Immunotherapy Found Safe for Young Children With Peanut Allergies

A new study is the first to demonstrate the safety of an oral immunotherapy for peanut allergy among a large group of preschool-aged children as a routine treatment in a hospital or clinical setting instead of a clinical trial.

During treatment with an oral immunotherapy, a patient consumes a small amount of a food they are allergic to, such as peanuts, and the dose of the immunotherapy is gradually increased to the maximum amount. The treatment goal is to allow patients to be exposed to more of an allergenic food without triggering an adverse event, which provides protection in cases of accidental exposure, according to the study, published in the Journal of Allergy and Clinical Immunology: In Practice.

As part of maintenance treatment, patients must continue to ingest the allergenic food regularly.

"Although there have been many clinical trials of peanut oral immunotherapy in older children, and one trial in preschoolers, there has been a lack of real-world data due to safety concerns of offering this treatment to preschoolers outside of a research setting," said lead study author Lianne Soller, an allergy research manager at British Columbia Children's Hospital. "But our findings confirm in a real-world setting that this treatment is not only safe but is well-tolerated in a large group of preschool-aged children."

The researchers studied 270 children between the ages of 9 months and 5 years who were diagnosed with a peanut allergy and were administered an oral immunotherapy from April 2017 to November 2018. The children were administered a peanut dose approximately every 2 weeks by a pediatric allergist, with the dose gradually increased during each visit to a community or hospital clinic.

The authors found that 243 children (90%) who were administered the oral immunotherapy were able to reach the maintenance stage after an average duration of 22 weeks compared with 27 children (10%) who dropped out for reasons such as allergic reactions, refusing to consume the daily dose, and parental anxiety, according to the study.

The study found that 68% of the children experienced at least 1 allergic reaction prior to reaching the maintenance stage, the majority of which were deemed mild (36.3%) or moderate (31.1%), whereas 0.4% experienced a severe reaction and 4% received epinephrine.

"Many allergists do not believe (oral immunotherapy) should be offered outside of research settings and have not routinely offered it as a therapy for peanut allergy in their clinics due to safety concerns," senior study author Dr Edmond Chan said in a press release. "We hope that our data demonstrate that the treatment is safe in preschoolers and could be offered to families of preschool children with peanut allergy who ask for it. There appears to be a big difference in outcomes in preschoolers compared to older children."