In the U.S., “a food allergy reaction sends someone to the emergency room every three minutes. Despite this, not a single treatment for food allergy has been approved by the FDA”, says Chicago paediatrician Christina Ciaccio, who was also involved in the study. The FDA is the agency that approves medicines in the U.S. Most food allergy emergencies and deaths in the U.S. are due to peanut allergies.
The study, published in the prestigious New England Journal of Medicine, investigated whether very small amounts of peanut protein ingested regularly by children and teenagers with a peanut allergy would reduce their symptoms. The study is also known by its abbreviation, PALISADE, which stands for ‘Peanut Allergy Oral Immunotherapy Study of AR101 for Desensitization’. AR101 is a medication based on peanut protein. It is taken orally and therefore swallowed.
How did the team conduct the study?
Three quarters of the 496 study participants aged between 4 and 17 years received the medication, while a quarter received a placebo. The dosage of the medication was increased every two weeks for the patients treated with AR10. At the end of the trial, all participants were given peanuts and monitored for allergy symptoms and their severity.
What were the findings of the study?
At the end of the trial, 67 per cent of the children and teenagers who received the medication were able to tolerate a small amount of peanuts. The dose at which no allergy symptoms appeared was equivalent to about two peanut kernels.
Only four per cent of the participants who received the placebo were able to tolerate two peanut kernels without symptoms.
However, treatment with AR101 caused adverse effects such as gastrointestinal, skin and respiratory problems. As a result, one in ten patients withdrew early from the study.
How can the findings help?
The treatment cannot ‘cure’ a peanut allergy, but it could mean that people with a peanut allergy who have received peanut protein treatment may not automatically wind up in the emergency room with life-threatening symptoms if they accidentally ingest a small amount of peanuts. Oral immunotherapy was previously not recommended due to insufficient data from earlier studies, explain the authors of the PALISADE study. The new medication has not yet been approved.
PALISADE Group of Clinical Investigators. AR101 Oral Immunotherapy for Peanut Allergy. N Engl J Med. 2018 Nov 22;379(21):1991-2001