Children with peanut allergies may not need large doses of\u00a0peanut oral immunotherapy\u00a0(OIT)\u00a0to\u00a0build\u00a0protection to\u00a0peanut,\u00a0finds\u00a0a new\u00a0study led by The Hospital\u00a0for Sick Children (SickKids) and\u00a0Montreal Children’s Hospital.\u00a0Researchers\u00a0found that a small dose can\u00a0help children\u00a0with their\u00a0peanut\u00a0allergy\u00a0and reduce the risk of severe\u00a0reactions from\u00a0accidental\u00a0exposures, with\u00a0less\u00a0side effects\u00a0than the\u00a0current\u00a0standard treatment.\u00a0<\/p>\n
In Canada, peanut allergies affect almost two per cent of children and adults and increasingly contribute to hospital admissions. Peanut OIT is a method to increase the amount of\u00a0peanut\u00a0that a child can eat before experiencing a reaction, helping to protect children against accidental contamination. Children receiving peanut OIT eat a gradually increasing amount of peanut over time until they reach a “maintenance” dose that is eaten regularly, even after the treatment, to help keep up\u00a0the benefits.\u00a0<\/p>\n
While peanut OIT can help children with peanut allergies to build\u00a0protection, current approaches use large doses that require lengthy treatment, close medical supervision and often\u00a0can\u00a0result in discontinuation due to dislike of the taste and\u00a0side effects\u00a0of allergic reactions\u00a0like anaphylaxis.\u00a0<\/p>\n
The\u00a0study is the first of its kind to compare\u00a0a commonly used\u00a0peanut OIT treatment to\u00a0reduced\u00a0doses in\u00a0children, and\u00a0provides evidence\u00a0to support\u00a0a significantly\u00a0lower\u00a0dose that\u00a0could\u00a0increase treatment accessibility\u00a0and help protect\u00a0more\u00a0children with peanut allergy.\u00a0<\/p>\n
A very little\u00a0goes a long way\u00a0<\/p>\n
To\u00a0investigate the safety and effectiveness of\u00a0a very low\u00a0maintenance dose of peanut\u00a0OIT,\u00a0the study, published in\u00a0the\u00a0Journal of Allergy and Clinical Immunology \u2013 In Practice,\u00a0randomly assigned 51 children with peanut allergy to three groups:\u00a0low-dose\u00a0treatment\u00a0(30mg\u00a0maintenance), standard-dose\u00a0treatment\u00a0(300mg\u00a0maintenance)\u00a0or avoidance\u00a0(no peanut OIT).\u00a0<\/p>\n
Both\u00a0peanut\u00a0OIT\u00a0treatment\u00a0groups\u00a0experienced\u00a0significant\u00a0and similar\u00a0increases\u00a0in\u00a0their\u00a0allergic reaction\u00a0threshold\u00a0to\u00a0peanuts, showing that eating even\u00a0small amounts\u00a0is better than avoidance when it comes to training the immune system to manage more\u00a0peanut.\u00a0<\/p>\n
“We were excited to find that\u00a0peanut OIT maintenance doses can be much lower than previously thought and still contribute to\u00a0positive outcomes,” says Dr.\u00a0Julia Upton, Head of the\u00a0Division of Immunology & Allergy, Project Investigator in the SickKids Research Institute, Co-Director of the SickKids Food Allergy and Anaphylaxis Program\u00a0and\u00a0co-first author.<\/p>\n
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The more\u00a0options we have,\u00a0the more we can support patients’ experience and provide meaningful, tailored care.”<\/p>\n
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Dr.\u00a0Julia Upton, Head of the\u00a0Division of Immunology & Allergy, Project Investigator, SickKids Research Institute\u00a0<\/p>\n
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Children who were in\u00a0the\u00a030 mg\u00a0maintenance group\u00a0had\u00a0fewer\u00a0adverse reactions\u00a0than\u00a0the\u00a0300 mg\u00a0maintenance group,\u00a0and\u00a0none\u00a0withdrew from treatment.\u00a0<\/p>\n
“This is a\u00a0small enough dose that even children\u00a0who\u00a0do not like the taste can\u00a0continue\u00a0treatment,” says\u00a0co-senior\u00a0study author Dr.\u00a0Thomas Eiwegger,\u00a0Adjunct Scientist in the\u00a0Translational Medicine\u00a0program.\u00a0“This is the first time we’ve compared standard doses to such a low\u00a0dose, but the minimum maintenance dose to provide benefit may be even lower than\u00a030mg.”\u00a0<\/p>\n
The research team notes that some children and families may\u00a0choose\u00a0to\u00a0remain\u00a0on\u00a0very low\u00a0doses, while others\u00a0may\u00a0prefer\u00a0to increase over time depending on their goals. This study marks\u00a0an important step\u00a0to\u00a0further the\u00a0development of safe and effective protocols\u00a0for peanut OIT.\u00a0Ultimately, the\u00a0goal is to\u00a0make\u00a0peanut OIT accessible to more peanut-allergic children.\u00a0<\/p>\n
“The study found that very small amounts of peanuts, that are associated with less reactions, could be used as effectively as large amounts for oral immunotherapy<\/a>, making it safer and accessible to more Canadians, even those who are very sensitive to the allergen,” says Dr. Moshe Ben-Shoshan, co-senior author of the study, a pediatric allergy and immunology specialist at the Montreal Children’s Hospital and Scientist in the Infectious Diseases and Immunity in Global Health Program at the Research Institute of the McGill University Health Centre.<\/p>\n Source:<\/p>\n The Hospital for Sick Children<\/a><\/p>\n Journal reference:<\/p>\n