Published Online: February 3, 2015
Anaphylaxis is a life-threatening allergic reaction, and exposure to peanuts can cause fatal anaphylaxis in people with a peanut allergy—an allergy for which there is currently no treatment. Instead, patients must simply avoid peanuts or peanut proteins. However, allergy immunotherapy is one approach that may reduce the severity of an allergic person’s reactions to peanut.
In a clinical study reported in 2013, patients with peanut allergy underwent 1 year of allergy immunotherapy, in which drops of peanut extract were placed under the tongue once daily. After a year, 14 of 20 active participants (70%) were able to safely consume small amounts of peanut powder in a controlled setting.
The study was continued 2 additional years, and the results of long-term treatment were recently published in The Journal of Allergy and Clinical Immunology. Dr. Wesley Burks and colleagues with CoFAR treated 40 patients for a total of up to 3 years and then evaluated the success of the treatment by giving patients oral food challenges with 10 grams of peanut powder (equivalent to about 16-18 peanuts).
Of the 40 patients, 4 (10%) were able to consume 10 grams of peanut powder in the food challenge. All 4 were able to consume 10 grams of peanut powder after their therapy had been stopped for 2 weeks. During the study, 16 patients stopped the therapy. The primary reason for stopping was difficulty taking the peanut extract every day.
During the 3-year study, peanut sublingual immunotherapy (“sublingual” meaning the peanut extract was placed under the tongue) had a good safety profile. No severe symptoms were reported. And no patients used epinephrine.
This study provides evidence that peanut sublingual therapy is safe and successful in reducing the severity of reactions to peanut for a minority of patients. For this approach to be used on a more widespread basis, the process would need to be made easier for patients to follow in the long term.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.