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New treatments found to induce peanut allergy remission in children


Anastasia Tsirtsakis


14/02/2022 3:46:37 PM

Australian researchers have discovered two treatments that are highly effective at inducing remission and improving quality of life.

A young boy reaching for a peanut.
Around three in every 100 children have a peanut allergy, which is the most common cause of anaphylaxis.

Kate Lawlor is trained to respond to medical emergencies.
 
But when her four-year-old son Declan had his first allergic reaction after consuming peanuts while on holiday on New South Wales’ south coast, it was an anxiety inducing experience.
 
‘It was a public holiday, so there was literally no GP and no pharmacy open that day, and the nearest hospital was an hour away down a highway,’ Ms Lawlor told newsGP.
 
‘I knew that he could start to resolve, or he’d stay the same and it would probably be okay.
 
‘But there was a chance that it could progress and we could be dealing with something a lot more severe – and that was sitting in the back of the mind as I white knuckled it down the highway.’
 
This is an experience many parents and carers face, given around three in every 100 children have a peanut allergy, which is the most common cause of anaphylaxis.
 
At present there are no approved treatments for food allergy in Australia, with the current standard of care allergen avoidance accompanied by education on responding to accidental exposure and an adrenaline autoinjector, prescribed for high risk patients.
 
But there is hope on the horizon thanks to new research led by the Murdoch Children’s Research Institute (MCRI), which has confirmed two treatments that can induce remission and desensitisation to peanut allergy.
 
Published in The Lancet Child & Adolescent Health, 201 children aged 1–10 with peanut allergy were randomly assigned to receive either a probiotic together with oral immunotherapy, oral immunotherapy alone, or a placebo for 18 months, with participants followed up to 12 months post-treatment.
 
The findings show that 51% of children who received the oral immunotherapy alone and 46% who received the combination treatment were in clinical remission compared to 5% in the placebo group, allowing them to stop treatment and eat around a standard serve of peanuts freely.
 
Lead author Professor Mimi Tang conducted research on oral immunotherapy in 2015 and set out to discover if the addition of a probiotic would improve effectiveness. While it did not, it did improve tolerability and safety, with fewer gastrointestinal side effects especially in children aged 1–5.
 
The potentially life-changing treatment involves administering increasing doses of peanut, starting at a very low dose to build up to a high maintenance dose, which is continued for 18 months.
 
‘One of the things about our approach is that we take children from their first dose of peanut to the top 2000 milligram dose quite quickly in a 16-week period,’ Professor Tang told newsGP.
 
‘We think that the fast escalation phase might contribute to the high rates of remission that have been achieved, partly because there have been studies in other settings showing that rapid escalation may be good at inducing anergy or deletion of allergy cells.’
 
The study also analysed the impact of the outcomes on participants’ quality of life, and found both treatments significantly improved anxiety and emotional distress, particularly for children who achieved clinical remission.
 
This has certainly been the case for Ms Lawlor’s son Declan. Now age nine, since participating in the trial he has been in remission and is able to safely consume 8–10 peanuts every 1–2 weeks without a reaction.
 
‘It’s incredible,’ Ms Lawlor said.
 
‘He just feels really confident and happy for himself – but he’s also really happy that there’ll be other kids that will also benefit.’
 
This improvement in quality of life has also extended to Ms Lawlor’s entire family. As well as making the weekly supermarket shop easier, it has eased her daughter’s anxiety, who at just eight years old had to be shown how to administer an EpiPen to assist her brother in the absence of her parents.
 
‘For us, it was the uncertainty of how quickly it might progress into a full anaphylaxis reaction, knowing that the first exposure is often not as severe as the subsequent exposures,’ Ms Lawlor said.
 
‘It can progress and become quite dangerous.’
 
However, it may still be some time before the treatments are widely available.
 
The Australasian Society of Clinical Immunology and Allergy’s (ASCIA) current position is that oral immunotherapies should only be used as part of a clinical trial, with the treatment now required to go through standard regulatory steps to be approved, a process that could take up to seven years.
 
In the meantime, with one in five Australians affected by allergies and anaphylaxis, a significant challenge is accessing allergy specialist care. Professor Tang attributes this in part to allergy being a recent phenomenon.
 
‘It’s increased dramatically in recent decades and so it wasn’t necessarily something that a lot of people had experience with through medical training,’ she said.
 
This is where Professor Tang says GPs have an important role to play.
 
‘There’s certainly been a focus amongst allergist tertiary centres across Australia to upskill GPs and paediatricians … and we see this as a very important aspect of improving access to care, where children with less complex food allergy concerns can access support in the local community,’ she said.
 
‘We’ve made great strides forward in Victoria in setting up training programs and education resources. I spearheaded that when I was appointed Head of the Department of Allergy and Immunology in 2006; that was one of my first initiatives and that seemed to help a lot.
 
‘But unfortunately rates continue to increase, so for every step forward we make the rates just chase ahead of us so it’s very difficult right now. More resources are needed, as with everything.’
 
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