Peanut Allergy Treatment
Peanut allergy is one of the most common food allergies in the United States. A 2017 study reports that nearly 2.5% of U.S. children may have a peanut allergy. In recent years, peanut immunotherapy has emerged as a treatment option. It is for adults and most children.
What is peanut allergy immunotherapy?
Peanut allergy immunotherapy is a treatment that focuses on building tolerance to peanut. It desensitizes the body to the allergen.
The treatment starts with giving a tiny amount of peanut protein, then gradually larger amounts until a target dose is reached. Building up peanut exposure desensitizes the patient to higher doses of peanut protein.
Peanut allergy immunotherapy is a treatment, not a cure. It is designed to reduce the frequency and severity of allergic reactions. This includes life-threatening anaphylaxis.
Peanut allergy immunotherapy should only be done in a medical setting. Emergency treatment should be immediately available in case of an allergic reaction to immunotherapy. Do NOT attempt peanut allergy immunotherapy on your own.
Considering peanut allergy treatment? What parents and patients need to know.
Stephanie Polk’s daughter Olivia has lived with peanut allergy since she was 2 years old. Olivia has successfully avoided peanut, but that could change as she begins middle school. Stephanie worries the potential for exposure could increase in a new environment.
Has Stephanie considered peanut allergy immunotherapy as a treatment option?
“It’s on my mind,” she says. “I have anxiety about exposing Olivia to her food allergen. We’ll wait to see how the school handles it and talk with teachers and the school nurse about the level of risk. The only way she would have peanut is if she were to eat someone else’s snack or there’s a school party with food. Olivia is pretty smart and careful about what she eats.”
Peanut allergy immunotherapy should be done by allergists with expertise in food allergy. Be sure to ask your allergist about their experience and training with OIT. Find out what steps are taken to maximize safety.
The decision to consider peanut allergy treatment is often a highly personal one for families.
What types of peanut allergy immunotherapy are available?
Peanut oral immunotherapy (OIT) is the most common peanut allergy treatment. The U.S. Food and Drug Administration (FDA) has approved one peanut allergy treatment.
Other products and methods of peanut allergy immunotherapy are being studied. But they are not available as a treatment or approved by FDA.
Oral immunotherapy (OIT)
OIT involves taking a small amount of peanut protein by one of two ways:
Palforzia (Aimmune Therapeutics) is the first peanut allergy treatment approved by the FDA. It consists of a capsule containing a measured dose of peanut powder. Palforzia is given under the supervision of a board-certified allergist. It is only for children between the ages of 4 to 17 years.
The treatment involves giving the patient a gradually increasing amount of the powder. If the patient is able to tolerate the treatment, then the patient stays on that dose indefinitely.
Allergists who specialize in peanut allergy treatment can provide oral immunotherapy with an office-based product. The allergist prepares a non-pharmaceutical grade peanut OIT using specific protocols. While these commercial products are not FDA-approved, they have shown proven benefits for many patients.
Researchers are evaluating biologics as peanut allergy treatments for adults and children. The biologics are omalizumab and etokimab. These medications are FDA-approved for other diseases, but not for peanut allergy. They can help desensitize patients to peanut.
Omalizumab is an anti-IgE medication. To treat peanut allergy, it would be administered one of two ways. First, it is for patients who are allergic to peanut and two other types of foods. Second, it is an add-on treatment for OIT.
Etokimab is an anti-IL-33 antibody medication. Both biologics would allow patients to tolerate peanut in case of accidental exposure.
Sublingual immunotherapy (SLIT)
SLIT is another form of peanut allergy treatment. It is not FDA approved. SLIT involves placing drops of a peanut protein extract under the tongue for 2 minutes before swallowing. A 2019 study of SLIT showed promise in children ages 1 to 11. But more research is needed to prove it is safe and effective.
Epicutaneous immunotherapy (EPIT)
Researchers are evaluating Viaskin™ Peanut (DBV Technologies) is another type of peanut allergy treatment. It is commonly referred to as the “peanut patch.” The product is not yet FDA-approved. It is currently in clinical trials. Researchers are compiling data to support the patch’s effectiveness.
The peanut patch involves attaching an adhesive patch to the skin. It works by desensitizing patients to peanut and increasing tolerance. It offers increased protection from an accidental exposure.
The patch contains a tiny dose of peanut allergen – approximately 1/1000 of a peanut on it. Because the dose of allergen on each patch is so small, this approach is often well tolerated by patients. Many can increase their threshold of peanut exposure and avoid an allergic reaction.
