Posted on 02/10/2025 12:21:40 PM PST by Red Badger
Groundbreaking research indicates that controlled peanut exposure can help children with certain peanut allergies build lasting tolerance, challenging the traditional avoidance method and offering a new, effective treatment pathway.
A study at Mount Sinai has shown that children with a high tolerance for peanuts can significantly increase their resistance to allergic reactions by consuming controlled, increasing amounts of peanut butter over time. This approach, safer and cheaper than current therapies, suggests a major shift towards personalized allergy treatments that could revolutionize how food allergies are managed.
Breakthrough in Peanut Allergy Treatment
Children with high-threshold peanut allergies who gradually increased their intake of store-bought peanut butter became significantly more desensitized than those who avoided peanuts, according to a new study from the Icahn School of Medicine at Mount Sinai. The study found that this approach led to higher and longer-lasting tolerance levels.
The research, funded by the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, was published today in the February 10 issue of NEJM Evidence.
Safer and More Effective Allergy Management
“Our study results suggest a safe, inexpensive and effective pathway for allergists to treat children with peanut allergy who can already tolerate the equivalent of at least half a peanut, considered a high-threshold peanut allergy,” said Scott Sicherer, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute at Mount Sinai Kravis Children’s Hospital, Chief of the Division of Allergy and Immunology in Mount Sinai’s Department of Pediatrics, and lead author of the paper. “Our findings open the gateway to personalized threshold-based treatments of food allergy and will encourage additional studies that delve deeper into peanut and other foods for this approach that might be a game-changer for the majority of people with food allergies.”
The standard approach to managing food allergies has been strict avoidance, but in recent years, peanut oral immunotherapy has emerged as an alternative. This treatment involves gradually increasing daily doses of peanut protein under medical supervision to build tolerance.
However, previous studies leading to FDA approval of peanut allergy treatments — both an injectable biologic and an oral immunotherapy — have primarily focused on individuals with extreme sensitivity, reacting to as little as half a peanut or less (classified as a low-threshold peanut allergy). In contrast, an estimated 800,000 children in the U.S. have a high-threshold peanut allergy, meaning they can tolerate at least half a peanut. This study specifically explores whether these children could benefit from a different treatment approach.
Rethinking Peanut Allergies
“Years ago, when people with milk and egg allergies were advised to undertake strict avoidance, our team initiated studies that found most people with milk and egg allergies could tolerate these foods in baked goods, which changed the global approach to these allergies,” said Julie Wang, MD, Professor of Pediatrics at the Icahn School of Medicine, clinical researcher at the Jaffe Food Allergy Institute, and co-senior author of the paper.
“The research team recognized that more than half of people with peanut allergy can tolerate half a peanut or more, and thought that this group of people might be treatable if we took a different approach to peanut oral immunotherapy. We were thrilled to find that this treatment strategy was even more successful than we had anticipated.”
To test this hypothesis, the study team recruited 73 children ages 4 to 14 years old. Study participants were assigned, at random, to either test the new treatment strategy or continue avoiding peanuts. The children in the peanut-ingestion group began with a minimum daily dose of 1/8 teaspoon of peanut butter and gradually increased their dose every eight weeks over the course of 18 months, ending at one tablespoon of peanut butter or an equivalent amount of a different peanut product. All dose increases took place under medical supervision. None of the study participants in the peanut-ingestion group had severe reactions or needed epinephrine during home dosing and only one received epinephrine during a supervised dosing visit.
Long-lasting Desensitization Success
Following the treatment regimen, children from the peanut-consuming cohort participated in a feeding test, carefully supervised by the study team, to evaluate how much peanut they could eat without an allergic reaction. All 32 children from the peanut-consuming group who participated in the feeding test could tolerate the maximum amount of nine grams of peanut protein, or three tablespoons of peanut butter. By contrast, only three of the 30 children from the avoidance group who underwent the feeding test after avoiding peanuts for the duration of the study could tolerate this amount.
Because the trial took place during the COVID-19 pandemic and some families preferred avoiding close encounters indoors, some did not return to the study site for the feeding test. Using a common statistical technique to account for the children who missed the feeding test, the team reported that 100 percent of the ingestion group and 21 percent of the avoidance group tolerated an oral food challenge that was at least two doses more than they could tolerate at the beginning of the study.
