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Study: Starting peanut immunotherapy at age 3 or younger can resolve allergies

Study: Starting peanut immunotherapy at age 3 or younger can resolve allergies
A new study has found that peanut immunotherapy can help many children with allergies to the nuts. Photo by Saramukitza/Pixabay

Jan. 20 (UPI) — Most young children with peanut allergies treated with peanut immunotherapy achieved desensitization within 2 1/2 years, a study published Thursday by the Lancet found.

More than seven in 10 children age 3 years and younger in the study were desensitized to peanuts at the end of their treatment, meaning they no longer had an allergic reaction when exposed to peanuts or products containing peanuts, the researchers said.

One in five child participants who received peanut immunotherapy remained in remission, or still did not have an allergic reaction, 26 weeks after treatment ended, the data showed.

Five of seven 1-year-olds in the study achieved remission, compared with seven of 20 2-year-olds and eight of 43 3-year-olds, according to the researchers.

“As a developing therapy, researchers are looking for ways to improve and prolong effects of peanut oral immunotherapy,” study co-author Dr. Stacie M. Jones said in a press release.

“We found that the treatment induced desensitization in a majority of peanut-allergic children and around one in five achieved remission,” said Jones, a professor of allergy and immunology at the University of Arkansas for Medical Sciences in Little Rock.

An additional one in five children whose peanut tolerability “increased significantly after treatment,” she said.

Peanut allergy affects 2% of children in Western countries, and most remain allergic through their lifetime, based on recent estimates.

In most cases, children with peanut allergies are advised to avoid the nuts and foods containing them or oils derived from them, and to use the rescue medication epinephrine following exposure to prevent severe reactions, according to the American College of Allergy, Asthma and Immunology.

However, in 2020, the Food and Drug Administration approved Palforzia, a powdered prescription medication that contains peanut protein, for the treatment of peanut allergies in children ages 4 to 17 years.

As an option for peanut immunotherapy, it contains gradually increasing amounts of peanut protein to build the body’s ability to tolerate it, with the goal of reducing the severity of allergic reactions, according to Aimmune, the product’s manufacturer.

Although generally safe for young children, the approach has been linked with an increased risk for anaphylaxis, or a severe allergic reaction.

Previous studies in school-aged children and young adults have found that oral peanut immunotherapy can achieve desensitization, or an increased allergic reaction threshold while on therapy, in most of those who receive it.

Still, success in achieving remission, or the lack of an allergic reaction even after discontinuing therapy, has been limited, Jones and her colleagues said.

For this study, the researchers recruited 146 children ages 1 to 3 years whose initial average tolerated dose of peanut protein of 25 milligrams and assessed them using a blinded food challenge at five medical centers in the United States.

Ninety-six children were randomly assigned to peanut oral immunotherapy treatment, using a formulation developed for the study, and 50 were given a placebo, or inert treatment that offers no clinical benefit, the researchers said.

Treatment in both groups lasted 2 1/2 years, with children receiving peanut immunotherapy starting with a 0.1-mg. daily dose of peanut protein powder and gradually increasing to 2,000 mg., or the equivalent of about six peanuts, according to the researchers.

At the end of treatment, researchers assessed the desensitization in a supervised, blinded food challenge in which children attempted to consume 5,000 mg. of peanut protein powder, or the equivalent of approximately 16 peanuts, without experiencing significant symptoms.

To test for remission, the food challenge was repeated 26 weeks after treatment ended, with children asked to avoid peanut consumption in-between the two food challenges, the researchers said.

Of the children treated with oral peanut immunotherapy, 68 of 96, or 71%, achieved desensitization, compared with one of 50, or 2%, in the placebo group, the data showed.

In addition, 20 of 96, or 21%, of the children in the oral peanut immunotherapy group achieved remission compared with one in 50, or 2%, in the placebo group, according to the researchers.

Another 20 children who received oral peanut immunotherapy did not achieve remission, but still could tolerate up to 3,800 mg., or roughly 12 peanuts, 26 weeks after the end of treatment, the researchers said.

Most study participants experienced at least one dosing reaction, primarily mild to moderate hives and skin rashes, stomach pain, itching in the mouth and coughing and wheezing, they said.

Epinephrine was needed in 21 participants for 35 allergic reactions to the oral peanut immunotherapy over the 2 1/2 year daily dosing period, according to the researchers.

“Those children who did achieve remission were more likely to be at the younger end of the age group, with the best outcomes in children aged 1 year old, suggesting that very early interventions may provide the best opportunity to achieve remission,” Jones said.

“However, there were only small numbers of children aged 1 year old enrolled in our study, so more studies are needed to investigate this finding,” she said.

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