An allergy to peanuts is one of the eight most common food allergies people have today.
These eight foods (cow’s milk, egg, soy, wheat, peanut, tree nuts, fish, and shellfish) are responsible for more than
Allergic reactions to these foods can range from mild to fatal, and there is currently no known cure.
An accepted approach to managing peanut allergy in the past was for people to avoid exposure altogether.
But in recent years, efforts to treat the allergy by way of oral immunotherapy — exposing people to small doses of peanuts gradually over time — have begun to gain traction.
However, at this point, there is no FDA-approved therapy involving this kind of peanut “microdosing,” and debate exists in the medical community over how safe this practice could be.
On one hand, a study published last month in
On the other, some doctors view this as an approach that could be better perfected and studied over time, offering those with peanut allergies hope that new ways to manage the condition are on the horizon.
“In patients with peanut allergy, high-certainty evidence shows that available peanut oral immunotherapy regimens considerably increase allergic and anaphylactic reactions over avoidance or placebo, despite effectively inducing desensitisation,” the authors of the new study wrote in the summary of their findings.
“Safer peanut allergy treatment approaches and rigorous randomised controlled trials that evaluate patient-important outcomes are needed.”
To reach this conclusion, the researchers looked at data from more than 1,000 people over the course of 12 separate studies.
They found that the risk for anaphylaxis — when your body goes into shock after your immune system releases a wave of chemicals in response to contact with an allergen — jumped from 7.1 to 22.2 percent when being exposed to this kind of microdosing therapy versus being given just a placebo.
People in these oral immunotherapy treatment studies also showed a higher need for epinephrine use and higher rates of non-anaphylactic reactions like vomiting.
The goal of immunotherapy is basically to train your body to respond differently to whatever substance normally causes an allergic reaction.
In 2018, a phase III trial published in the The New England Journal of Medicine showed encouraging results to parents whose children were given an immunotherapy drug designed to build up immunity to a peanut protein.
That study looked at 551 people, with 496 between the ages 4 and 17. Out of this number, 67.2 percent who received the active drug were able to ingest 600 milligrams — about two kernels — or more of peanut protein without major symptoms.
What are people to make of these different studies?
According to Dr. Lakiea Wright, a physician in internal medicine and allergy and immunology at Brigham and Women’s Hospital in Boston and the medical director at Thermo Fisher Scientific, more studies need to be performed.
“Yes, I think peanut oral immunotherapy (OIT) will become more accepted and utilized because it helps those being treated have more freedom,” Wright told Healthline.
“When a patient has a peanut allergy, it can be scary to do simple things like eat in a restaurant. Those on peanut OIT can eat in restaurants and if they have a small amount of exposure to peanut from cross contamination, there is less of a risk of a severe reaction.”
She added, “However, the downside of peanut OIT is that it does not 100 percent cure your allergy, and some people experience anaphylaxis during the buildup phase and/or while on maintenance.”
Wright said that these anaphylactic episodes tend to occur in a controlled environment, like the person’s home. She said that when it comes to this kind of immunotherapy, there needs to be more testing to “develop biomarkers” that would help identify people who are at greater risk of experiencing this kind of reaction.
She stressed that she doesn’t recommend oral immunotherapy because there are no FDA-approved therapies out there.
While clinical trials are going on and the results are promising, Wright added that more needs to be done to ensure this kind of treatment is safe.
“Perhaps one way to make OIT safer is to add a biologic agent to the treatment plan. There are ongoing clinical trials examining the use of biologics — for example, dupilumab or omalizumab — in combination with immunotherapy,” she said.
“The thought behind this combination therapy is that by adding these medications which tamper down the immune system, the risk of anaphylaxis while on peanut OIT may be reduced.”
Dr. Maria Garcia-Lloret, who specializes in pediatric allergy and immunology at UCLA Health, sees this field as ever evolving.
She said that parents of children with peanut allergies often feel “tremendous anxiety.” There is always the fear that something a child comes into contact with at school or on a vacation might include an accidental dose of peanut.
“There isn’t a clear option for treatment out there [as with] diabetes or cancer,” she told Healthline.
Instead, Garcia-Lloret said it can be frustrating for parents to be told there is no conclusive treatment for this kind of allergy other than simply “avoid it.” It can cause a lot of stress over what could possibly be lurking in the treat in the Halloween basket or the snack being passed around the day care center.
Garcia-Lloret said that big pharmaceutical companies are now investing in more experimental therapies. The need is certainly great.
In the decade between 1997 and 2008, the prevalence of peanut or tree nut allergy seemed to more than triple among U.S. children, according to Food Allergy Research and Education (FARE).
For Garcia-Lloret, it’s encouraging that medical institutions and pharmaceutical companies are at least attempting to find new treatment approaches as opposed to shutting down families with the dismissive “there’s nothing we can do, just try an epinephrine.”
However, she stressed that, as with many experimental treatments, what might seem like a good idea now might not stand years down the line.
“It (oral immunotherapy) might not prove to be effective in the end at all,” she said. “Maybe we will look five, six years from now and say, ‘What were we thinking?’ That’s where we are right now.”
Wright added that people with peanut allergies should still feel hopeful.
“Families should still maintain hope. Although this new article paints a grim picture, families can still be cautiously optimistic. These immunotherapy protocols are still under investigation, and investigators are learning more and more each day. They will fine-tune the protocols to make them more safe,” Wright said.
“Also of note, there is a peanut patch-based immunotherapy under investigation that is less effective compared to oral immunotherapy, but the safety profile is better.”
Wright added, “Each individual family will have to weigh the risks and benefits to decide if oral immunotherapy is for them. The benefit of a child becoming potentially desensitized or tolerant to peanut may outweigh the risk of OIT-induced anaphylaxis.”
A recent review of past studies published in
The study authors found that people who tried this experimental therapy were actually more likely to experience anaphylaxis, a potentially deadly allergic reaction.
While other research has revealed more favorable results of this therapy, the jury is still out on whether this is the best method moving forward to treat peanut allergy.
Doctors say that there is still hope. More trials are being done, and there may yet be a future when this kind of therapy proves helpful and safe. Until then, it isn’t recommended.
There are currently no FDA-sanctioned oral immunotherapy treatments for peanut allergy.