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The BTK Inhibitor, Acalabrutinib, Can Reduce or Prevent Allergic Reactions to Peanut During Oral Food Challenges

AAAAI News Release

February 3, 2023

April Presnell, Media & Member Communications Manager
(414) 272-6071

Findings being presented at the 2023 AAAAI Annual Meeting suggest BTK inhibitors could have potential as short-term therapies for procedures such as allergen immunotherapy and drug desensitizations.

Milwaukee, WI – Acalabrutinib, a BTK inhibitor, can reduce or even eliminate clinical reactions to peanut in adults with peanut allergies undergoing oral food challenges (OFC), according to new research conducted at Johns Hopkins University under the direction of Principal Investigator Melanie C. Dispenza, MD, PhD.  Researchers will present the results during the 2023 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI).

Ragha V. Suresh, MD, primary author of the study, explained the rational for the research. “We know that BTK is an essential enzyme involved in signaling through the IgE receptor, which is important in the pathogenesis of allergic reactions. Acalabrutinib is a BTK inhibitor which is FDA-approved for the treatment of B-cell malignancies, but is generally well-tolerated. Therefore, our goal was to re-purpose this drug to see if it could prevent allergic reactions.”

Adults with confirmed peanut allergy were enrolled in an open-label clinical trial. All participants started with a placebo-controlled single-blinded graded OFC to peanut to determine the amount of peanut protein which they tolerated at baseline.

Participants then received four standard doses (100 mg) of acalabrutinib twice a day and underwent a second OFC. Patients’ median tolerated amount of peanut protein was 29 mg at baseline before taking study drug. During OFC while taking acalabrutinib, 7/10 participants were able to tolerate 4,044 mg of peanut protein without clinical reaction, the maximum amount offered in the study protocol. Three of the participants’ tolerance increased significantly, though not to the full peanut protein amount.

Acalabrutinib was also found to abolish all IgE-mediated activation of basophils, a type of allergic cell, in all subjects. No participants experienced any drug-related serious adverse events.

“There are no known therapies that can reliably prevent IgE-mediated allergic reactions,” said Dr. Dispenza. “Our study suggests that BTK inhibitors could achieve this protection, with a very quick onset of action.”

“Our study results could have important ramifications for how we approach more risky procedures related to food allergy,” said Dr. Suresh. “Acalabrutinib could potentially be used as a short-term therapy to make procedures such as immunotherapy and drug desensitizations safer.”

Visit to learn more about anaphylaxis. Research presented at the AAAAI Annual Meeting, February 24-27 in San Antonio, Texas, is published in an online supplement to The Journal of Allergy and Clinical Immunology.

The American Academy of Allergy, Asthma & Immunology (AAAAI) is the leading membership organization of more than 7,100 allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. The AAAAI is the go-to resource for patients living with allergies, asthma and immune deficiency disorders. Established in 1943, the AAAAI has more than 7,100 members in the United States, Canada and 72 other countries. The AAAAI’s Find an Allergist/Immunologist service is a trusted resource to help you find a specialist close to home.

View the abstract.