Allergies are becoming more prevalent in the US, affecting over 100 million individuals. Common allergies include eczema, seasonal, and food allergies. Not surprisingly, food allergies can be the most severe and have been rising among children since the 1990s. These allergies include milk, eggs, peanuts, tree nuts, soy, wheat, fish, and shellfish, which can all vary in severity. Peanut allergies can result in deleterious symptoms and even be fatal. Recent data, according to an article in The Journal of Allergy and Clinical Immunology, indicate that about 2% of the general population has a peanut allergy. Although highly prevalent in children, 20% of kids grow out of it. As allergy diagnoses rise, physicians work to meet treatment needs. Besides taking action to avoid contact with allergens, current treatment options involve medications that target symptoms, including antihistamines, nasal sprays, vaccinations, and epinephrine. Currently scientists are working to understand how to enhance allergy therapies and even build tolerance in patients.
Interestingly, a New York Times Article reported that physicians are seeing a general decrease in pediatric peanut allergies after doctors recommended exposing infants to peanut products. Another report in The Journal of Allergy and Clinical Immunology, by Dr. Moshe Ben-Shoshan and others, demonstrates that low dose peanut exposure can build allergy protection in children. Ben-Shoshan is an Associate Professor in the Division of Allergy and Clinical Immunology at McGill University Health Centre (MUHC).
A novel form of peanut oral immunotherapy (P-OIT) was administered to peanut allergy reactive children to determine if low dose peanut protein could safely and effectively improve peanut tolerance. Consequently, P-OIT reduced the risk of severe reactions with little side effects compared to current standard-of-care (SOC) treatment. Although this novel method can help build protection, current therapies in the clinic use larger doses with a lengthy period of treatment and close medical surveillance. Unfortunately, these regimens result in discontinuation due to unpleasant taste of peanut protein and adverse side effects.
This study is the first-time scientists investigate reducing allergen exposure in current peanut exposure therapy or P-OIT. As a result, it provides evidence that only small doses of peanut protein are needed to improve tolerance and protect children. The study randomized 51 children with a peanut allergy and placed them in groups: low-dose treatment (30mg), SOC treatment (300mg), or no treatment. Both treatment groups (30mg and 300mg) demonstrated an increase in allergy tolerance; however, children taking the lower dose had fewer side effects with no child withdrawing from treatment. Researchers highlight that the dose is low enough that children who do not like the taste can still tolerate exposure and continue therapy. Scientists even speculate the dose can be reduced further with similar outcomes.
This P-OIT improvement is groundbreaking and provides more options for children with allergies. It has successfully made P-OIT accessible and safer for peanut-allergic children. Clinicians and scientists hope to offer this treatment option in the clinic as an alternative for those that prefer low dose exposure, compared to the current 300mg SOC. Overall, this work provides insight into the necessary dose needed to build allergy tolerance and has directly influenced SOC treatment allowing access to more children with peanut allergies.
New York Times Article, report, Moshe Ben-Shoshan, Division of Allergy and Clinical Immunology, McGill University
