Peanut oral immunotherapy may help young children who are highly allergic to peanuts become desensitized to their allergy, or go into remission. The corresponding clinical trial was funded by the National Institute of Health (NIH) and published in The Lancet.
Around 2% of people aged 17 and under in the US are affected by peanut allergy, equating to almost 1.5 million individuals. Many remain allergic to peanuts for their whole lives, and are at risk of a life-threatening allergic reaction to the legume upon swallowing.
Prior to this study, two studies had provided a proof of concept that peanut oral immunotherapy can be given safely to young children, and improve symptoms of peanut allergy. As young children's immune system is still maturing, the assumption is that gradual introduction to peanuts may be able to modify any allergic response.
Altogether, 146 children aged between 1 and 3 years old were enrolled in a randomized, double-blind placebo-controlled study across US-based centers. The participants were randomly assigned on a ratio of 2:1 to receive either flour containing peanut protein to be mixed in with their foods or a placebo flour for 134 weeks followed by 26 weeks of avoidance.
At the end of the study, the children underwent an oral food challenge to eat 5 grams of peanut protein, equivalent to around 16 peanuts. Those who did not have an allergic reaction were then fed 8 grams of peanut butter to check their allergic response.
At the end of the study period, the researchers noted that 71% of children who had received peanut oral immunotherapy, compared to 2% in the control group, were desensitized to peanuts. Desensitization, they noted, was defined as being able to eat 5 grams of peanuts without an allergic reaction.
The researchers further noted that after 6 months of discontinuing the treatment, just 21% of the children who received peanut flour could eat 5 grams of peanut protein without having an allergic reaction. The same was true for 2% of the placebo group. These children, the researchers say, can be considered as being in remission from the peanut allergy.
The researchers noted that children who started oral immunotherapy earlier were more likely than those who started later to experience remission. While 71% of those who started the therapy at age 1 went into remission, the same was true for 35% of 2 years olds and 19% of 3 year olds.
"The landmark results of the IMPACT trial suggest a window of opportunity in early childhood to induce remission of peanut allergy through oral immunotherapy," said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH. "It is our hope that these study findings will inform the development of treatment modalities that reduce the burden of peanut allergy in children."