Desensitization for Peanut Allergies in Children

Abstract

Opinion Statement Immunotherapy for peanut allergy has been an exploding topic of study within the last few years. Sublingual, epicutaneous, and oral immunotherapy are being investigated and show promise in the treatment of peanut allergy. Oral immunotherapy has shown the most clinical benefit; however, sublingual and epicutaneous immunotherapy appear to have the most favorable safety profiles. Most studies to date suggest that only a minority of subjects achieve sustained unresponsiveness to peanut after discontinuation of immunotherapy. Recent efforts have been focused on identifying adjunct therapies, such as omalizumab, that may assist patients in achieving peanut desensitization more quickly and with greater success. Several underlying immunologic mechanisms, including a switch from IgE to IgG4 production and induction of T regulatory cells, have been studied although more research is needed to identify reliable biomarkers. This article will describe the immunotherapy approaches that are being investigated to induce peanut desensitization, and highlight the benefits and risks of these therapies that need to be considered before they are ready for routine clinical practice.

The impact of modifiable risk factor reduction on childhood asthma development

“…The National Institute of Allergy and Infectious Disease recommends early introduction of peanut-containing foods between 4 and 6 months of age to high-risk infants after evaluation for allergy testing and around 6 months for infants with mild-to-moderate eczema [ 80 ]. There are ongoing trials studying the efficacy of oral, sublingual, and epicutaneous immunotherapy in the primary prevention of peanut allergy; however, no specific therapy is on the market and it is unknown whether there will be an impact on asthma development [ 81 ].…”

Sequential hypoallergenic boiled peanut and roasted peanut oral immunotherapy

“…Oral immunotherapy (OIT) using roasted peanut flour can effectively desensitize peanut‐allergic children but is considered not to be ready for clinical practice due to high rates (≥45%) of adverse events (AEs) . This necessitates medically supervised up‐dosing in hospital and limits the number of patients that can be treated.…”