New evidence from BC Children’s Hospital and University of British Columbia (UBC) researchers shows babies can safely be treated for peanut allergies. This follows the team’s groundbreaking findings in 2019 that demonstrated toddlers and preschoolers can safely overcome peanut allergies with a treatment called oral immunotherapy.
This new real-world study focused on infants younger than 12 months and reveals that oral immunotherapy is not only effective against peanut allergies, it’s even safer for this age group than it is for one-to-five year olds.
"This treatment is affordable, very safe and highly effective, particularly if we can get the treatment going before the infant is 12 months old," says Dr. Edmond Chan, BC Children's Hospital investigator and the study's senior author, who is also a clinical professor and head of allergy and immunology in UBC's department of pediatrics.
The study, recently published in the Journal of Allergy and Clinical Immunology: In Practice, looked specifically at outcomes for a group of 69 infants among a larger study group of 452 children aged five and under.
Oral immunotherapy is a treatment protocol in which a patient consumes small amounts of the allergenic food — in this case, peanut flour — with the dose gradually increased to a determined maximum amount. The aim is to desensitize the child until they can have a full serving of peanut protein without triggering a dangerous reaction. To sustain their immunity, the child must continue to eat peanut products on a regular basis long-term.
For this study, children visited a pediatric allergist in a community or hospital clinic approximately every two weeks to receive their peanut dose. Parents gave the same daily dose at home between clinic visits. After eight to 11 clinic visits, the children had built up to a maintenance dose of 300 milligrams (mg) of peanut protein.
Clinicians recorded any symptoms or reactions and advised parents how to manage reactions at home.
Forty-two infants completed the build-up period plus one year of maintenance dosing. At the end of it, none of them had more than a mild reaction to a 4,000 mg dose of peanut protein — the equivalent of roughly 15 whole peanuts, compared to 7.7 per cent of the older children who completed the protocol in the previous study.
Even before beginning treatment, infants were shown to be at less risk than toddlers and preschoolers. In initial testing, only a third of infants had a reaction beyond mild, in comparison to about half of one-to-five year olds.
"Despite infants showing the best safety, we were still very satisfied that this is a safe treatment for older preschoolers. The risk of a severe reaction is much lower than it is for school-age kids,” says Dr. Chan. “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."
The treatment worked equally well for both age groups. After a year of one peanut per day, around 80 per cent of the children had developed a tolerance for 4,000 mg of peanut protein in one sitting.
The first step in trying to prevent peanut allergies among at-risk children is to introduce them to age-appropriate, peanut-containing foods such as peanut butter or peanut flour at around six months of age. If the infant still develops a peanut allergy, Dr. Chan's research suggests that oral immunotherapy can be an effective alternative to avoiding allergens for a lifetime. Trying to avoid allergens altogether carries different risks, such as poor quality of life, social isolation and anxiety.
With this new data, the next step recommended by Dr. Chan’s team is for practitioners to offer oral immunotherapy as soon as possible after failed food allergy prevention during infancy, a concept that has recently been accepted for publication in a separate “Rostrum” article in the Journal of Allergy and Clinical Immunology: In Practice.
Dr. Chan has embraced oral immunotherapy in his own clinical practice. His research will help inform future clinical practice guidelines and provide health professionals with the data they need to recommend it for their young patients as well.
Credit: UBC News