Can boiled peanuts improve child allergies?

Australian research published in Clinical & Experimental Allergy shows that boiling peanuts can help overcome children’s allergic reactions, with up to 80% of participants becoming desensitised.
 
Of the 70 children aged 6–18 in the trial, 56 became desensitised to the target dose of peanuts after a course of oral immunotherapy comprised of boiling peanuts and incremental increases in exposure.
 
Lead author, Associate Professor Luke Grzeskowiak, said the results are promising.
 
‘Boiling peanuts may provide a safe and effective method for treating peanut-allergic children with sequential doses of boiled and roasted peanuts over an extended period of time,’ he said.
 
However, he told newsGP that the therapy must only be attempted in consultation with a doctor under strict medical supervision.
 
‘What is really important is that people do not try this at home,’ he said.
 
‘The products developed as part of this trial were carefully prepared and assessed for quality and suitability before administration to study participants.
 
‘This included confirming that the boiled peanuts had reduced allergenicity.’
 
At the start of oral immunotherapy, capsules containing ground boiled peanut or roasted defatted peanut powder were packaged into capsules, which the participants then emptied onto a spoon of yoghurt.
 
Doses were escalated weekly within each treatment phase and each initial dose was given in an outpatient clinic with two hours of monitoring.
 
The trial’s multi-step process of oral immunotherapy included consuming 12-hour boiled peanuts for 12 weeks, then two-hour boiled peanuts for 20 weeks and finally roasted peanuts for 20 weeks.
 
After this, they entered a 6—8-week maintenance phase while awaiting an oral food challenge (OFC), which comprised a cumulative dose of 12 roasted peanuts. If they were able to consume them without experiencing symptoms, they were considered to have achieved the primary efficacy-end point.
 
Dr Nicholas Cooling, Chair of RACGP Special Interests Allergy, told newsGP it is an interesting study.
 
‘Lots of parents are asking about it. It would give them a lot of relief that their kids can tolerate peanuts,’ he said.
 
‘It’s still very experimental and usually done in a hospital. There are potential risks such as itch, lip swelling, abdominal symptoms and some children can get anaphylaxis.
 
‘Some trials also add probiotics which can improve the risk of adverse events.’
 
Professor Grzeskowiak highlights the importance of strict monitoring with oral immunotherapy.
 
‘Oral immunotherapy has risks, and the treatment of peanut allergies remains experimental at this point in time and therefore is restricted to use in carefully controlled clinical settings, undertaken with appropriate medical supervision,’ he said.
 
Treatment-related adverse events were reported in 61% of participants; however, only three withdrew from the trial, which the authors say demonstrates a favourable safety profile.
 
Epinephrine use was reported by 4% of participants while the most common adverse events were gastrointestinal and dermatological.
 
According to the Australasian Society of Clinical Immunology and Allergy (ASCIA), food allergy occurs in approximately 5–10% of children.
 
The most common foods implicated are egg, peanut, cow’s milk, tree nuts, soy, sesame, wheat, fish and crustaceans.
 
According to ASCIA, peanut and tree nut allergies are less likely to be outgrown and tend to remain lifelong.
 
Regarding other nut allergies, Professor Grzeskowiak points to evidence that boiling them may also be beneficial.
 
‘We have not explored the process of thermal processing [boiling] on other nuts, but there is some evidence to support changes in allergenicity with boiling of other nuts,’ he said.
 
‘This may open up [the] potential for using thermal processing as a strategy for reducing allergenicity of allergens introduced in the early phases of oral immunotherapy.’
 
The researchers were able to follow up 80% of participants who passed OFC several months after the trial and found the majority continued to consume peanuts daily with none experiencing anaphylaxis.
 
ASCIA currently recommends strict avoidance of confirmed food allergens until food allergy oral immunotherapy is proven to be effective, safe and standardised for routine use.
 
Dr Cooling also says allergenic foods should be introduced in infants’ diets within the first six months of solids.
 
‘ASCIA now recommends early introduction as soon as a child has solids, usually around six months, for example egg, cow’s milk, sesame, fish, wheat and all standard allergenic foods,’ he said.
 
Despite the apparent success of the trial, there are still no approved peanut allergy treatments in Australia and Professor Grzeskowiak says ‘a lot more research’ is needed.
 
‘In particular, a large definitive clinical trial is required to determine if using boiled peanuts as part of oral immunotherapy represents a safer and more effective approach than alternative oral immunotherapy protocols,’ he said.
 
‘Unfortunately, oral immunotherapy doesn’t work for everyone, and we are in the process of improving our understanding of how these treatments work and what factors can influence how people respond to treatment.
 
‘This will be really important for assessing individual suitability for treatment and improve treatment decisions in the future.’
 
Whatever future research may hold, Dr Cooling says trials should involve specified periods in which participants have a break from continuous allergen ingestion.
 
‘Most studies show you need to continue peanuts regularly to remain desensitised,’ he said. ‘But the trouble is, do people want to take peanuts daily?
 
‘Eighty percent of kids flip back to allergy if they stop consuming peanuts, so the holy grail is the sustained unresponsiveness and only 20% achieve this in the studies.
 
‘So, these kids are often stuck with taking regular peanuts as a type of medication, and carry an Epipen.
 
‘We still need to find ways to switch off the immune system.’
 
Meanwhile, Professor Grzeskowiak says more data is yet to come from the trial.
 
‘We are currently funded to undertake additional research using samples collected from participants involved in this trial to help us better understand how oral immunotherapy works as well as identifying individual level factors that influence treatment response,’ he said.
 
‘This will help us better identify who is most suitable for treatment and guide future treatment decisions.’
 
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