The peanut patch is a treatment that requires close supervision by a physician.
How does peanut allergy oral immunotherapy work?
Peanut allergy patients are given a capsule with peanut powder. It can be mixed into food. When taking it, patients consume a controlled dose of peanut protein. The dose is gradually increased over time. In time, the patient reaches a level of peanut tolerance. This means if there’s an accidental exposure, it won’t trigger a severe allergic reaction.
Peanut allergy OIT is not a cure. Patients must continue to avoid peanut products. They may need to continue undergoing OIT even after reaching a tolerance level.
Food allergy OIT is not for everyone. Work together with a food allergy specialist to determine if OIT is right for you.
Important: OIT should only be done under a doctor’s supervision; do NOT try OIT on your own.
Can peanut allergy OIT be taken at home?
Peanut allergy oral immunotherapy (including Palforzia) is not a home treatment. It is only taken under the care of a qualified allergy specialist and at a medical facility. Epinephrine, the first-line treatment for a severe allergic reaction, must be available.
How do I determine if peanut allergy immunotherapy is right for me or my child?
Allergists can work together with you to make sure peanut allergy OIT is a shared decision. Your decision should be evidence-based, not fear-based.
Several factors can play a role in the decision:
How have you or your child fared with strict avoidance of peanut?
What is the risk of exposure?
How severe are the allergic reactions to peanut?
What age should children undergo peanut oral immunotherapy (OIT)?
Talk with a board-certified allergist who specializes in peanut OIT to learn about treatment options for your child. Your child may be eligible for either an office-based OIT or Palforzia peanut.
Palforzia is FDA-approved for children ages 4 to 17 years. What about children ages 1 to 3 years? The new IMPACT study suggests OIT can desensitize peanut-allergic children ages 1 to 3. It could also help some peanut-allergic children become non-allergic to peanuts.
The study involved 146 peanut-allergic children. Participants received either 2,000 milligrams of peanut protein per day or a placebo. After 2.5 years, the researchers found 71% of those who received OIT had become desensitized to peanuts. After three years, 20.8% of those who received peanut protein were in remission of peanut allergy.
The research suggests that starting peanut OIT at ages 1 to 3 offers a chance of remission. Doctors caution that more longer-term research is needed.
Important: do not try peanut OIT with a child at home. There is a risk of a severe allergic reaction. Peanut OIT should only be done under the care of a doctor who specializes in the treatment.
How do I find accurate information about peanut allergy immunotherapy?
When considering OIT, it’s important to make sure you find trustworthy, credible information.
With food allergy, there is so much information available, and just as much misinformation. You add food allergy treatment options such as immunotherapy, and sometimes you may wonder: How do I make decisions about this?
Your first source for accurate information is your allergist or a healthcare professional knowledgeable in OIT. Speak with your allergist to confirm information you may have read online. Ask questions. Talk about your concerns or uncertainties.
If you’re like most people, you search for health news and information online. As you do this, ask yourself: what online resources am I using and what websites am I going to? Are my sources of information trustworthy and credible? What social media platforms do I visit and are they trustworthy?
Getting good solid information is the first step to making a decision that is best for you and your family.
How do I evaluate the pros and cons of peanut allergy immunotherapy?
Most people living with a food allergy simply want protection against accidental exposure. Talk with your allergist about the pros and cons of peanut immunotherapy. Determine whether benefits outweigh the risks. Find out about any potential side effects. Discuss the differences in OIT with Palforzia or an office-prepared product.
For some, peanut avoidance is most appropriate and preferred. These patients must have an anaphylaxis emergency plan in place. They should also carry epinephrine with them in case of an accidental exposure.
For others, peanut OIT may be recommended if:
- accidental exposure to peanut leads to severe allergic reactions;
- you want to consume peanut as part of your diet.
Ask yourself, ‘What are my goals with immunotherapy? Why do I want to pursue this?’ When you focus on the why, all the processes and procedures can become clear to you. And your decisions may start to fall into place.
Unsure about peanut OIT even after consulting with an allergist? Talk with a patient who recently underwent peanut allergy OIT. Another perspective may help with your decision-making.
See Related Pages
Douglas Jones, MD, FACAAI, is a board-certified allergist and immunologist with the Tanner Clinic in Layton, Utah. He founded Rocky Mountain Allergy, a treatment center known for its food allergy program involving oral immunotherapy.