Patients may experience vomiting, a sudden drop in blood pressure, fainting, and blue or pale skin.

The issue can be particularly dangerous for children, who rarely have control over what they eat. That’s why an increasing number of schools are going “nut-free”. That means no more peanut butter and jelly sandwiches in the cafeteria unless the child brings it from home. Many schools and organizations would rather ban the food outright than practice “allergy awareness” by carefully monitoring the food in school.

Over the last few years, awareness of the issue in children has increased as has the number of cases of peanut allergies in children being reported. A 2017 study reported that peanut allergy in children had increased 21% since 2010.

But help may soon be on the way.

The “IMPACT” clinical trial involved 150 children ages 1 to 3 at five academic centers around the country. Only children who had an allergic reaction after eating half a gram of peanut protein or less were eligible to join the study.

The peanut protein powder was mixed in with oat flour.

They received increasingly large portions of the powder, up to 2 grams, over a 30-week period. The children then ate either peanut or placebo flour for another two weeks to create a control group.

At the end of the therapy, the children ate up to a maximum of 5 grams of peanut flour before avoiding peanuts entirely for six months. Finally, the children participated in a “food challenge” where they ate 5 grams of peanut flour in one sitting.

Remission was defined as those who were able to eat 5 grams of peanut protein without having an allergic reaction six months after receiving the immunotherapy treatment.

The kids that didn’t have an allergic reaction were later fed 8 grams of peanut butter on a different day to confirm that they could eat peanuts without having a reaction.

The report concluded that 71% of those who got the peanut powder could tolerate the equivalent of 16 peanuts. Six months later, 21% still could. As for the control group, 2% could tolerate 16 peanuts at the end of the treatment and six months later.

Most of the children in the peanut flour group had an allergic reaction during the study, but they were mostly mild to moderate. However, some in the group required treatment with an EpiPen.

According to the NIH, those who started the process with lower levels of peanut-specific antibodies were most likely to achieve remission.

“The investigators found that lower levels of peanut-specific immunoglobulin E antibodies at the start of the trial and being younger predicted whether a child would achieve remission. In an analysis done after the investigators could view the study data, they found an inverse relationship between age at the start of the trial and remission, with 71% of the 1-year-olds, 35% of the 2-year-olds and 19% of the 3-year-olds experiencing remission,” the NIH explained in a press release.

Dr. Anthony Fauci, White House chief medical adviser and director of the National Institute of Allergy and Infectious Diseases (NIAID), commented on the study as well. 

“The landmark results of the IMPACT trial suggest a window of opportunity in early childhood to induce remission of peanut allergy through oral immunotherapy,” he said in a statement. “It is our hope that these study findings will inform the development of treatment modalities that reduce the burden of peanut allergy in children.”

Kids with peanut allergies can take medical treatment, but it is only available to children ages 4 and up. It also doesn’t induce readmission but rather protects against accidental exposure to small amounts of peanuts.

Health experts encourage parents to feed babies with peanut-containing foods early on to prevent a peanut allergy.

However, children are still encouraged to avoid peanuts and carry an EpiPen just to be safe. When the treatment stops, the protection from the allergy stops as well.