Children with high-threshold peanut allergies showed incredible improvements after undergoing an 18-month program using store-bought peanut butter to desensitize them. The approach could help nearly a million kids with this type of allergy.
While some children have severe peanut allergies, where ingesting even the slightest trace of the legume could prove disastrous, there are about 800,000 other kids who have what's known as a high-threshold peanut allergy, which means that they can tolerate eating a half a peanut or more without having a reaction.
Researchers from Mount Sinai School of Medicine working with the National Institutes of Health decided to see if they could help these kids by using the simple and commonly used method of desensitization.
“The research team recognized that more than half of people with peanut allergy can tolerate half a peanut or more, and thought that this group of people might be treatable if we took a different approach to peanut oral immunotherapy," said study co-senior author Julie Wang from Mount Sinai. "We were thrilled to find that this treatment strategy was even more successful than we had anticipated.”
During the study, Wang and her team recruited 73 children ranging in age from 4 to 14 years with high-threshold peanut allergies and split them into a test and control group. The control group avoided all peanuts for the duration of the 18-month study. Children in the test group, though, were started with a ⅛ daily teaspoon of peanut butter, given under medical supervision. Then, every eight weeks, the dose was increased slightly until it reached a full tablespoon, which the children tolerated without incident.
After the 18-month program, the children underwent a feeding test, again under medical supervision, to see just how much peanut butter they could tolerate. All 32 kids in the peanut-consuming group were able to eat the maximum of nine grams – roughly three tablespoons – of store-bought peanut butter without a reaction.
Further probing the success of the method, after the feeding test, the researchers had the children in the test group eat at least two tablespoons of peanut butter a week for 16 weeks, and then cut peanuts out entirely for an additional eight weeks. Then, they were tested again. Twenty-six of the kids were still able to eat the nine-grams of peanut butter, showing that the technique created long-lasting improvement in the allergy symptoms of the majority of participants.
Don't try this at home
The study is significant because current FDA-approved treatment for peanut allergies – consisting of either injected biologic or oral peanut immunotherapy – focuses on the most serious kind of low-threshold allergies. The new technique can spare children with high-threshold allergies from this path using readily available store-bought peanut butter.
“Children with high-threshold peanut allergy couldn’t participate in previous food allergy treatment trials, leaving them without opportunities to explore treatment options,” said Jeanne Marrazzo. “Today’s report focuses on this population and shows that a very safe and accessible form of therapy could be liberating for many of these children and their families.” Marrazzo is the director of the National Institutes of Health's National Institute of Allergy and Infectious Diseases.
All that being said, it's important to note that all of the peanut butter in the study was administered under medical supervision, so the researchers are in no way suggesting such a regimen be undertaken at home. Instead, they feel hopeful that their program could lead to simpler treatments for a broader range of allergies.
“Our findings open the gateway to personalized threshold-based treatments of food allergy and will encourage additional studies that delve deeper into peanut and other foods for this approach that might be a game-changer for the majority of people with food allergies,” said study lead author Scott Sicherer from Mount Sinai.
The research has been published in the journal NEJM Evidence.
Sources: National Institutes of Health, Mount Sinai
