Peanut allergy: New trial sheds light on treating the reaction

Since the Natasha Act came into force in Wales and the rest of the UK on October 1, 2021, which stipulated that all grocery stores had to provide a full list of ingredients with clear labeling of allergens on “PPDS” foods (any food that is unpackaged or packaged after you order), an extra layer of allergy protection has been put in place.

Natasha’s Law follows the tragic death of Fulham teenager Natasha Ednan-Laperouse, who died of an allergic reaction to a Pret a Manger baguette in July 2016.

Natasha had a sesame allergy and was not told that sesame seeds had been baked into the sandwich bread she had purchased.

Natasha Ednan-Laperouse died in 2016 aged 15 from an allergic reaction after eating a Pret a Manger baguette containing hidden sesame seeds. Her family welcomed the introduction of Natasha’s Law. Photo: PA

However, common causes of severe allergic reactions are not limited to foods such as nuts, dairy products and shellfish, with insect bites, medications and pollen also representing people seeking medical assistance.

In 2010, Health Boards for Wales reported that 801 people sought treatment for an allergic reaction. In 2018, this figure was 1,628.

Peanuts are however a common cause of food allergy, affecting around 1 in 50 children in the UK in recent decades. According to the British Medical Journal, this particular allergy is also one of the most common causes of food-related death in the UK.

However, a US trial at the University of North Carolina with a new drug that seeks to combat reactions in children, saw seven out of ten participants achieve allergy desensitization after two and a half years of treatment.

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After that time, the majority of young children given the peanut protein were able to safely consume the equivalent of about 16 daily treatment peanuts, according to the study.

The researchers described this as desensitization.

According to the research, one in five children were able to repeat this food challenge 26 weeks after treatment ended, which was described as remaining in remission.

In children with peanut allergy, starting treatment – known as oral peanut immunotherapy – before the age of four has been associated with increased desensitization and remission.

Further analysis indicated that children who were younger at the start of treatment were more likely than older children to achieve remission.

The authors called for more research to investigate this finding because it may indicate a window of opportunity early in life when oral peanut immunotherapy is most effective.

The children were closely monitored during the trial and given small amounts of peanut protein powder, which was gradually increased to 2,000 mg per day, the equivalent of six peanuts.

The study enrolled 146 children aged one to three years, whose average tolerated dose of peanut protein was 25 mg at study entry at five medical centers in the United States.

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Ninety-six children were randomly assigned to treatment and 50 children were randomly assigned to a placebo group.

The doses were mainly administered at home by the parents, but whenever the dose was increased, it was done in medical centers under observation.

In the study, 71% of children treated with oral peanut immunotherapy achieved desensitization, compared to 2% in the placebo group.

Some 21% of people treated with oral peanut immunotherapy achieved remission, compared to 2% in the placebo group.

The authors note some limitations to their study published in The Lancet, including that there was a high dropout rate between the end of treatment and testing for remission after 26 weeks of avoidance.

Additionally, 27% (22/81) of children in the treatment group and 20% (7/35) in the placebo group did not reach the maximum treatment dose of 2000 mg, which may lead to an underestimation of the response to treatment.

Previous research has suggested that peanut allergy affects 2% of children in Western countries and most remain allergic throughout their lives.

The current standard of care for children with peanut allergy is food avoidance and access to epi-pens, but the risk of serious reactions still exists.

In the UK, a new treatment called Palforzia, which contains peanut protein powder, has been made available to around 600 children in England.

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