Peanut therapy for allergic kids may sound promising but has risks
Published Thursday, April 25, 2019 10:00PM EDT
Headline-making study after headline-making study suggests that peanut allergies in children can be reversed by exposing kids to gradually increasing doses of peanuts.
The reality, a new analysis of those studies claims, is that the therapy remains experimental – and it may carry more risks than many doctors and parents believe.
“Oral immunotherapy is an emerging experimental treatment for peanut allergy, but its benefits and harms are unclear,” reads the study, which was published Thursday in The Lancet.
Researchers from McMaster University in Hamilton, Johns Hopkins University and other institutions reviewed a dozen studies involving more than 1,000 children between the ages of five and 12.
They found evidence suggesting that current oral immunotherapy treatments actually triple an allergic person’s chance of having a severe allergic reaction – even though the immunotherapy is supposed to reduce the risk of potentially dangerous reactions.
"We found a significant concern that the risk actually was increased,” lead author Dr. Derek Chu told CTV News.
Additionally, Chu and his team found that children who underwent immunotherapy needed to use epinephrine pens or auto-injectors containing epinephrine twice as often as those who simply tried to avoid peanut products.
Chu, who has been allergic to peanuts for nearly his entire life, practises avoidance himself. He checks the contents of all the food he eats, and stays away from anything that he worries might cause a reaction.
He recommends the same course of action to his patients, both because of practical concerns – immunotherapy can involve a daily dose of peanut that cannot be taken too closely to bedtime, exercise or a hot shower – and because the treatment remains at the experimental stage.
“There is no government-approved product [anywhere in] the world for this,” he said, calling for more research until the therapy is made widely available.
Not all doctors agree with Chu’s advice. Dr. Doug Mack, a pediatric allergist based in Burlington, Ont., sees hundreds of children with food allergies every year. When peanut allergies are in play, he recommends oral immunotherapy -- particularly in youngsters under five -- and he has found that many patients report a “significant improvement in [their] quality of life” from the therapy.
“Parents feel like they’re much more in control of their lives. They are doing things with their families that they were in quite a bit of fear about doing beforehand,” he said.
Recent research from the University of British Columbia concluded that oral immunotherapy appears to be effective in children aged five and under – a younger group than was studied in the other analysis – based on monitoring of 270 Canadian children who were given the treatment over 16 weeks.
While more than two-thirds of the children had at least one allergic reaction over the course of their testing, only one of the children had a severe reaction.
“Between the ages of one to five, our study showed very impressive safety results suggesting that it’s safe for many families,” study author Dr. Edmond Chan told CTV News.
Chan said parents should consider immunotherapy as a way to reduce the “negative consequences” of peanut allergies, which he said can include anxiety, bullying and social isolation – as long as they start their children on the therapy at a young age.
“The younger the better,” he said. “If you have a one-year-old, that would be ideal.”
It seems the jury may still be out on the overall effectiveness of oral immunotherapy for treating peanut allergies, and researchers involved in the newest study say that alone should give parents pause.
“People think we cured the food allergy through this process – we have not,” co-author Dr. Susan Waserman said in an interview.
“We don’t want to derail oral immunotherapy, but both physicians and patients need to be educated about the risks and benefits of this procedure.”