A first-of-its-kind clinical trial has tested whether slowly introducing small quantities of boiled peanuts to a child's diet can treat allergies. After the year-long treatment, 80% of children in the trial could safely tolerate peanuts but the researchers say the therapy is still experimental.
Over the last few years oral immunotherapy treatments for peanut allergies have become increasingly accepted as effective tools to help desensitize children. These treatments generally involve slowly introducing very small and controlled doses of peanut proteins to help a child gradually develop a tolerance to the allergen over time. These kinds of treatments are not without risks, and adverse effects are still common when slowly escalating doses of peanuts in children with known allergic responses.
For some years it has been suggested that boiling peanuts can reduce their allergenicity. A 2017 pilot study found slowly introducing boiled peanuts to subjects with allergies was very successful at inducing peanut tolerance. So a larger study was planned, enrolling 70 children with peanut allergies aged between six and 18.
The year-long trial spanned three phases. The first phase ran for 12 weeks and slowly introduced small quantities of peanuts that had been boiled for 12 hours. Starting with 62.5 milligrams of boiled peanut powder, at the end of 12 weeks the participants were eating up to four boiled peanuts per day.
The next phase started with powder of peanuts boiled for just two hours. At the end of 20 weeks the cohort was consuming around 10 whole peanuts a day. The final 20-week phase moved to roasted peanuts, again starting with powder and looking to reach a point where the participants were eating up to six whole roasted peanuts twice a day.
At the end of the 52-week trial, 80% of the cohort were successfully tolerating the target of safely eating nearly a dozen roasted peanuts a day.
The novel treatment did come with a moderate degree of risk. Around 60% of the cohort reported experiencing some kind of adverse allergic response during the course of the study. However, the vast majority of those effects were classified as mild, only requiring minor antihistamine or corticosteroid treatment.
The researchers do note that three participants (4%) did experience a serious adverse response to the therapy requiring treatment with epinephrine. But this rate of serious allergic responses to the immunotherapy was still lower than the 14% reported in prior peanut powder trials.
Luke Grzeskowiak, lead author on the new study, said the results are promising, demonstrating boiled peanuts could be a potentially safer way to introduce peanuts to allergic children. But he also stresses this kind of therapy does not work for everyone and should not be deployed at home by parents trying to desensitize their children to peanuts.
“It’s really important that people are not embarking on immunotherapy without having an appropriate level of supervision," Grzeskowiak said to The Guardian. "At this point, it’s part of experimental studies."
The researchers are now conducting another trial comparing a boiled peanut immunotherapy protocol against a more common peanut flour protocol. That study will hopefully clarify whether this is a safer strategy for inducing peanut tolerance in children.
The new research was published in the journal Clinical and Experimental Allergy.
Source: Flinders University
