Peanut allergy treatment most effective when started early in infants: Study

In 2019, UBC researchers reported that utilising an oral immunotherapy treatment, pre-schoolers may safely overcome peanut allergies. They now have evidence that the earlier pre-schoolers start therapy, the better.

The study’s findings were published in the ‘Journal of Allergy and Clinical Immunology.’ In Practice focuses on infants under the age of 12 months and finds that not only is oral immunotherapy helpful against peanut allergies, but it is also safer for this age group than it is for toddlers and older preschoolers.

“This treatment is affordable, very safe and highly effective, particularly if we can get the treatment going before the infant is 12 months old,” said Dr Edmond Chan, the study’s senior author who is also a clinical professor and head of allergy and immunology in UBC’s department of paediatrics at the BC Children’s Hospital Research Institute.

The study focused on the outcomes of 69 newborns among a broader study sample of 452 children aged five and under.

Oral immunotherapy is a therapeutic regimen in which a patient takes tiny amounts of the allergic food—in this example, peanut flour—with the dose progressively increasing to a maximum quantity established. The goal is to desensitise the youngster to the point when they can consume a complete meal of peanut protein without experiencing a hazardous response. To maintain their immunity, the youngster must consume peanut products on a regular basis.

Children in this research attended a paediatric allergist in a community or hospital clinic every two weeks to obtain their peanut dosage. Between clinic sessions, parents administered the same daily dose at home. After eight to eleven clinic visits, the children had reached a “maintenance dosage” of 300 milligrammes of peanut protein, or around 1.3 grammes of peanuts.

Clinicians documented any signs or reactions and counselled parents on how to handle them at home. The build-up period and one year of maintenance dosage were completed by 42 babies. At the end of the programme, none of them had more than a minor response to a 4,000-gram dosage of peanut protein, compared to 7.7 percent of the children aged one to five who finished it.

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Along the way, seven babies died. Four others had more severe responses, but none required epinephrine injections. Another 20 people were not tested for peanut allergy towards the end, either by choice or due to extensive wait lists.

Even before beginning the treatment, infants were shown to be at less risk than toddlers and pre-schoolers. In initial testing, only 33.9 per cent of infants had a reaction beyond mild, in comparison to 53.7 per cent of one-to-five-year-olds.

“Despite infants showing the best safety, we were still very satisfied with the safety of this treatment for older pre-schoolers. The risk of a severe reaction is much lower than it is for school-age kids,” Dr Chan noted.

“Many of the interventions we use in medicine, such as medications or surgical procedures, carry a small amount of risk that is outweighed by the benefit. If this treatment is performed by well-trained allergists and clinicians then I’m really comfortable with the risk. It’s actually very safe.”

In terms of efficacy, the medication was equally beneficial for both age groups. After a year of eating one peanut per day, almost 80% of the youngsters had built a tolerance for 4,000 mg of peanut protein in one sitting—the equivalent of around 15 entire peanuts.

At about six months of age, the first step in attempting to avoid peanut allergies in at-risk children is to introduce them to age-appropriate peanut-containing foods such as peanut butter or peanut flour.

If the newborn develops a peanut allergy, Dr. Chan’s study implies that oral immunotherapy may be a viable option to avoiding allergens for the rest of one’s life. Attempting to avoid allergies entirely entails a number of dangers, including decreased quality of life, social isolation, and anxiety.

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