Therapy Helps Peanut-Allergic Kids

Photo:  EVGENIY AGARKOV/ADOBE STOCK

Gradually increasing doses of peanut butter over 18 months enabled 100% of children with high-threshold peanut allergy to consume three tablespoons without an allergic reaction. This treatment strategy could fulfill an unmet need for about half of children with peanut allergy, who already can tolerate the equivalent of at least half a peanut, considered a high threshold.

The findings come from a NIAID trial. Results were published in the NEJM Evidence.

The food allergy treatments currently approved by the FDA were tested in children with low-threshold peanut allergy, who cannot tolerate the equivalent of even half a peanut. Therefore, researchers tested whether a low-cost, convenient treatment strategy could help children with high-threshold peanut allergy increase their tolerance. The mid-stage trial involved 73 children ages 4 to 14 years, who tested the new treatment strategy or continued avoiding peanut.

The peanut-ingestion group began with a minimum daily dose of 1/8 teaspoon of peanut butter and increased their dose every eight weeks up to 1 tablespoon.

Following the treatment regimen, the peanut-consuming children underwent a supervised challenge to see how much peanut butter they could eat safely. All 32 children who participated could tolerate 9 grams of peanut protein, the equivalent of 3 tablespoons of peanut butter. Only three of the 30 children in the avoidance group from the same challenge could tolerate 9 grams of peanut protein.

Children in the peanut-ingestion group who passed the challenge consumed at least 2 tablespoons of peanut butter weekly for 16 weeks, then avoided peanut for eight weeks. Investigators found that 68.4% of the peanut-ingestion group achieved sustained unresponsiveness, while only 8.6% of the avoidance group developed natural tolerance.

The investigators want to learn if the same treatment strategy would work for food allergens other than peanuts. Future follow-up is needed to determine the therapy’s effectiveness at inducing long-lasting tolerance of peanut.