Finally some good news for adults with peanut allergies. For a while now it has been known that peanut allergies in young children can be treated with oral immunotherapy (using very tiny doses of peanut protein). But what about adults?
The Phase 2 Trial in adults (average age 24.2 years) with peanut allergies also found good results - by the end they could consume the equivalent of more than 4 peanuts without reacting.
The Grown Up Peanut Immunotherapy (GUPI) trial consisted of 21 adults who ingested tiny doses of peanut protein (peanut flour) taken under strict supervision - with slight increases of peanut protein every 2 weeks until reaching a maintenance dose of 1000 mg (4 large peanuts). 67% of the participants reached the maintenance goal, but 3 adults withdrew from the study due to adverse reactions, and another 3 for unrelated reasons. The 67% also tolerated well a final challenge equivalent to 12 peanuts.
Doing this under supervision was important because when the peanut doses were increased, there initially were side effects. It was also important that daily doses weren't skipped.
In other words, it appears that oral peanut immunotherapy might be an effective treatment for many (most?) adults with peanut allergies. The same researchers will now continue the next phase of clinical trials. Stay tuned...
From Medical Xpress: Daily doses of peanuts tackle allergic reactions in adults, Phase II trial shows
The first clinical trial to test whether adults allergic to peanuts can be desensitized has shown great success with two thirds of the cohort consuming the equivalent of five peanuts without reacting.
The Grown Up Peanut Immunotherapy (GUPI) trial is the first study entirely in adults with severe allergy to test whether daily doses of peanuts taken under strict supervision can be safely tolerated.
The approach, known as oral immunotherapy, has seen success in trials in infants and children worldwide. The findings of the first trial in an exclusive adult cohort have been published in the journal Allergy by a research team from King's College London and Guy's and St Thomas' NHS Foundation Trust.
Chief Investigator Professor Stephen Till, Professor of Allergy at King's College London, said, "Constant fear of life-threatening reactions place a huge burden on people with peanut allergy. The only way to manage a peanut allergy is strict avoidance and treatment of allergic reactions, including with adrenaline.
"Although peanut immunotherapy is known to be effective in children, this trial provides preliminary evidence that adults can also be desensitized and that this improves quality of life. The average tolerated dose of peanuts increased 100-fold over the course of the trial."
The Phase II trial recruited 21 adults between 18 and 40 with a clinical diagnosis of peanut allergy at Guy's and St Thomas' NHS Foundation Trust. Allergy was confirmed via a skin prick test, blood test and then an oral food challenge.
In a clinical setting, participants received the first dose of 0.8mg peanut flour mixed in with food, then 1.5 mg 30 minutes later followed by 3mg a further 30 minutes later.
Participants who tolerated 1.5 mg or 3 mg of peanut flour continued on a daily dose at home for two weeks. This is the equivalent of 0.5–1% of a whole peanut.
Then participants returned at two-weekly intervals for supervised doses of more peanut protein, increasing from 6mg (around 1/40th of a whole peanut) to 1g (four whole peanuts). If participants could tolerate 50–100mg of peanut protein, participants were switched to eating whole peanuts, peanut butter or peanut products, with the first dose being under supervision of the clinical team.
Once participants achieved a daily dose of 1g, they remained on this dose for at least four weeks before undergoing a double‐blind placebo‐controlled food challenge. This involved being given increasing doses of either peanut or placebo (dummy) on separate days under close supervision to test their tolerance.
Participants then continued daily dosing for at least three months before exiting the trial, as well as the option of continuing post-study.
Results showed that 67% of participants were able to consume at least 1.4g peanut protein—the equivalent of five peanuts—without reacting. Participants of the trial could then consume peanuts every day at home to remain desensitized.
Professor Till said, "We are very pleased with the results. The efficacy rate is broadly in line with peanut oral immunotherapy trials in children. The next stage of the research will be confirming this in larger trials, and also identifying the group of adult patients who would most likely benefit from oral immunotherapy, and see whether it can lead to long-term tolerance in this age group."
"Everyday situations such as eating in restaurants and social events are anxiety-provoking and our patients tell us that the condition also affects travel choices and career options. We found that quality of life significantly improved after oral immunotherapy and fear of food also decreased. Many participants who completed the trial told us that the treatment had been life-changing and they were no longer living in fear."