Study examines treatment of peanut allergies in children

The younger children with peanut allergy are when exposed to controlled doses, the more effective treatment can be at building a tolerance, research shows.

After two and a half years, the majority of young children given the peanut protein were able to safely consume the equivalent of about 16 daily treatment peanuts, according to the study.

The researchers described this as desensitization.

According to the research, one in five children were able to repeat this food challenge 26 weeks after treatment ended, which was described as remaining in remission.

In children with peanut allergy, starting treatment – known as oral peanut immunotherapy – before the age of four has been associated with increased desensitization and remission.

Further analysis indicated that children who were younger at the start of treatment were more likely than older children to achieve remission.

The authors called for more research to investigate this finding because it may indicate a window of opportunity early in life when oral peanut immunotherapy is most effective.

The children were closely monitored during the trial and given small amounts of peanut protein powder, which was gradually increased to 2,000 mg per day, the equivalent of six peanuts.

The study recruited 146 children aged one to three years, whose average tolerated dose of peanut protein was 25 mg at study entry at five medical centers in the United States.

Ninety-six children were randomly assigned to treatment and 50 children were randomly assigned to a placebo group.

The doses were mainly administered at home by the parents, but whenever the dose was increased, it was done in medical centers under observation.

In the study, 71% of children treated with oral peanut immunotherapy achieved desensitization, compared to 2% in the placebo group.

Some 21% of people treated with oral peanut immunotherapy achieved remission, compared to 2% in the placebo group.

Previous research has suggested that peanut allergy affects 2% of children in Western countries and most remain allergic throughout their lives.

The current standard of care for children with peanut allergy is food avoidance and access to epi-pens, but the risk of serious reactions still exists.

Dr Wesley Burks, from the University of North Carolina at Chapel Hill, America, said: “The serious and unpredictable nature of food allergic reactions can be worrying for affected children and their parents.

“Exploring safe and effective treatment options for children with peanut allergy is critical to improving the quality of life for this group of patients, especially since most children remain allergic throughout their lives.”

The authors note some limitations to their study published in The Lancet, including that there was a high dropout rate between the end of treatment and testing for remission after 26 weeks of avoidance.

Additionally, 27% (22/81) of children in the treatment group and 20% (7/35) in the placebo group did not reach the maximum treatment dose of 2000 mg, which may lead to an underestimation of the response to treatment.

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