Peanut allergy treatment is safest when started before children are one year old
UBC researchers demonstrated in 2019 that preschoolers can safely overcome peanut allergies with a treatment called oral immunotherapy.
Now they have proof that the earlier preschoolers start this treatment, the better.
This real-world study focused on infants under 12 months of age and finds that not only is oral immunotherapy effective against peanut allergies, it is even safer for this age group than for toddlers and older preschoolers.
“This treatment is affordable, very safe and very effective, especially if we can start treatment before the infant is 12 months old,” said Dr Edmond Chan, lead author of the study who is also a clinical professor and Head of Allergy and Immunology in the UBC Department of Pediatrics at the BC Children’s Hospital Research Institute.
The study, recently published in the Journal of Allergy and Clinical Immunology: In practicespecifically looked at the results for a group of 69 infants from a larger study group of 452 children aged five and under.
Oral immunotherapy is a treatment protocol in which a patient consumes small amounts of the allergenic food – in this case, peanut flour – with a dose gradually increased to a specified maximum amount. The goal is to desensitize the child until they can have a full serving of peanut protein without triggering a dangerous reaction. To maintain immunity, the child should continue to eat peanut products regularly for the long term.
For this study, children visited a pediatric allergist at a community or hospital clinic approximately every two weeks to receive their peanut dose. Parents gave the same daily dose at home between clinic visits. After eight to 11 clinic visits, the children had reached a “maintenance dose” of 300 milligrams of peanut protein, the equivalent of about 1.3 grams of peanuts.
Clinicians recorded any symptoms or reactions and advised parents how to manage reactions at home.
Forty-two infants completed the preparation period plus one year of maintenance treatment. At the end, none of them had more than a mild reaction to a dose of 4,000 milligrams of peanut protein, compared to 7.7% of children aged one to five who completed the protocol .
Seven infants gave up along the way. Four experienced reactions beyond mild, but none required epinephrine injections. Twenty others did not have their peanut tolerance assessed at the end, either by choice or because of long waiting lists.
Even before treatment began, infants have been shown to be at lower risk than toddlers and preschoolers. In initial testing, only 33.9% of infants had a reaction beyond mild, compared to 53.7% of children aged one to five.
“Despite infants showing the best safety, we were still very happy with the safety of this treatment for older preschoolers. The risk of a severe reaction is much lower than for school-aged children,” noted Dr. Chan. “Many of the interventions we use in medicine, such as drugs or surgery, carry a small risk that is outweighed by the benefits. If this treatment is performed by well-trained allergists and clinicians, I’m really on board comfortable with the risk. It’s actually very safe.
As for effectiveness, the treatment worked equally well for both age groups. After a year of a peanut a day, about 80 percent of children had developed a tolerance to 4,000 milligrams of peanut protein in a single sitting, or the equivalent of about 15 whole peanuts.
The first step in trying to prevent peanut allergies in at-risk children is to introduce them to age-appropriate peanut-containing foods, such as peanut butter or peanut flour, around age six. month. If the infant still develops a peanut allergy, Dr. Chan’s research suggests that oral immunotherapy may be an effective alternative to avoiding allergens for a lifetime. Trying to completely avoid allergens comes with different risks, such as poor quality of life, social isolation, and anxiety.
With these new data, the next step recommended by Dr. Chan’s team is for practitioners to offer oral immunotherapy as soon as possible after failure to prevent food allergies in infancy, a concept that has recently been accepted for publication in a separate article “Rostrum” in the Journal of Allergy and Clinical Immunology: In practice.
Dr. Chan has adopted oral immunotherapy in his own clinical practice. His research will help inform future clinical practice guidelines and provide healthcare professionals with the data they need to recommend it to their young patients as well.
Reference: Soller L, Carr S, Kapur S, et al. Real-world peanut OIT in infants may be safer than non-infant preschool OIT and just as effective. Cabinet J Allergy Clin Immunol. 2022;10(4):1113-1116.e1. doi: 10.1016/j.jaip.2021.12.009
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