To test if the response to treatment was durable, children in the peanut-ingestion group who could tolerate nine grams of protein during the feeding test went on to consume at least two tablespoons of peanut butter weekly for 16 weeks and then avoided peanuts entirely for eight weeks. Twenty-six of the 30 treated children who participated in a final feeding test after the eight-week abstinence period continued to tolerate nine grams of peanut protein, indicating that they had achieved sustained unresponsiveness to peanuts. The three participants from the avoidance group who could eat nine grams of peanut protein without reaction at the earlier food test were considered to have developed natural tolerance to peanuts. A comprehensive analysis of data collected from all 73 study participants revealed that 68.4 percent of the peanut-ingestion group achieved sustained unresponsiveness, while only 8.6 percent of the avoidance group developed a natural tolerance.
“These study results are very exciting and a huge step forward in personalizing food allergy treatment,” concluded Dr. Sicherer, the Elliot and Roslyn Jaffe Professor in Pediatric Allergy and Immunology at Mount Sinai. “My hope is that this study will eventually change practice to help these children and encourage additional research that includes this approach for more foods.”
In addition to expanding the work to more foods and validation studies of their approach, the Mount Sinai study team aims to determine a better way of identifying individuals with higher thresholds, because the best way to do so currently requires a feeding test that is bound to cause an allergic reaction.
Reference:
“Randomized trial of high dose, home measured peanut oral immunotherapy in children with high threshold peanut allergy”
10 February 2025, NEJM Evidence.
DOI: 10.1056/EVIDoa2400306
Ping!...............
Why is this surprising? I am no expert but it seems like pretty standard immunology. Small doses, the body creates antibodies. Over time it is no longer toxic. Maybe this won’t work for every allergy in every person but it makes sense to me. I am open to correction from experts.
The article says it works for those who can tolerate higher peanut exposure before experiencing symptoms. I’m not sure it will work for those with the more serious peanut allergies.
Yes, this is really an old timey method from long ago.............
It would be easier and faster with an mRNA shot and 3 boosters.
Seriesly
bkmark
Maybe that’s why there are so many peanut allergies in youngsters these days ... they rarely at peanut butter as a kid. Man, I lived on that stuff. Mom was constantly buying it.
My niece was born with a pretty noticeable peanut allergy.
My sister in law started giving small, to increasingly larger samples of peanut butter on a normal spoon (graduating to a full spoonful after about a year) from about 18 months to three years old is when she did this.
My niece eats peanut butter and Jelly now for lunch. She’s 10.
‘Bamba’ is a favorite Israeli snack. It’s like a baked Cheeto with peanut powder instead of cheese powder.
My sister gave all three of her kids bamba when they were babies to prevent peanut allergies it’s what they do in Israel and it works
Me too!................
We started introducing high allergy potential foods to our kids at around 6 months. Peanut butter in oatmeal, a little scrambled egg, some minced cooked shrimp.
It’s the opposite with the oily sap called “urushiol” found in poison ivy, poison oak, and poison sumac. It causes more severe allergic reactions every time you get it.
Sensitivity builds up after the skin is exposed to the substance. When initially exposed to urushiol, the skin alerts the immune system of the presence of the irritating chemical. However, it’s common for no visible reaction will occur the first time a person comes in contact with a poison plant. The immune system then prepares a defensive reaction for the next time the skin encounters the substance. This sensitizes the skin so that new contact with urushiol causes an allergic reaction.
I got it so bad about 45 years ago on one hike that it went systemic throughout my body. It took cortisone shots to finally stop it.
My mom put pb in our oatmeal every morning. School lunch was pb and whatever. After-school snack was pb on Celery sticks. We even had pb and ice cream for desert sometimes.
54 and I still eat it.
Jiff is the best.
I have had poison ivy. Not pleasant. My friend is immune. He can pluck the plants out of the ground with bare hands and have no reaction.
I don’t understand it. I do understand that if the oil is on one’s skin, it can spread to other surfaces or people..
“it can spread to other surfaces or people”
Indeed. And you can get it from those other surfaces. It can also get on your pet’s fur and you can get it from petting them! So don’t let your dog go romping off in the weeds when the dangerous plants are around.
But then, mothers with peanut allergic kids will no longer be special.
Well duh. Isn’t that how vaccines sort of work?
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.