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Peanut Desensitizing Found Safe, Effective Long-Term

Bag of peanuts

(Radu Marcusu, Unsplash)

5 Sept. 2019. A clinical trial shows children with peanut allergies taking peanut protein under the tongue avoid allergic reactions from peanuts for up to five years. Results of the trial conducted by researchers at University of North Carolina in Chapel Hill, appear in yesterday’s issue of the Journal of Allergy and Clinical Immunology (paid subscription required).

Allergies to peanuts and other foods are a result of the body’s immune system misinterpreting certain foods as pathogens, and responding by the release of histamines, chemicals in the body causing the allergy symptoms. In most cases, the symptoms are mild, such as runny nose and itching, but people with peanut allergies face a real and elevated risk of anaphylaxis, a life-threatening condition constricting airways, swelling the throat, and causing a sharp drop in blood pressure. Food Allergy Research and Education says some 32 million people in the U.S. have a food allergy, including 5.6 million children, with growing numbers of people reporting an allergy.

A team led by Edwin Kim, professor of pediatrics and immunology at UNC-Chapel Hill, assessed a preventive treatment for peanut allergy known as sublingual immunotherapy, or SLIT, to desensitize the immune system and prevent an allergic reaction to larger amounts of peanuts. With SLIT, a small amount of liquid protein extracted from peanuts is given each day, and taken under the tongue, which absorbs the protein immediately, bypassing the digestive system. Other desensitization methods require ingesting small amounts of peanut extract, and gradually increasing the dosage over time, or wearing a skin patch, which absorbs peanut protein through the skin.

The early and mid-stage clinical trial tested the SLIT approach over an extended period, but did not evaluate the technique against other desensitization methods. The paper reports on 48 children age 1 to 11 with peanut allergies who received peanut SLIT treatments, gradually increasing to 2 milligrams per day, and were tracked for up to 5 years. To test the effectiveness of the treatments, participants in the trial were given small quantities of peanuts to consume at the beginning of the trial, then periodically for up to 5 years.

Of the 48 children receiving peanut SLIT treatments, 37 took part in at least 3 years of follow-up tests. Of the original group of 48 participants, two-thirds (32 or 67%) were able to consume 750 milligrams of peanuts without a reaction, and 12 of the 48 children (25%) successfully consumed 5,000 milligrams — 1 peanut kernel is about 300 milligrams. About 5 percent of participants reported mainly mild adverse effects from the treatments, most often temporary itching around the mouth that required no treatment. More serious adverse effects requiring antihistamine treatments were rare, and no epinephrine, an emergency rescue drug for severe allergic reactions, was needed.

“SLIT participants tolerated between 10 and 20 times more peanut protein than it would take for someone to get sick,” says Kim in a university statement. Kim, whose own children have food allergies, adds, “The main idea beyond immunotherapy is not for kids to be able to eat peanut butter and jelly sandwiches. It’s to keep them safe from the small hidden exposures that could occur with packaged foods, at restaurants, and with other food exposures.”

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