A new study suggests preschoolers who are allergic to peanuts can be treated safely by eating small amounts of peanut protein with guidance from a medical specialist.
The findings offer assurances to allergists in clinics and hospitals that oral immunotherapy does not have to be confined to research settings.
Senior author and pediatric allergist Dr. Edmond Chan says many allergists shy away from the technique for fear it might trigger a serious allergic reaction. But he and other scientists and pediatric allergists at the University of British Columbia and BC Children’s Hospital say the risk is actually quite small.
Their study found just 0.4 per cent of 270 children who received oral immunotherapy had a severe reaction. Meanwhile, 11 children, or four per cent, received epinephrine. Researchers say nearly 68 per cent of the children experienced at least one allergic reaction, but 36.3 per cent were mild and 31.1 per cent were moderate.
The children were aged nine months to five years and were treated from April 2017 to November 2018.
The Canada-wide findings were published in the “Journal of Allergy and Clinical Immunology: In Practice.”
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Oral immunotherapy is a relatively new approach in which a patient is directed to eat small amounts of an allergenic food to build up tolerance. The dose is gradually increased to a determined maximum, known as a maintenance level, that is continued for at least one year, even two.
At that point, a child might be ready for a food challenge to determine whether they have become desensitized to their allergen, for example by eating one serving of peanut.
It’s found success in clinical trials but Canadian allergists remain split in opinion, says Chan.
“There are some allergists who feel that it should only be done within research and then there are other allergists who feel that in carefully selected patients it could be offered outside of research,” says Chan, who adds the treatment should only be offered by an allergy specialist, not a family physician alone.
“I was observing several of my patients flying to the United States and going to far-away clinics to get this treatment and I felt it was very confusing…. They were told by one allergist that, ‘Oh yeah, it’s totally available and it’s time to do it,’ and then other allergists (said) that it wasn’t. And some (families) were left to their own devices.”
Chan is among those who offer oral immunotherapy, believing that peanut allergies are very treatable, especially among young children.
He considers the study “a game-changer” in encouraging other allergists to consider OIT, and hopes it will move the conversation to establishing national guidelines that can ensure safe practice.
“Because the ship has sailed already and there are a certain number of allergists offering it outside of research already, maybe we should try to make sure it’s safe for patients getting it in those offices by having more uniform criteria and guidelines for how to offer it.”
The Canadian Press
