Peanuts are one of the most common food allergens, and one that can lead to anaphylaxis, a life-threatening reaction that requires immediate treatment. From 1997 to 2008, the number of children with a peanut or tree nut allergy more than tripled – leaving many parents searching and hopeful for new ways to treat this potentially dangerous food allergy.
Oral immunotherapy (OIT) is one option that has gained traction in recent years as it moves closer to becoming an FDA-approved peanut allergy treatment. J. Andrew Bird, M.D., Director of the Food Allergy Center at Children's Health℠ and Associate Professor at UT Southwestern, explains how oral immunotherapy works and what to expect from this emerging peanut allergy treatment.
What is oral immunotherapy?
Oral immunotherapy involves feeding a person with food allergies a small amount of food allergen with the goal of increasing their tolerance. For example, a child with peanut allergies is given very small amounts of peanut protein. Over a period of months, the dose of peanut gradually increases, raising the threshold that triggers an allergic reaction for the child. This process is referred to as desensitization to the allergen.
Currently, there is no FDA-approved regulatory product available for peanut OIT, meaning it is considered an investigational therapy. Researchers expect that the first oral drug for peanut allergy, AR101 (with the proposed name Palforzia), may be approved by the Food and Drug Administration in 2020 or sooner.
Is oral immunotherapy a peanut allergy cure?
The goal of oral immunotherapy is not to cure peanut allergies, but to increase the amount of peanut required to trigger a reaction. This can help protect a highly allergic child who accidentally ingests peanuts.
Even after oral immunotherapy, children with peanut allergies will need to carry epinephrine and take other precautions to prevent peanut exposure. While the therapy may reduce risk of a severe reaction, it is expected that most children who start OIT will need to stay on OIT indefinitely to maintain their level of desensitization.
Is oral immunotherapy safe?
Any exposure to food allergens like peanuts carries risk of anaphylaxis. It is important that oral immunotherapy is given under guidance of a trained specialist in a controlled environment.
"Allergists are best-equipped to recognize anaphylaxis – as well as to characterize which patients would benefit from OIT and which ones wouldn't," explains Dr. Bird.
Other possible side effects of OIT include GI issues such as abdominal pain, cramping and vomiting, as well as oral itching, rash, hives, swelling and wheezing. Some patients have also developed eosinophilic esophagitis (EoE), though it is not always clear if oral immunotherapy caused the condition.
However, clinical trials have shown that for the right patients, oral immunotherapy can be a safe and effective treatment option. Approximately 60-80% of patients show desensitization in peanut, egg and milk OIT studies.
What other new treatments for food allergies are being researched?
Dr. Bird says that once an FDA-approved peanut allergy therapy is on the market, more treatments will follow.
"It's an exciting time for the food allergy community," he says. "I recommend that any family facing food allergies have an honest conversation with their allergist about upcoming treatments and what may be the best fit for them."
In addition to being involved in oral immunotherapy clinical trials, Dr. Bird has supported research on sublingual immunotherapy (SLIT), a desensitization therapy exposing the allergic patient to allergen through drops of allergen placed under the tongue, and epicutaneous immunotherapy (EPIT), a desensitization therapy that uses a skin patch. Injectable and combination therapies are also being researched, and new studies are focusing on expanding treatment options to younger children.
Even with new therapies on the horizon, Dr. Bird cautions that the best treatment for food allergies will vary for each child.
"There is no one-size-fits-all approach for food allergies," he says. "It's important that you discuss the pros and cons of any treatment with your allergist."
The Food Allergy Center at Children's Health is the only academic-affiliated pediatric food allergy center in North Texas. We offer comprehensive testing, diagnosis and management for food allergies and access to groundbreaking research and clinical trials aimed to develop new therapies for children with food allergies. Learn more about the Food Allergy program and services.
Interested in participating in food allergy research? Contact us.
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