Does Immunotherapy For Peanut Allergy Work? We Answer All Your Questions

The prevalence of allergies has continued to extend at an alarming rate. It’s estimated that 3% of Australia’s 4.7 million children have peanut allergies.

In the US, 2.5% of the 73.1 million children suffer from peanut allergies. In children, peanut allergies are by far the most common food-related allergies, making them a significant health concern.

On exposure to peanut protein, patients undergo a reaction referred to as anaphylaxis. This is often a life-threatening reaction.

Every day, families of over 1.81million children within the US risk the prospect of experiencing these terrifying experiences.

For an extended time, peanut allergy treatment involved only the strict avoidance of all substances that might trigger an aversion. The employment of epinephrine was in cases of emergency due to accidental consumption. 

This practice has lasted until now, when immunotherapy for peanut allergy has emerged as a useful means of managing peanut allergy.

What Is Peanut Allergy Immunotherapy?

Peanut Allergy Immunotherapy refers to a treatment plan that’s designed to build a patient’s tolerance to peanuts. This treatment is aimed at desensitising the body to peanuts such that possible allergic reactions are minimised.

What happens during this treatment procedure is that the patient is exposed to small amounts of the allergen (peanuts), which at the most times is ready in powdered form.

The amount of peanut given is gradually increased until the required target dose is reached. The working rule behind this procedure relies on the body’s ability to develop increased tolerance levels on exposure to increasing doses of the allergen.

A New Treatment Option?

Immunotherapy for peanut allergy

Currently, there’s no cure for peanut allergy, and health care providers have had to accommodate diagnosed cases of peanut allergy by educating and counselling patients and their families on the way to avoid accidental exposure to the allergen.

Immunotherapy for peanut allergy is an emerging treatment option that has shown the potential to scale back the frequency and severity of hypersensitive reactions. However, this treatment option is obtainable by only a limited number of allergists, thanks to criticism of a scarcity of established protocols. 

The US Food and Drug Administration (FDA)  in January 2020 approved a completely unique peanut-derived oral immunotherapy product for treating childhood peanut allergy: Palforzia (peanut leguminous plant allergen powder-dnfp)

This treatment option is specific to children within the age range of 4 and 17. Palforzia (peanut allergy treatment) contains a powder obtained from roasted peanuts, which is then packaged in capsules or sachets at specific doses.

This capsuled powder isn’t designed to be swallowed but emptied and mixed with food like pudding or something similar, then given in dosing phases in line with the present trend in immunotherapy for peanut allergy.

Although these treatments are indicated for youngsters, the symptoms of peanut allergy in children are identical in adults; hence peanut allergy treatment for adults can also be achieved with the employment of palforzia (peanut allergy treatment)

Whatever the case, be it in children or adults, immunotherapy for peanut allergy should always be allotted in a doctor’s office to stop adverse reactions.

Parents deciding to use this treatment for their children may have doubts and easily relate with Stephanie Polk, whose 10-year-old daughter has an allergy to peanuts. She says, “It’s within the back of my mind.” “I have some anxiety about exposing Olivia to her food allergen.”

The cost of peanut immunotherapy is additionally an element to think about before engaging in this treatment option.

Is oral immunotherapy the solution to peanut allergies? Here is all you would like to understand about immunotherapy for peanut allergy.

What varieties of Peanut Allergy Immunotherapies Are Available?

Immunotherapy for peanut allergies is categorised into 

  • Oral Immunotherapy (OIT)
  • Epicutaneous Immunotherapy (EPIT)
  • Sublingual Immunotherapy (SLIT)
  • Biologic Medications

Oral Immunotherapy (OIT)

Oral immunotherapy

This is the foremost common variety of immunotherapy for peanut allergy sufferers, and like all other sorts of peanut allergy treatment, it involves taking small amounts of peanut powder in progressive order till a target dose is achieved. This is often carried out in one among two ways:

1. Application of Palforzia (Peanut Allergy Treatment): 

This is a capsule containing a set dose of peanut powder and is run under the supervision of a board-certified allergist. Patients are given food mixed with the powder. The dose is gradually increased until a tolerance level is reached, then the patient stays on a maintenance dose indefinitely.

