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 Palforzia (developed by Aimmune, a subsidiary of Nestle), a treatment that 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 is currently licensed for children between the ages of 4 and 17 years old.
However, ongoing clinical trials are exploring the effectiveness of the treatment for younger children and adults with peanut allergies.
The team at the Southampton Peanut Clinic is actively involved in these trials and closely monitoring the results.
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 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.
Mast Cell Disorder
Additionally, 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.
These are rare allergic disorders, and the team of experts at the Southampton Peanut Clinic will be able to advise you on the safety of peanut OIT for your child.
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 Saturdays at the Children’s Hospital in Southampton, and the clinics are led by an allergy doctor, accompanied by several children’s allergy nurses.
The appointments are typically relaxed, and there is ample time to ask questions and seek clarification.
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 will take approximately four hours. During this time, you will receive a reminder on how to recognise and treat allergic reactions, information about Palforzia, 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.
Following the first appointment, your child will return with you on Tuesday (three days later) for a check-up before being given the first pack of treatments to take home.
For the first stage of peanut allergy treatment, your child will take home a 6mg dose of peanut flour to be taken every day until the next appointment – two weeks after the start (on a Saturday).
If you have any questions or concerns during the treatment, you can access your specialist team by 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 allergy doctors the same day if you contact us by 5 pm. This is helpful for dosing advice, as most children dose after school between 4-7 pm.
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 90 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).
After this, your child will still require regular virtual appointments for the first two years.
After the six to twelve months of treatment, your child will be switched from prescription OIT to a form of dietary peanut, which helps keep the treatment costs low for our families.
Our payment plan is in place only while you need prescription peanut OIT. We will ensure that you are established on dietary treatment for the next 12 months with regular contact, usually by video consult.
High Quality Care
The video calls are not charged and are part of our commitment to high-quality care and the ongoing safety of your child.
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 3 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 at Southampton Children’s Hospital will be required every 2 weeks on a Saturday, 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 recognize 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 peanut hotline, and one of our allergy doctors 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.