Many allergic diseases respond to the use of allergen immunotherapy, which represents a treatment that can either reduce or eliminate allergic symptoms. While there's proof of allergen immunotherapy's being useful for the treatment of allergic rhinitis, allergic conjunctivitis, allergic asthma, venom allergy and atopic dermatitis, the therapy currently isn't routinely used for the treatment of food allergy. Past studies on the use of allergen immunotherapy for food allergies have been disappointing: it doesn’t work well and is extremely dangerous. Therefore, there's no widely accepted treatment for food allergies, except for avoidance, and treatment of immediate symptoms of food allergy when they occur after eating the culprit food.
Many common food allergies, such as milk, egg, soy and wheat, are frequently outgrown during childhood. But peanut allergy (along with tree nut and seafood allergy) tends to not be outgrown in most children, and therefore represents an allergy that would potentially benefit from allergen immunotherapy. In other words, people with peanut allergy would like to have a treatment option that could potentially cure their allergy. Oral immunotherapy — that is, giving the food that a person is allergic to by mouth in order to induce tolerance — is probably the safest and most effective way of administering immunotherapy to foods.
There are a number of small studies focusing on the use of oral immunotherapy for the treatment of peanut allergy. These studies involve giving increasing amounts of peanut flour (often in gelatin capsules) to swallow on a daily basis, for a period of weeks to months. After this time period, an oral challenge to peanut is used to determine how much peanut the person could then tolerate without experiencing an allergic reaction. A few studies have shown that after children had undergone oral immunotherapy to peanut for many months, they could then eat a large amount of peanuts (approximately 20) without experiencing an allergic reaction. Unfortunately, almost all of these children experienced some form of allergic reaction during the course of the oral peanut immunotherapy.
In addition to the symptoms of anaphylaxis that have been reported to occur in the majority of children undergoing oral peanut immunotherapy, there are a growing number of reports of children developing eosinophilic esophagitis as a side effect of the oral immunotherapy. Therefore, as a result of the frequent, sometimes severe side effects of oral peanut immunotherapy, as well as the question of how long the benefit of the immunotherapy will last, it is not recommended for use outside of a clinical research setting. This therapy is not ready to be offered by community allergists, and should only be offered by major universities or allergy training centers, or as part of a research study.
Experts on food allergies have concluded that "peanut oral immunotherapy represents a promising, potentially disease-modifying therapeutic approach for the management of IgE-mediated peanut allergy. However, currently there is insufficient evidence in terms of long-term effectiveness, safety and cost-effectiveness of peanut oral immunotherapy to recommend its routine use in clinical practice."
Sampson HA. Peanut Oral Immunotherapy: Is It Ready for Clinical Practice. J Allergy Clin Immunol. 2013;1:15-21.
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