Oral Immunotherapy for Peanut Allergy: Is It Time? - Nemours Blog


Oral Immunotherapy for Peanut Allergy: Is It Time?

Oral Immunotherapy for Peanut Allergy: Is It Time? by Magee DeFelice, MD, Promise, Brought to You by Nemours

For over 100 years, allergists have used a method called “immunotherapy” to safely and successfully treat environmental allergies. Unlike medications, which only treat the symptoms of allergic reactions, immunotherapy actually teaches the immune system to become more tolerant of allergens. For allergic nasal and eye symptoms, asthma, and atopic dermatitis (eczema), immunotherapy is very helpful in the form of allergy shots. An oral form of immunotherapy (“oral immunotherapy,” or “OIT”) is available for certain types of allergies, and has been shown to be effective as well.

How Does Oral Immunotherapy Work?

The goal of oral immunotherapy is to make the immune system less reactive to a food allergen by eating small, gradually increasing amounts of the food over time.

Researchers have been working for decades on a way to apply immunotherapy to the treatment of food allergies, with mixed results. However, a recent study in the Journal of Allergy and Clinical Immunology showed more promising results than previous studies for the use of oral immunotherapy as a potentially safe and effective treatment for peanut allergy.

In this study, patients ate peanut flour mixed into soft foods such as apple sauce or pudding every day for two to six years (an average of two and a half years). Once children completed treatment, they had to avoid peanuts for four weeks. Researchers then had the children try an oral challenge to peanut to see if they had a reaction.

What Did the Study Find?

About 80 percent of the children passed the challenge. Those children were then advised to incorporate peanut into their diet going forward. The researchers will follow the children over time to make sure they continue without symptoms when eating peanuts in the future.

  • Although the study’s results are encouraging, more research is needed to confirm the findings. Here are some important points to consider about the study:
  • Only 32 children completed treatment. The study began with 40 infants and toddlers. But three stopped participating because they had adverse reactions during treatment. Three didn’t qualify for treatment. And two others withdrew during therapy.
  • The study excluded children with a history of life-threatening peanut allergy, severe eczema, or severe asthma.
  • Almost all children experienced acute symptoms during treatment. Symptoms included abdominal pain, vomiting, hives, congestion, and sneezing.
  • About half of the children required antihistamines for acute symptoms. And one child required an injection of epinephrine for a more serious reaction.
  • Children with higher blood testing levels for peanut allergy required longer treatment and were less likely to successfully incorporate peanut into their diet.
  • Most of the children could eat peanuts a month after therapy was completed. But it is possible the treatment could wear off over time.

So What Does This Mean?

We can’t generalize the results of this one study to the larger population of children with peanut allergy. That’s because the number of patients in the study was small, and children with life-threatening peanut allergy couldn’t participate for safety reasons.

At this time, oral immunotherapy for food allergies should only be completed in allergist-supervised settings.

But, as this study points out, investigators are making great strides toward developing alternative treatment options for food allergy.

Learn More

Get in-depth information from Nemours‘ KidsHealth.org:

Magee DeFelice, MD

Dr. Magee DeFelice is the chief of Allergy and Immunology at Nemours Children's Hospital in Wilmington, Del.