An estimated 1%-3% of children in western countries are affected by peanut allergy. Prior research has shown that boiled peanuts may be effective as an oral immunotherapy (OIT) treatment for kids because boiling reduces the allergenicity of the food.
Researchers from the Flinders Health and Medical Research Institute in Adelaide sought to assess the efficacy and safety of oral immunotherapy using sequential doses of boiled peanuts followed by roasted peanuts for treating peanut allergy in children. Their study was published in the journal Clinical and Experimental Allergy.
In an open-label, phase 2, single-arm clinical trial, children aged 6–18 years with a positive history of peanut allergy and positive peanut skin prick test ≥ 8 mm and/or peanut-specific IgE ≥ 15 kU/L at screening were recruited.
Between July 2017 and June 2018, 70 participants underwent an OIT regimen involving sequential up-dosing with 12-hour boiled peanut for 12 weeks, 2-hour boiled peanut for 20 weeks, and roasted peanut for 20 weeks. The target was a maintenance dose of 12 roasted peanuts daily.
The study’s primary outcome was the proportion of children passing an open-label oral food challenge involving cumulative administration of 12 roasted peanuts (12 g peanuts; approximately 3000 mg peanut protein) 6–8 weeks after reaching the target maintenance dose. Secondary outcomes included treatment-related adverse events and the use of medications for treating allergy symptoms.
The study found that desensitization was successfully achieved in 56 of 70 (80%) participants, with three withdrawing due to treatment-related adverse events. Treatment-related adverse events were reported in 43 (61%) participants, corresponding to a rate of 6.58 per 1000 OIT doses.
Medication use associated with the treatment-related adverse events was infrequent, with rescue epinephrine use reported by three (4%) participants (0.05 per 1000 doses).
The researchers concluded that OIT using boiled followed by roasted peanuts represents a pragmatic approach that appears effective in inducing desensitization and is associated with a favorable safety profile.
Here follows a press release from Flinders University regarding the study.
Clinical trial shows boiled peanuts could help overcome child peanut allergy
Boiling peanuts for up to 12 hours could help overcome children’s allergic reactions according to the results of a clinical trial at Flinders University and SAHMRI in Australia which found up to 80% of children with peanut allergy became desensitised to eating peanuts.
The clinical trial, which was funded by the Channel 7 Children’s Research Foundation and published in the journal Clinical & Experimental Allergy, tested whether a therapy delivering sequential doses of boiled peanuts, followed by roasted peanuts, may help children overcome their peanut allergies.
The trial built on previous research conducted by senior author and Flinders University’s College of Medicine and Public Health Associate Professor Tim Chataway showing that heat affects the protein structure and allergic properties of peanuts, meaning they were less likely to cause a severe allergic reaction.
“Small and increasing doses of boiled nuts were first given to children to partially desensitise them, and when they showed no signs of an allergic reaction, increasing doses of roasted peanuts were then provided to increase their tolerance in the next stage of treatment.”
To achieve this multi-step process known as oral immunotherapy, the researchers asked 70 peanut-allergic children (6-18 years) to consume peanuts boiled for 12 hours for 12 weeks, 2 hour boiled peanuts for 20 weeks, and roasted peanuts for 20 weeks.
This novel two-step therapy was tested in anticipation of achieving daily targets of participants consuming 12 roasted peanuts without allergic reactions.
The results show 56 of the 70 (80%) participants became desensitized to the target dose of peanuts. Treatment-related adverse events were reported in 43 (61%) of participants, however only 3 withdrew from the trial as a result, demonstrating a favourable safety profile.
Flinders University’ College of Medicine and Public Health and South Australian Health and Medical Research Institute Associate Professor Luke Grzeskowiak, the lead author of the study, says with up to 3% percent of children in Western countries grappling with peanut allergies, this clinical trial could help develop a novel treatment pathway to reduce the risk of accidental peanut exposure and significantly improve quality of life for peanut allergic children and their carers.
“Our clinical trial shows promising early signs in demonstrating that boiling peanuts may provide a safe and effective method for treating peanut allergic children with sequential doses of boiled and roasted peanuts over an extended period of time,” says Associate Professor Grzeskowiak, Channel 7 Children’s Research Foundation Fellow in Medicines Use and Safety.
“With no currently approved treatment for peanut allergy in Australia there is a lot more research to be done. Unfortunately, oral immunotherapy doesn’t work for everyone and we are in the process of improving our understanding of how these treatments work and what factors can influence how people respond to treatment. This will be really important for assessing individual suitability for treatment and improve treatment decisions in the future.”
The study was undertaken in collaboration with Paediatric Allergist Dr Billy Tao, who has been developing the novel desensitisation process to treat peanut allergies for the past decade after being inspired by similar research in the 1990’s.
The study authors conclude that while these findings hold great promise that current approaches to oral immunotherapy could be made safer and more effective, this requires confirmation in a larger definitive clinical trial.
‘Oral immunotherapy using boiled peanuts for treating peanut allergy: An open-label, single-arm trial’ by Luke E Grzeskowiak, Billy Tao, Kamelya Aliakbari, Nusha Chegeni, Scott Morris and Tim Chataway is published in Clinical & Experimental Allergy. DOI: 10.1111/cea.14254
For Further information please contact:
Associate Professor Luke Grzeskowiak
Flinders University and SAHMRI
Mobile: 61 423 554 614
Email: luke.grzeskowiak@flinders.edu.au
Yaz Dedovic
Media Adviser
Flinders University
M: 61 401095501
E: yaz.dedovic@flinders.edu.au
Callum MacPherson
Media & Production Officer
SAHMRI
M: 61 419 607 905
E: callum.macpherson@sahmri.com
- Oral immunotherapy using boiled peanuts for treating peanut allergy: An open-label, single-arm trial — Clinical and Experimental Allergy
- Boiled peanuts could help overcome child peanut allergy — Flinders University
