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Oral Immunotherapy for Peanut Allergies?

Preliminary results suggest that tiny incremental daily doses of peanut flour increase tolerance in some children.

Peanut allergies affect up to 1% of the U.S. population, cause a range of reactions, and account for nearly half of food allergy–related deaths. Most children do not outgrow the allergy, and presence of mild symptoms does not eliminate the possibility of more-serious future reactions. Families and children who deal with peanut allergies must be especially careful because many foods contain peanuts or are produced in factories that process peanuts in other products. Two abstracts presented at the American Academy of Allergy, Asthma & Immunology describe clinical and laboratory findings in children with peanut allergy who received oral immunotherapy with tiny incremental daily doses of peanut flour for at least 2 years in ongoing trials.

In one study, nine children stopped immunotherapy for 4 weeks and were given oral food challenges. Four children with peanut IgE levels <2 kU/L passed the food challenge test and are now clinically tolerant of peanuts in their diet. A second abstract reported cytokine responses and regulatory T-cell levels in 21 patients before and after oral immunotherapy. The most interesting finding was a temporary increase in FoxP3-positive regulatory T cells.

Comment: These studies offer hope that tolerance might be inducible in some patients with peanut allergy. However, these studies were performed under tightly controlled conditions, and therapy was not successful in all patients. Previous studies of oral immunotherapy for food allergies have had varying success rates. Before this therapy can be more widely used, additional and confirmatory studies are needed. For now, family education and peanut avoidance are still the mainstays of therapy. Any attempt at desensitization should be done as part of a medically supervised research study protocol.

— Peggy Sue Weintrub, MD

Published in Journal Watch Pediatrics and Adolescent Medicine March 25, 2009

Citation(s):

Varshney P et al. Oral immunotherapy (OIT) induces clinical tolerance in peanut-allergic children. J Allergy Clin Immunol 2009 Feb; 123:S174.

Jones SM et al. Double-blind, placebo-controlled (DBPC) trial of oral immunotherapy (OIT) in peanut allergic children. J Allergy Clin Immunol 2009; 123:S211.

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