Peanut Allergy Treatment Immunotherapy

Peanut Allergy Treatment for Children

In the past, families dealing with food allergies were left without any treatment options and advised to wait and hope that their child would eventually outgrow their peanut allergy.

During this time, they had to be extremely vigilant in protecting their child from exposure to peanuts. However, after extensive research, the UK has now granted approval for the licensing of peanut immunotherapy using a specific medication. This treatment can improve the threshold of how much peanut a person with an allergy can consume before experiencing a reaction.

Breakthrough Peanut Allergy Treatment

This breakthrough treatment provides a viable option for children with peanut allergies to minimise their risk of serious reactions due to accidental exposure.

Who can have peanut allergy oral immunotherapy (OIT)?

Peanut allergy immunotherapy using Palforzia is currently licensed for children between the ages of 4 and 17 years old.

However, treatment options are available for people of any age. Whilst not licenced, many allergists believe that peanut allergy can be treated effectively using other protocols which involve ‘real food’. This allows children of any age and adults, the ability to receive treatment.

This page summarises information about Palforzia but the concept for any food oral immunotherapy is similar.

Children With Multiple Allergies

For children with multiple allergies, treatment for one allergen, such as peanut, can still be beneficial in reducing the risk of severe reactions, especially given the prevalence of peanuts in many foods today. It is also possible to target multiple allergies using multi-OIT. This will be fully discussed in your assessment appointment.

Reasons Immunotherapy May Not Be Offered

If your child has a history of or current severe mast cell disorder, peanut OIT will not be recommended. If your child has experienced a severe anaphylactic reaction, treatment should not be started for 60 days.

If your child is on an immunosuppressant medication such as Methotrexate, then treatment may not be feasible.

If the person having treatment has Eosinophilic Oesophagitis, OIT may not be the best option, and Sublingual Immunotherapy may be safer.

It is important to note that if your child has asthma, their condition must be well-controlled before starting peanut OIT to prevent the risk of severe reactions and asthma exacerbations.

What does peanut OIT involve?

After an initial assessment for your peanut allergy with the Dr Helen Allergy team, your child will be evaluated for peanut OIT.

The appointments are held on weekdays or Saturdays in Ringwood, and on Thursdays in Belfast.

The appointments are typically relaxed, and there is ample time to ask questions and seek clarification.

Peanut Desentisation

Peanut immunotherapy is a relatively new treatment in the UK which has been NICE approved but as yet, is offered by few NHS centres due to cost and the challenges of ensuring adequate staffing. Peanut immunotherapy is licenced for children aged from 4yrs to 17yrs. To be considered for peanut immunotherapy, Dr Helen (or one of her team) will undertake a consultation and ensure that there is a clear history of peanut allergy and positive allergy test either on skin prick or IgE blood test. An indepth consultation is held to be sure that the whole family are on board with treatment as it requires a lot of time and commitment for the first 6 months. Every 2 weeks the individual is required to travel to clinic for supervised updosing and adaptations need to be made to daily life as exercise and showers/ baths cannot be performed for several hours following the dose each day.

Dependent on individual history, there may be the possibility for some updoses to be undertaken remotely.

This treatment does not offer a cure of the peanut allergy, however, by the end of treatment, individuals will safely be able to eat at least 1.5 -2 peanuts without fear of a reaction. This can be life changing as families no longer need to worry about foods with precautionary labelling such as ‘may contain’, they can eat out without fear and for many, they find they can travel with more confidence.

For those who have progressed through treatment well and who enjoy eating peanuts, higher levels of peanut can be introduced to allow for this to be freely incorporated back into the diet.

When peanut immunotherapy is undertaken early in life, there is the potential this may induce permanent change.

For more information, please watch this video of Dr Helen discussing immunotherapy and speaking to families about their experiences.

What happens in the first appointment?

The first appointment with Palforzia will take approximately four hours. For those using ‘real food’, appointment times tend to be an hour. During this time, you will receive a reminder on how to recognise and treat allergic reactions, information about the treatment, and support.

Peanut immunotherapy comes in capsules containing set amounts of highly purified peanut flour, which are carefully opened and mixed with a cold food like yogurt, apple sauce, or salsa.

During the first appointment, your child will be given a tiny dose of peanut flour and monitored for 30 minutes. In total, your child will receive five doses at 30-minute intervals, amounting to 6mg of peanut flour (1/50th of a peanut).

How will my child be monitored?

Your child will be monitored by our specialists at all times during the appointment, and the environment is safe in case of any reactions.