2. Utilization of Non-Pharmaceutical Grade Products: 

In this case, a board-certified allergist who makes a speciality of peanut allergy desensitisation carefully prepares and administers a non-pharmaceutical-grade peanut product using specific protocols. While these commercial products don’t seem to be FDA-approved as an allergy treatment, they have shown proven benefits for thousands of patients.

OIT Expected Outcomes

The anticipated results of oral immunotherapy for peanut allergy as a therapeutic intervention are proven to have high efficacy.  The bulk of patients that have undergone the procedure has achieved remarkable levels of desensitisation.

Based on predictions, patients who have received oral immunotherapy for peanut allergy may consume large quantities of peanuts, far beyond the amount present in contaminated snacks and meals.

OIT may be effective in older children and people with high peanut-sIgE levels (the physician can use peanut-sIgE levels to predict the outcomes of oral food challenges in patients suspected of getting peanut allergy; the reported cutoff value is 14 kU/L).

In general, it’s expected that successful completion of the up-dosing phase and also the continuation of maintenance dosing will provide significant protection, preventing reactions to small accidental exposures to peanuts and attenuating reactions to larger exposures, decreasing their severity.

Taking part in oral immunotherapy doesn’t entail the patient abandoning strict avoidance of peanuts or abandoning their Epinephrine autoinjectors.

Side Effects Of OIT

Immunotherapy side effects

Oral immunotherapy for peanut allergy isn’t without its risks, with the foremost prominent being hypersensitive reactions to treatment. These side effects, though, are mostly mild and might be easily treated.

A number of the foremost common side effects experienced include mouth itching, throat itching, mild abdominal pain or cramping, and sometimes a gentle rash.

These symptoms are typically experienced during treatment, particularly during up-dosing or early maintenance phases, and are resolved with an antihistamine, or perhaps without treatment.

An additional risk of OIT involves external factors, like viral illnesses, exercise, tiredness, and menstruation, which have the potential to lower the brink of reactivity in patients undergoing OIT.

According to the recently published Threshold Reactivity and Clinical Evaluation Study (TRACE), both exercise and sleep deprivation significantly increase the danger of peanut reactions in patients with peanut allergies.

The development of eosinophilic esophagitis (EoE) as a result of OIT is another current concern. There’s evidence that approximately 3% of patients with immunoglobulin E-mediated food allergies who underwent OIT developed this complication, with symptoms often resolving after treatment discontinuation.

According to their report, these symptoms ceased after dosage modifications or temporary discontinuation of treatment. Interestingly, half the patients were able to achieve full desensitisation, and quite two-thirds were able to achieve partial desensitisation.

Starting doses > 120 mg, doses over fourfold within the second month and baseline absolute eosinophil counts > 600/L were all identified as risk factors for developing transient gastrointestinal symptoms of peripheral eosinophilia (the participants received OIT for milk, peanut, egg, or sesame).

Epicutaneous Immunotherapy (EPIT)

This is another kind of immunotherapy for peanut allergy sufferers. It’s commonly named the “peanut patch”, which is an indication of how it works. Though still in its developmental stages, ViaskinTM Peanut (manufactured by DBV Technologies) has also shown appreciable levels of efficacy.

Unlike in OIT, epicutaneous immunotherapy involves the utilisation of an adhesive patch that’s attached to the skin. The patch contains a fraction of peanut protein—approximately 1/1000, which makes it a well-tolerated approach by patients.

The aim of EPIT remains the desensitisation of patients to peanuts and, overall, to extend tolerance levels. Many that have undergone the procedure are able to increase the brink of peanut exposure that’s needed to trigger a hypersensitive reaction.

While this treatment option provides increased protection from accidental exposure, it must be applied under the strict supervision of an allergist.

Sublingual Immunotherapy (SLIT)

Sublingual immunotherapy

This is a less common procedure as more research is being done to work out its safety and efficacy. SLIT involves placing drops of a peanut protein extract under the tongue for two minutes before swallowing.

Biologic Medications

Progress has been made on the utilisation of biologic medications like omalizumab and etokimab for peanut allergy treatment, but these don’t seem to be conclusive yet and need more work to determine a clinical relationship between these medications and peanut allergy treatment.

