Peanut allergy is not only a potential life-threatening condition, but also a daily strain that forces families to maintain nut-free households while exercising continuous dietary vigilance when not at home. About 3 out of every 500 people in the United States are allergic to peanuts. The only way to prevent symptoms is to avoid peanuts altogether. “It’s a very challenging hazard to control, not only for manufacturers but also for the allergic consumer. You have to read every label, ask a lot of questions and trust no one, essentially.” The result is constant uncertainty and, in many cases, stress and anxiety—accidental consumption of peanuts could prove fatal. “To live with a child with severe allergies is to live in a world of constant uncertainty. What if he accidentally eats a peanut-filled granola bar? Cracker Jacks at the baseball game? How can we ever stop worrying when he is at a friend’s house, a birthday party, in the school cafeteria—never mind all those milestones later on, like sleepover camps and trips abroad?”
The most severe symptom of a peanut allergy is anaphylaxis, which can become life-threatening if not treated promptly. So, what is anaphylaxis? According to the Mayo Clinic, “Anaphylaxis is a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to something you’re allergic to, such as a peanut or the venom from a bee sting. The flood of chemicals released by your immune system during anaphylaxis can cause you to go into shock; your blood pressure drops suddenly and your airways narrow, blocking normal breathing. Signs and symptoms of anaphylaxis include a rapid, weak pulse, a skin rash, and nausea and vomiting. Common triggers of anaphylaxis include certain foods, some medications, insect venom and latex. Anaphylaxis requires an immediate trip to the emergency department and an injection of epinephrine. If anaphylaxis isn’t treated right away, it can lead to unconsciousness or even death.”
Fortunately, in most cases, peanut allergy is characterized by milder symptoms: itchy skin or hives, which can appear as small spots or large welts; an itching or tingling sensation in or around the mouth or throat; nausea; a runny or congested nose. Even more fortunately, results from several studies show that new forms of therapy may successfully treat peanut allergy. One of these new forms of therapy is oral immunotherapy—also known as exposure therapy. In this approach, peanut-allergic children are given very tiny amounts of peanut protein orally under medical supervision. Over time, the body’s reaction to peanuts decreases.
Results from an ongoing clinical trial show that a different approach, which uses a wearable patch, may treat children and young adults with peanut allergy, with greater benefits for younger children. The wearable patch delivers small amounts of peanut protein through the skin. This form of treatment is called epicutaneous immunotherapy, or EPIT for short. The results were published in the Journal of Allergy and Clinical Immunology on October 26, 2016.
Researchers randomly assigned 74 peanut-allergic volunteers aged 4 to 25 years to treatment with either a high-dose (250 micrograms peanut protein), low-dose (100 micrograms peanut protein), or placebo patch. Each day, study participants applied a new patch to their arm or between their shoulder blades. After 52 weeks of treatment, the researcher evaluated the therapy efficacy. They found that about half of the clinical trial participants treated with the patch for one year were able to consume at least 10 times more peanut protein than they were able to prior to treatment. More specifically, low-dose and high-dose regimens offered similar benefits, with 46 percent of the low-dose group and 48 percent of the high-dose group achieving treatment success, compared with 12 percent of the placebo group. They also observed greater treatment effects among children aged 4 to 11 years, with significantly less effect in participants aged 12 years and older.
Daniel Rotrosen, Director of the Division of Allergy, Immunology and Transplantation (DAIT, NIAID, NIH), said in a press release: “The clinical benefit seen in younger children highlights the promise of this innovative approach to treating peanut allergy. Epicutaneous immunotherapy aims to engage the immune system in the skin to train the body to tolerate small amounts of allergen, whereas other recent advances have relied on an oral route that appears difficult for approximately 10 to 15 percent of children and adults to tolerate.”
The study results also indicate that the patch is easy to use, convenient and safe. Thus, epicutaneous immunotherapy is a novel, potentially effective approach for peanut allergy treatment—it does deserve further evaluation.