In a new study published Thursday in the journal The Lancet, a clinical trial funded by the National Institutes of Health (NIH) found that giving peanut oral immunotherapy to children ages 1 to 3 years old who are highly peanut-allergic induced remission of that allergy in one-fifth.
The authors gave toddlers daily increasing amounts of peanut protein powder to a group of toddlers for 2.5 years.
Nearly 150 children participated in the “IMPACT” trial at five academic medical centers. Only children who had an allergic reaction after eating half a gram of peanut protein or less were eligible to join the study.
They were given doses of peanut powder mixed in food or a dummy powder — oat flour.
The children gradually ate escalating doses of up to 2 grams of peanut protein over a 30-week period. For an additional two years, the children then continued to consume their daily dose of peanut or placebo flour.
Following that, the children received gradually increasing doses of peanut protein up to a cumulative maximum of 5 grams, before halting treatment and avoiding peanuts for half a year.
Lastly, the children had a repeat “food challenge” with 5 grams of peanut protein.
Remission was defined as those who were able to eat 5 grams of peanut protein without having an allergic reaction six months following immunotherapy treatment.
Those who did not have an allergic reaction were later fed 8 grams of peanut butter on a different day to confirm that they could eat peanuts without having a reaction.
At the conclusion of treatment, 71% of those who got the peanut powder could tolerate the equivalent of 16 peanuts. Six months later, 21% still could. In the dummy powder comparison group, 2% could tolerate 16 peanuts at the end of the treatment and six months later.
Most of the children had a reaction during treatment, mostly mild to moderate. Some in the peanut group required treatment with an EpiPen.
In a news release, the NIH said those who started the process with lower levels of peanut-specific antibodies were most likely to achieve remission.
“The investigators found that lower levels of peanut-specific immunoglobulin E antibodies at the start of the trial and being younger predicted whether a child would achieve remission. In an analysis done after the investigators could view the study data, they found an inverse relationship between age at the start of the trial and remission, with 71% of the 1-year-olds, 35% of the 2-year-olds and 19% of the 3-year-olds experiencing remission,” the agency explained.
Peanut allergy impacts about 2% of U.S. children, or nearly 1.5 million individuals ages 17 and younger.
“The landmark results of the IMPACT trial suggest a window of opportunity in early childhood to induce remission of peanut allergy through oral immunotherapy,” Dr. Anthony Fauci, White House chief medical adviser and director of the National Institute of Allergy and Infectious Diseases (NIAID), said in a statement. “It is our hope that these study findings will inform the development of treatment modalities that reduce the burden of peanut allergy in children.”
NIAID sponsored the trial.
While treatment for peanut allergies exists, it is only approved in ages 4 and older and protects against accidental exposure to small amounts of peanuts.
Children are still supposed to avoid eating the nuts, and carry an EpiPen or other medicine for allergic reactions.
When children stop taking the treatment, the protection stops.
To prevent peanut allergies from developing, health experts have encouraged parents to feed babies with peanut-containing foods early on.
The Associated Press contributed to this report.