The Allergy & Asthma Network continues to track the progress of these medications and to be in communication with the FDA to bolster the importance of treatment options for those living with peanut allergies.

How Does Peanut Allergy Oral Immunotherapy Work?

Patients with peanut allergies are given a capsule with peanut powder that may be mixed into food. When taking it, patients consume a controlled dose of peanut protein under the supervision of a board-certified allergist.

The dose is gradually increased over time. Eventually, A level of peanut tolerance is reached. So, if there’s an accidental exposure, it won’t trigger a severe hypersensitive reaction.

10 Tips To Optimize Oral Immunotherapy For Peanut Allergy

Peanut allergy immunotherapy

Oral immunotherapy continues to be a brand new intervention within the management of peanut allergy; hence, it is vital for medical experts and families to search out ways to form the procedure as functional as possible. Here are the top ten tips which will help all parties involved bring the simplest results from OIT.

  1. Prepare to supply peanut powder: Not all facilities meet the necessities to administer and monitor the procedure. A secure administration requires adequate spacing and staff availability.
  1. Assess treatment eligibility: Like every drug therapy solution, the benefit-risk ratio of OIT must be weighed carefully before placing a patient on the treatment plan. This is often an indefinite therapy, so caution must be taken when diagnosing a patient and administering OIT. Other factors like concurrent medications, history of severe systemic aversions, and psychosocial factors should be considered when ascertaining a patient’s eligibility for the powder.
  1. Utilise shared decision-making: Considering the possible risks involved, clinicians should put aside time to answer questions about the treatment before initiating it. The patient’s opinions, preferences, and expected outcomes must even be put into consideration, as not every treatment works for everybody.
  1. Educate staff, patients, and families: Everyone involved in ensuring patient’s care—from medical staff to families—needs to be taught about the procedure. For medical staff, this suggests identifying the best patient for peanut powder, understanding the patient’s treatment goals, knowing oral immunotherapy’s pathophysiology, administering and monitoring doses correctly, managing adverse reactions, and securing consent forms from patients and members of the family.
  1. Create office procedures: Medical staff should specialise in “scheduling practices that are efficient and versatile,” Staff members should also develop ways to observe and properly handle anaphylactic emergencies.
  1. Manage patient expectations: The medical staff has to emphasise that the powder “is not a cure” in which the danger of anaphylaxis remains possible in those that receive the immunotherapy. It must be emphasized that continued peanut avoidance mustn’t be stopped.
  1. Offer guidance on adverse events: Staff members should develop ways to reduce patient discomfort by discussing and learning from adverse events.
  1. Optimise administration and adherence: Establishing “dosing protocols and standard administration methods can assist with delivery. Preemptively reproval patients about disliking the taste of peanuts may improve the patients’ willingness to accommodate the treatment regimen. Also, patients should avoid exercise for up to three hours after receiving a dose, reducing the danger of adverse reactions that might impact medication adherence.
  1. Remain flexible: “Although the dosage schedule for this procedure has been extensively studied, personalising treatment to the individual patient is important.” for instance, the standard time between up-dosing visits is 2 weeks. However, “extending the time between up dosing visits may increase the tolerability and safety of the peanut powder.”
  1. Be encouraging and interesting. Clinicians must have in mind that exposing patients to allergen will never be a simple experience for the patient. A supportive disposition will go an extended way towards ensuring patient compliance.

So, Does Immunotherapy For Peanut Allergy Work? 

Immunotherapy for allergies isn’t a cure yet, but it’s shown high potential for reducing the severity of sensitivity, and this greatly reduces a patient’s fear of getting a fatal reaction to accidental ingestion of peanuts.

After a year of peanut OIT (POIT), U.S. investigators reported that during a randomised controlled study of 28 participants with peanut allergy, 84% of the active subjects passed a final challenge of 20 peanuts (5000 mg of peanut protein) compared with just one peanut (280 mg of peanut protein) tolerated by the placebo group.

Before deciding to undergo immunotherapy for peanut allergy, you ought to discuss with your allergist thoroughly to make sure that you just are making a secure and beneficial decision.