Current developments in the treatment of peanut allergy

Abstract

Peanut allergy is a potentially life-threatening disease because it leads to severe allergic reactions, especially in children but also in adults. So far, allergen avoidance is the most effective therapy for treating peanut allergy. In this article, current developments of peanut allergy specific immunotherapy are critically discussed based on the existing literature. These include sublingual, epicutaneous and oral peanut immunotherapy. Nonspecific treatment approaches with new-targeted antibodies such as anti-IgE (omalizumab) or anti-IL-4/IL-13 receptor antibodies (dupilumab) can also be used to treat peanut allergy with regard to the mode of action of these antibodies. Multiple studies are already available for omalizumab and are currently performed with dupilumab. Whether and which therapies for the treatment of peanut allergy will be available on the market in the future is not only relevant in terms of clinical effectiveness in the sense of a long-term stable increase in the threshold level, but also in terms of the tolerability in everyday life of affected patients.

Peanut oral immunotherapy: current trends in clinical trials

“…Clinical trials over the last decade have evaluated various protocols of immunotherapy for peanut allergy, which typically involve the administration of gradually increasing amounts of peanut protein up to a defined maintenance dose via either the gastrointestinal tract, categorised as oral immunotherapy (OIT) or sublingual immunotherapy (SLIT), or via the skin, categorised as epicutaneous immunotherapy (EPIT) [ 9 ]. Epicutaneous and sublingual delivery of allergens show very good tolerability but lower efficacy compared to OIT protocols [ 10 ]. Viaskin-mediated EPIT (DBV Technologies, France and USA) represents an innovative epidermal powder delivery system in a patch containing 250 μg peanut protein and has been shown to successfully increase peanut tolerance in clinical studies without evoking anaphylaxis ( Table 1 ) [ 11 ].…”