Science, Health and Technology
June 16, 2022 | Contact Erik Rolfsen for more information
UBC researchers demonstrated in 2019 that preschoolers can safely overcome peanut allergies with a treatment called oral immunotherapy.
They now have evidence that the sooner children in preschool begin this treatment, the better.
This real-world study focused on infants under 12 months of age and reveals that oral immunotherapy is not only effective against peanut allergies, but is even safer for this age group than for young children and older preschoolers.
“This treatment is affordable, very safe and highly effective, especially if we can start treatment before the baby is 12 months old,” said Dr. Edmond Chan, lead author of the study who is also a clinical professor and head of allergy and immunology in the pediatric department of the UBC at the BC Children’s Hospital Research Institute.
The study, recently published in the Journal of Allergy and Clinical Immunology: In Practice, specifically analyzed the results of a group of 69 infants among a study group larger than 452 children five years of age or younger.
Oral immunotherapy is a treatment protocol in which a patient consumes small amounts of allergenic food — in this case, peanut flour — with the dose gradually increasing to a certain maximum amount. The goal is to desensitize the child until he or she can take a full serving of peanut protein without causing a dangerous reaction. To maintain his immunity, the child should continue to eat peanut products regularly on a long-term basis.
For this study, the children visited a pediatric allerologist at a community or hospital clinic approximately every two weeks to receive their dose of peanuts. Parents gave the same daily dose at home between clinic visits. After eight to eleven clinic visits, the children had accumulated a “maintenance dose” of 300 milligrams of peanut protein, or the equivalent of about 1.3 grams of peanuts.
Doctors recorded any symptoms or reactions and advised parents how to manage the reactions at home.
Forty-two babies completed the accumulation period plus one year of maintenance dosing. In the end, none of them had more than a mild reaction to a dose of 4,000 milligrams of peanut protein, compared to 7.7 percent of children ages one to five who completed the protocol.
Seven children left the road. Four experienced reactions beyond mild, but none required epinephrine injections. Another 20 did not have their peanut tolerance in the end, either by choice or by long waiting lists.
Even before starting treatment, it was shown that infants were at lower risk than young children and preschoolers. In the initial tests, only 33.9% of babies had a mild reaction, compared with 53.7% of children aged one to five years.
“While babies show the best safety, we were still very pleased with the safety of this treatment for older preschoolers. The risk of a severe reaction is much lower than for school-age children.” pointed out Dr. Chan. “Many of the interventions we use in medicine, such as medications or surgical procedures, involve a small amount of risk that is offset by the benefit. If this treatment is performed by well-trained allergists and doctors, I feel very comfortable with the risk. “In fact, it ‘s very safe.”
In terms of effectiveness, the treatment worked just as well for both age groups. After a year of one peanut a day, about 80% of children had developed a tolerance of 4,000 milligrams of peanut protein in one session, the equivalent of about 15 whole peanuts.
The first step in trying to prevent peanut allergies among children at risk is to introduce them to age-appropriate foods that contain peanuts such as peanut butter or peanut flour around the age of six months. age. If the baby is still developing a peanut allergy, Dr. Chan suggests that oral immunotherapy may be an effective alternative to prevent allergens for life. Trying to avoid allergens altogether carries different risks, such as poor quality of life, social isolation, and anxiety.
With this new data, the next step recommended by Dr. Chan is that professionals offer oral immunotherapy as soon as possible after a mistake in the prevention of food allergies during childhood, a concept that has recently been accepted for publication in a separate article ” Rostrum “in the Journal of Allergy and Clinical Immunology: In Practice.
Dr. Chan has adopted oral immunotherapy in his own clinical practice. Their research will help inform future clinical practice guidelines and provide healthcare professionals with the data they need to recommend it to their young patients as well.
Language (s) of the interview: English, Cantonese