Peanuts are one of the most common food allergens, and one that can lead to anaphylaxis, a potentially 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. In fact, in January 2020, the Food and Drug Administration (FDA) approved the first OIT drug for children. J. Andrew Bird, M.D., Director of the Food Allergy Center at Children's Health℠ and Associate Professor at UT Southwestern, explains how OIT works and what to expect from this emerging peanut allergy treatment.
What is oral immunotherapy?
OIT 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 a peanut allergy is given very small amounts of peanut protein daily. 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.
In recent years, there was no FDA-approved regulatory product available for peanut OIT, meaning it was considered an investigational therapy. However, on January 31, 2020, the FDA approved the first oral drug for peanut allergy, Palforzia, for use in children ages 4-17.
Is oral immunotherapy a peanut allergy cure?
The goal of OIT is to increase the amount of peanut required to trigger a reaction, but it is unlikely that the treatment will lead to permanent remission of the peanut allergy for most allergic patients. This can help protect a highly allergic child who accidentally ingests peanut protein.
Even after starting OIT, children with peanut allergies will need to carry epinephrine and take other precautions to prevent peanut exposure. While the therapy may increase the amount of peanut required to trigger a 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, and studies have shown that some patients experience more allergic reactions, including anaphylaxis, while on OIT compared to practicing strict avoidance of peanut. It is important that OIT 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).
However, clinical trials have shown that for the right patients, OIT can be a safe and effective treatment option. Approximately 60-80% of patients show desensitization in peanut OIT studies.
What other new treatments for food allergies are being researched?
Dr. Bird says that now 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 OIT clinical trials, Dr. Bird has participated in research studies on other new peanut allergy treatments, including:
- Sublingual Immunotherapy (SLIT), a desensitization therapy exposing the allergic patient to allergen through drops of allergen placed under the tongue
- 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 a food allergy will vary for each child.
"There is no one-size-fits-all approach for food allergies," he says. "Just because therapeutic options are on the market does not mean that every patient needs to be on therapy. Avoidance of the allergen is still a viable option that many families choose until safer and more effective treatments are available. 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.