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The Evolving Science of Peanut Allergy

Changes in parental care could reduce the incidence of peanut allergy, and a new therapeutic approach may increase tolerance.

The apparent increase in cases of peanut allergy has led to renewed study of the allergy's etiology and treatment. Two groups of researchers investigated these topics.

Researchers in the U.K. identified 49 preschool children with histories of peanut allergy among 13,971 children who were enrolled in a longitudinal, prospective study; the allergy was confirmed by challenge in 23 of 36 tested children. Maternal consumption of peanuts during pregnancy or breast-feeding was unrelated to the development of peanut allergy in children. Intake of soy milk or soy-based formula by children was independently associated with peanut allergy. Use of creams containing peanut oil was also significantly related to allergy (91% of children with positive peanut allergy had been exposed to such creams, vs. 53% of atopic controls and 59% of healthy controls).

In a double-blind, randomized treatment trial, 82 patients (age range, 13-59 years) with histories of immediate peanut hypersensitivity received weekly treatment with subcutaneous doses of 150, 300, or 450 mg of TNX-901 (a humanized IgG1 monoclonal antibody) or placebo for 4 weeks. Two to 4 weeks after treatment ended, recipients of the higher doses of TNX-901 had significantly greater tolerance of ingested peanut flour than did recipients of the lower doses.

Comment: The search continues for easy modifications that can avoid the induction of peanut allergy. These findings suggest that parents should not give their children soy milk, soy formula, or creams containing peanut oil. The ultimate test of a therapeutic approach to peanut allergy will be how well treated patients react to inadvertent exposures; in this study, monoclonal antibody appeared promising.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine March 24, 2003

Citation(s):

Lack G et al. Factors associated with the development of peanut allergy in childhood. N Engl J Med 2003 Mar 13; 348:977-85.

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• Medline abstract (Free)

Leung DYM et al. Effect of anti-IgE therapy in patients with peanut allergy. N Engl J Med 2003 Mar 13; 348:986-93.

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• Medline abstract (Free)