For the first stage of peanut allergy treatment, your child will take home a 3mg dose of peanut flour to be taken every day until the next appointment – two weeks after the start.

If you have any questions or concerns during the treatment, you can access advice via email seven days a week, including bank holidays.

Our clinic email is monitored every day, and you will receive a response from one of the team usually on the same day.

What happens next in my child’s peanut allergy treatment?

Your child will return to the clinic every two weeks for the first six months to receive a step-wise increasing dose of peanut protein.

Each follow-up appointment will take around 60 minutes. By the end of the six months, your child will be able to tolerate 300mg of peanut protein (the equivalent of one to two peanuts).

Ongoing Treatment

After this, your child will still require regular appointments for the first two years. This can be continued with Dr Helen and her team or continued in the NHS. Ongoing follow up is recommended, to consider when dosing can be reduced, and/or whether the amount of peanut can be increased.

After six months of treatment with Palforzia (and where real food OIT has not been used), your child will be switched from Palforzia to a form of dietary peanut, which helps keep the treatment costs low for families.

Are there any adaptations that need to be made to fit peanut OIT into life?

Taking peanut OIT requires a commitment from both the child and their family. Peanut OIT should be taken at the same time every day to ensure a dose is never missed.

Daily life will need to be adapted to fit in peanut OIT safely, and certain activities such as exercise, hot baths or hot showers should be avoided for 2 hours before or after treatment. The child should also be monitored for 2 hours after treatment and carry two adrenaline autoinjectors at all times.

Regular appointments will be required every 2 weeks, and in the long term, the child will need to eat some form of dietary peanut each day to maintain tolerance.

Are there any side effects from treatment for Peanut Immunotherapy?

Like any medication, peanut oral immunotherapy (OIT) can result in side effects, such as an itchy mouth or abdominal pain. However, taking an anti-histamine before or after treatment can often alleviate these symptoms. In most cases, side effects tend to improve over time. It’s worth noting that around 13% of children may need to stop treatment during up dosing, with lifestyle factors typically being the main issue, rather than side effects.

There is also a small chance that individuals taking peanut OIT may develop eosinophilic oesophagitis, a condition that affects the food pipe and can lead to symptoms such as difficulty swallowing, indigestion, or stomach pain. If this occurs, treatment may need to be discontinued.

It’s important to note that one of the potential risks of peanut OIT is anaphylaxis, a severe allergic reaction. However, the risk of anaphylaxis is still relatively low, and patients and their families will be trained on how to recognise and treat it. Our team will also educate you on other risk factors that could increase the likelihood of anaphylaxis occurring.

Clinical studies have shown that the risk of anaphylaxis is three times more likely in children undergoing peanut OIT compared to those who avoid peanut altogether. However, the benefits of peanut OIT include a higher likelihood of successfully completing a peanut oral food challenge, with those who undergo peanut OIT being 12 times more likely to pass compared to those who have not been treated.

It’s worth noting that peanut OIT is not suitable for all children, and our team will carefully consider the risks and benefits during your initial assessment. Ultimately, the decision to proceed with treatment will be based on a shared discussion of the potential risks and benefits for your child. Dr. Helen and the team will be available to discuss this with you in detail.

What benefits are there of having Peanut OIT?

Peanut OIT can have life-changing benefits for children with peanut allergies and their families. After undergoing treatment, these children are less likely to have a severe reaction if accidentally exposed to peanuts. This can give them newfound freedom to try foods that may have been off-limits before, such as products with precautionary labelling.

Families may feel more confident traveling abroad and eating out, and parents may feel more comfortable allowing their teenager to attend parties, hang out with friends, and even go to university without worrying about the risk of a fatal allergic reaction. The benefits of peanut OIT can extend beyond physical health, as it can improve the mental well-being and quality of life for both the child and their family.

What happens if I have questions whilst my child is having treatment?

Throughout your child’s peanut OIT treatment journey with us, we encourage you to ask any questions you may have. During the initial two weeks of up dosing, you’ll have face-to-face contact with our team on a regular basis. Our doctors and nurses will ask how things have been and if there have been any difficulties. You’ll also receive full training during the initial dose escalation phase, with written instructions provided as well.

Before each appointment, you’ll have an opportunity to ask any questions you may have before your child is given their next increased dose of peanut OIT. If you experience any questions or difficulties at home, you can email our advice line, and one of our team will respond on the same day if you contact us before 5 pm.

We want you to feel supported throughout the process, and our team is always available to address any concerns or questions you may have. So please don’t hesitate to reach out to us if you need assistance.