Oral immunotherapy for peanut allergies is very effective when started for infants under 12 months.

In 2019, UBC researchers demonstrated that preschoolers can safely overcome peanut allergies with a treatment called oral immunotherapy.

Now they have evidence that early preschoolers are better off starting this treatment.

This real-world study focuses on infants <12 months of age, not only that oral immunotherapy is effective against peanut allergies, but also more than preschoolers of infants and older. It is clear that this age group is safer.

“This treatment is affordable, very safe and very effective, especially if the baby can start treatment before the age of 12 months,” said a clinical professor responsible for allergies. Dr. Edmond Chan, the lead author of this study, who is also a professor, said. UBC Pediatric Immunology at the BC Children’s Hospital Research Institute.

Recently published research Journal of Allergy and Clinical Immunology: In PracticeWe specifically examined the results of a group of 69 babies in a large study group of 452 children under the age of 5.

Oral immunotherapy is a treatment protocol in which a patient consumes a small amount of allergenic food (in this case, peanut powder) and gradually increases the dose to a determined maximum. The goal is to desensitize the child until he or she is fully ingested with peanut protein without causing a dangerous reaction. To maintain immunity, children need to eat peanut products on a regular basis for extended periods of time.

In this study, children visited a pediatric allergist in a community or hospital clinic approximately every two weeks to receive peanuts. Parents gave the same daily dose at home during the clinic visit. After 8-11 visits, the children had accumulated up to 300 milligrams of peanut protein or a “maintenance amount” equivalent to about 1.3 grams of peanuts.

The clinician recorded symptoms and reactions and advised parents on how to manage the reactions at home.

Forty-two infants completed the accumulation period and one year of maintenance dosing. At the end of it, none of them had a mild response to 4,000 grams of peanut protein, compared to 7.7 percent of children aged 1 to 5 years who completed the protocol.

Seven babies dropped out on the way. There were four more than mild experienced reactions, but no epinephrine injection was required. Another 20 did not evaluate peanut tolerance at the end, either by choice or because of a long waiting list.

Infants have been shown to be at lower risk than infants and preschoolers, even before starting treatment. In the first test, only 33.9% of babies responded more than mildly, compared to 53.7% aged 1-5 years.

Despite the fact that infants show the highest safety, we are still very pleased with the safety of this treatment for older preschoolers. The risk of severe reactions is much lower than in school-aged children. Many of the interventions we use in medicine, such as dosing and surgical procedures, carry small risks that are more important than benefits. If this treatment is done by a well-trained allergist or clinician, I’m really happy with the risk. It’s actually very safe. “

Dr. Edmund Chan, lead author of the study

In terms of efficacy, the treatment worked equally well in both age groups. One year after one peanut a day, about 80% of children developed tolerance to 4,000 milligrams of peanut protein in a single sitting. This is equivalent to about 15 whole peanuts.

The first step in preventing peanut allergies in children at risk is to introduce them to age-appropriate peanut-containing foods, such as peanut butter and peanut flour, about 6 months old. If the baby still develops a peanut allergy, Dr. Chan’s research suggests that oral immunotherapy can be an effective alternative to avoiding allergens for life. Attempting to avoid allergens involves a variety of risks, including poor quality of life, social isolation, and anxiety.

Using this new data, the next step recommended by Dr. Chan’s team is for practitioners to provide oral immunotherapy as soon as possible after failing to prevent food allergies in infancy. the Journal of Allergy and Clinical Immunology: In Practice..

Dr. Chan is incorporating oral immunotherapy into his own clinical practice. His research helps inform healthcare professionals in providing information on future clinical practice guidelines and the data needed to make recommendations to younger patients as well.