Low-dose peanut therapy may help protect more children with peanut allergies

New research finds a significantly lower dose of peanut oral immunotherapy may provide similar protection from accidental contamination, compared to standard treatment.

Children with peanut allergies may not need large doses of peanut oral immunotherapy (OIT) to build protection to the allergen, finds a new study led by the Montreal Children’s Hospital and The Hospital for Sick Children (SickKids). Researchers found that a small dose can help children with their peanut allergy and reduce the risk of severe reactions from accidental exposures, with fewer side effects than the current standard treatment.

"The study found that very small amounts of peanuts, that are associated with fewer reactions, could be used as effectively as large amounts for oral immunotherapy, making it safer and accessible to more Canadians, even those who are very sensitive to the allergen," says Dr. Moshe Ben-Shoshan, co-senior author of the study, a pediatric allergy and immunology specialist at the Montreal Children's Hospital and Scientist in the Infectious Diseases and Immunity in Global Health Program at the Research Institute of the McGill University Health Centre.

In Canada, peanut allergies affect almost two per cent of children and adults, and increasingly contribute to hospital admissions. Peanut OIT is a method to increase the amount of peanut that a child can eat before experiencing a reaction, helping to protect children against accidental contamination. Children receiving peanut OIT eat a gradually increasing amount of peanuts over time until they reach a “maintenance” dose that is eaten regularly, even after the treatment, to help keep up the benefits.

While peanut OIT can help children with peanut allergies to build protection, current approaches rely on large doses that require lengthy treatment, close medical supervision and often lead to discontinuation because of dislike of the treatment’s taste and allergic reactions like anaphylaxis.

The study is the first of its kind to compare a commonly used peanut OIT treatment to reduced doses in children and provides evidence that a dose 10 times lower could increase treatment accessibility and help protect more children with peanut allergies.

A very little goes a long way

To investigate the safety and effectiveness of a very low maintenance dose of peanut OIT, the study, published in the Journal of Allergy and Clinical Immunology – In Practice, randomly assigned 51 children with peanut allergies to three groups: low-dose treatment (30mg maintenance), standard-dose treatment (300mg maintenance) or avoidance (no peanut OIT).

Both peanut OIT treatment groups experienced significant and similar increases in their allergic reaction threshold to peanuts, meaning that they were able to tolerate a larger quantity of the allergen. This shows that eating even small amounts is better than avoidance when it comes to training the immune system to manage more peanuts.

“We were excited to find that peanut OIT maintenance doses can be much lower than previously thought and still contribute to positive outcomes,” says Dr. Julia Upton, Head of the Division of Immunology and Allergy at SickKids, Project Investigator in the SickKids Research Institute, Co-Director of the SickKids Food Allergy and Anaphylaxis Program and co-first author. “The more options we have, the more we can support patients’ experience and provide meaningful, tailored care.”

Children who were in the 30mg maintenance group had fewer adverse reactions than the 300mg maintenance group, and none withdrew from treatment.

“This is a small enough dose that even children who do not like the taste can continue treatment,” says co-senior study author Dr. Thomas Eiwegger, Adjunct Scientist in the Translational Medicine program in the SickKids Research Institute. “This is the first time we’ve compared standard doses to such a low dose, but the minimum maintenance dose to provide benefit may be even lower than 30mg.”

The research team notes that some children and families may choose to remain on very low doses, while others may prefer to increase over time depending on their goals. This study marks an important step to further the development of safe and effective protocols for peanut OIT. Ultimately, the goal is to make peanut OIT accessible to more peanut-allergic children, even those who are very sensitive to the allergen.

This study was funded by the Montreal Children’s Hospital Foundation, SickKids Food Allergy and Anaphylaxis Program, Canadian Institutes of Health Research (CIHR) and the US peanut advisory board.

Media contact
Christine Bouthillier
Communications Coordinator, Montreal Children’s Hospital
[email protected]