Science, health and technology
June 16, 2022 | Contact Eric Rolfsen for more information
UBC researchers demonstrated in 2019 that preschoolers can safely overcome peanut allergies with a treatment called oral immunotherapy.
They now have evidence that the earlier preschoolers start this treatment, the better.
This real-world study focuses on infants under 12 months of age and reveals that oral immunotherapy is not only effective against peanut allergies, but is even safer for this age group than for young children and older children. preschool age.
“This treatment is affordable, very safe and highly effective, especially if we can start treatment before the baby is 12 months old,” said Dr. Edmond Chan, senior author of the study, who is also a clinical professor and head of allergy and immunology. in UBC’s Department of Pediatrics at the BC Children’s Research Institute.
The study, recently published in the Journal of Allergy and Clinical Immunology: In Practice, specifically looked at the results for a group of 69 babies among a larger study group of 452 children aged five and under.
Oral immunotherapy is a treatment protocol in which the patient consumes small amounts of allergenic food – in this case peanut flour – and the dose is gradually increased to a certain maximum amount. The goal is to reduce the child’s sensitivity while he can get a full serving of peanut protein without causing a dangerous reaction. To maintain immunity, the child should continue to eat peanuts regularly in the long run.
For this study, children visit a pediatric allergist at a community or hospital clinic approximately every two weeks to receive their dose of peanuts. The parents gave the same daily dose at home between visits to the clinic. After eight to 11 visits to the clinic, the children accumulated up to a “maintenance dose” of 300 milligrams of peanut protein, or the equivalent of about 1.3 grams of peanuts.
Clinicians record any symptoms or reactions and advise parents on how to manage the reactions at home.
Forty-two infants completed the accumulation period plus one year of maintenance dosing. At the end of it, none of them had more than a mild reaction to a dose of 4,000 milligrams of peanut protein, compared to 7.7% of children aged one to five who completed the protocol.
Seven babies fell off the road. Four out-of-mild reactions were experienced, but none required epinephrine injections. Another 20 did not receive a peanut tolerance assessment at the end, either by choice or due to long waiting lists.
Even before starting treatment, it has been shown that babies are at lower risk than young children and pre-school children. In the initial tests, only 33.9% of babies had a mild reaction, compared with 53.7% of children aged one to five.
“Although babies show the best safety, we were still very pleased with the safety of this treatment for older preschoolers. The risk of a severe reaction is much lower than in school-age children, “said Dr. Chan. “Many of the interventions we use in medicine, such as drugs or surgical procedures, carry a small risk that outweighs the benefits. If this treatment is performed by well-trained allergists and clinicians, then my risk is very calm. It’s actually very safe. “
In terms of effectiveness, the treatment worked equally well for both age groups. After one year of peanuts a day, approximately 80% of children developed a tolerance to 4,000 milligrams of peanut protein in one sitting – the equivalent of approximately 15 whole peanuts.
The first step in trying to prevent peanut allergies among children at risk is to introduce them to age-appropriate peanut-containing foods such as peanut butter or peanut flour at about six months of age. If the baby still develops a peanut allergy, Dr. Chan’s study suggests that oral immunotherapy may be an effective alternative to avoiding allergens for life. Trying to avoid allergens generally carries various risks, such as poor quality of life, social isolation and anxiety.
With these new data, the next step recommended by Dr. Chan’s team is for practitioners to offer oral immunotherapy as soon as possible after unsuccessful prevention of food allergies in infancy, a concept that was recently adopted for publication in a separate article. in Rostrum in the Journal of Allergy and Clinical Immunology: in practice.
Dr. Chan has adopted oral immunotherapy in his own clinical practice. His research will help inform future clinical practice guidelines and provide healthcare professionals with the data they need to recommend it to their young patients.
Interview languages: English, Cantonese
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