January 30, 2014

expert reaction to oral immunotherapy for children’s peanut allergies

Results of a phase II clinical trial, published in the Lancet, suggested children with peanut allergies could benefit from a treatment in which peanut protein is consumed in increasingly larger amounts on a regular basis to build up tolerance.

Professor Sebastian Johnston, Asthma UK Clinical Professor & Director, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, and Professor of Respiratory Medicine & Allergy, Imperial College London, said:

“I think this is a very significant advance. We have had immunotherapy by injection for resolution of allergies for many years, but this has been very difficult to use practically, as patients are required to come to specialist allergy clinics for every injection (usually weekly, then fortnightly then eventually monthly, for 3 years) and to wait 2 hours after every injection. This has been very difficult for patients and doctors, so injection immunotherapy is not widely used.

“More recently oral immunotherapy (via a tablet or liquid under the tongue) has come in and been found to be effective for resolution of grass pollen allergies, and also for the house dust mite. This has the great advantage that oral immunotherapy can be safely undertaken by the patient at home – adding great convenience for the patient. We have not until today had such encouraging evidence that it may one day be safe and effective to perform oral immunotherapy at home for food allergies.

“This study suggests that before very long this may be possible. Patients were dosed in the clinic for the first dose, and again for the first dose after each increase in dose, but then took the remaining doses at home. Most importantly it appeared both safe and effective.

“This study is likely to pave the way for further similar studies and is a significant step forward for peanut allergy sufferers, as well as perhaps for other types of food allergy. Until more work is done though, food allergy patients must continue to avoid the foods that cause their food allergy symptoms.”

Professor Barry Kay, Department Of Allergy And Clinical Immunology, Imperial College London, said:

“There have been previous studies on OIT (oral immunotherapy) treatment for peanut allergies showing similarly encouraging results.  The real issues that still remain include how long the results will last, and whether the positive effects might lead affected individuals to have a false sense of security.  Another issue to address is whether there will be long term side-effects of repeated peanut exposure even where full allergic reaction does not occur, such as eosinophilic oesophagitis (inflammation of the oesophagus).  So, this study shows encouraging results that add to the current literature, but more studies are needed to pin down these issues before the current advice to peanut allergy sufferers, which is to avoid eating peanuts, is changed.”

Professor Chris Elliott, Professor of Food Safety and Director of the Institute for Global Food Security, Queen’s University Belfast, said:

“Having an allergy to peanuts is extremely serious and can be life threatening. The number of those suffering from this allergy is growing worldwide. Currently the only way to deal with the problem is an ‘avoidance diet’, that is making sure that absolutely no peanuts are consumed. This is a massive challenge, especially for the parents of young children. The excellent research published builds on other studies that have shown that when children are exposed to very small amounts of peanut over a course of time the allergic responses are greatly reduced. While the research is very welcome it is far from clear what doses of peanut should be given and over what time period. Thus it would be dangerous for any parent to think about trying to reduce the level of allergy in their children. The best advice is to consult with a GP before thinking of attempting any form of peanut treatment. Hopefully within a few years there will be clear guidance available on how to better manage peanut allergy.”

‘Assessing the efficacy of oral immunotherapy for the desensitisation of peanut allergy in children (STOP II): a phase 2 randomised controlled trial’ by Katherine Anagnostou et al. published in the Lancet on Thursday 30 January 2014.