Cleveland Clinic researchers found that starting oral immunotherapy with peanuts under medical supervision during childhood can improve the child's immune response to food over time.
THE results were recently published in the Journal of Allergy & Clinical Immunology: In Practice.
Peanut allergy in children
Cleveland Clinic is the first health system in Northeast Ohio, and one of few in the country, to offer oral immunotherapy for infants and toddlers allergic to peanuts.
Through its Food Allergy Center of Excellence, children under four have developed a tolerance for the food by eating small amounts of it in a controlled step-by-step process.
“We have seen oral peanut immunotherapy be well tolerated in young children, but there is limited real-world evidence available to demonstrate benefits in children,” said Sandra Hong, MD, allergist and director of the Allergy Center of Excellence food at Cleveland Clinic.
“We have leveraged data from infants in our program to better understand the safety and effectiveness of this treatment in infants 12 months of age and younger.”
For the retrospective study, the research team examined data from 22 children, ages 7 to 11 months, who received oral peanut immunotherapy at Cleveland Clinic's Food Allergy Center of Excellence.
Through a plan implemented by an allergist and parents, the children were started on a daily dose of 18 milligrams (about double the weight of a grain of table salt) of peanut protein in the form of peanut butter or peanut powder .
Over the course of six months, they were given increasingly larger portions to consume each day until they reached a maintenance dose of 500 milligrams (the equivalent of two peanut kernels).
The researchers found that all 22 children in the cohort reached this milestone. During treatment, more than half of the patients experienced mild allergic reactions that resolved on their own, and one required the use of epinephrine. About 27% of children did not have any allergic reactions.
“Safety is paramount. Whenever the children were exposed to more peanut protein, it was done under the careful supervision of an allergist,” Dr. Hong said. “They were monitored for an hour in our office after the highest dose was administered.”
After completing peanut oral immunotherapy, 14 of the 22 children underwent an allergy test to check for peanut-specific antibody levels. The results indicated that all 14 children had reduced sensitivity to peanut.
Then, 11 of these children participated in an oral feeding challenge in which they were fed increasing doses of peanut protein up to 2,000 milligrams (about nine peanuts). After completing the challenge, 91% of them could tolerate peanuts without triggering allergic reactions.
“Our study shows that the majority of children were able to safely consume peanuts after oral immunotherapy,” said Sarah Johnson, MD, lead author of the study and fellow at the Cleveland Clinic. “Overall, this signals that age is a crucial factor in the success of this treatment.
A child's immune system is more adaptable, allowing them to develop a tolerance to peanuts with less severe reactions and fewer side effects than older children.”
Currently, 1.5 million American children live with a peanut allergy, and less than a third naturally develop a tolerance.
Although peanut oral immunotherapy shows promise in helping young children overcome allergies, treatment should always be done under the care of an experienced allergist.
“At the end of the day, we want families to be safe,” Dr. Hong said. “This is not something you can try on your own due to the significant risk of triggering allergic reactions. When you have an allergist overseeing the process, you ensure that any reactions your child experiences are quickly identified and treated.”
Can boiled peanuts help cure allergies they cause?
Because heat can affect the structure and immunoreactivity of peanuts, researchers recently tested whether a therapy using sequential doses of the boiled fruits followed by roasted peanuts can help children overcome allergies.
For the study, 70 children ages 6 to 18 with peanut allergies were given boiled peanuts for 12 hours for 12 weeks, a. boiled for 2 hours for 20 weeks and roasted peanuts for 20 weeks, at a target maintenance dose of 12 a. toasted. daily.
Fifty-six of 70 (80%) participants became desensitized to peanuts. Treatment-related adverse events were reported in 43 (61%) participants, 3 of whom withdrew from the study.
“Oral immunotherapy with a. boiled followed by a. toasted represents a pragmatic approach that appears effective in inducing desensitization and is associated with a favorable safety profile,” the authors wrote.
Peanut treatment reduces the risk of severe allergic reactions in preschool children
“There is a common misperception about peanut allergy: that it is not a serious health problem. Although the risk of a fatal reaction to peanuts is low in allergy patients, it has a major impact on quality of life and many families feel hopeless in dealing with what may seem like an unmanageable problem.”
said the study's senior author, Dr. Edmond Chan, chief of the division of pediatric allergy and immunology at UBC's faculty of medicine and a clinical researcher at the BC Children's Hospital Research Institute.
The study, recently published in the Journal of Allergy and Clinical Immunology: In Practice, is the first to demonstrate that exposing children to a small regular dose of an allergen (in this case, peanuts) in a real-world context (outside of a clinical study) is effective in reducing the risk of allergic reactions.
The treatment method, known as oral immunotherapy, involves gradually increasing the amount of peanuts (or peanut products) given to the child.
One of the goals of treatment is to achieve desensitization, whereby the child can ingest a full serving of peanuts without triggering a dangerous reaction.
Another goal is protection in the event of accidental exposure and reducing or eliminating the need for epinephrine injections in response to reactions. To support their immunity level, your child should continue to eat peanut products regularly.
During this study, 117 preschool children – aged nine months to five years – with peanut allergies from across Canada received a daily maintenance dose of 300 mg of peanut protein, equivalent to approximately a peanut or a quarter of a teaspoon of tea. peanut butter.
After a year, researchers found that nearly 80 percent of preschoolers were able to eat 15 peanuts (equivalent to 4,000 mg of peanut protein) without reactions during a supervised oral allergy test.
And nearly all of the children (more than 98%) who participated in the study were able to eat three to four peanuts without reactions, which is enough to protect them from 99% of accidental exposures.
Although some children in the study (21.4%) experienced an allergic reaction during the oral test under the supervision of the allergist, the reactions were mild (14.5%) or moderate (6%). Two children received epinephrine for moderate reactions. There were no serious reactions.
This study follows another analysis conducted by the same researchers last year that was the first to demonstrate the safety of peanut oral immunotherapy for a large group of preschool children when offered as routine treatment in a hospital or clinic. a clinic rather than within a clinical trial.
“Now, thanks to oral immunotherapy, these children can accidentally eat something that contains peanut butter, like a cookie or cake, and not suffer a reaction, which is wonderful news for families.”
said the study's lead author, Dr. Lianne Soller. , UBC Allergy Research Manager based at BC Children's Hospital.
For Ravinder Dhaliwal, oral immunotherapy was a turning point for his family and for his six-year-old daughter, Saiya, who was diagnosed with a peanut allergy when she was still a child.
“Before starting therapy, our lives were filled with anxiety because every outing revolved around his food allergies,” Ravinder said. “Now we can go to a restaurant or a birthday party without being constantly afraid.”
As one of the study participants, Saiya began receiving maintenance therapy in the spring of 2018, eating a small amount of peanut products every day. A year later, she was able to eat 20 peanuts in one sitting without having any reaction.
Today, Saiya not only eats peanut butter sandwiches three times a week, but for the first time in her life she is enjoying the taste of peanut products and asking for them as a treat.
“After undergoing oral immunotherapy, I am no longer afraid: it's like having a shield to protect my child. The experience gave strength to all of us,” Ravinder said.
According to Chan and Soller, the earlier children receive oral immunotherapy, the better. If left unchecked, peanut allergies are often life-long and reactions can become more severe, which can result in social isolation, bullying and anxiety.
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