Wait, what? Can peanuts treat peanut allergy? It might sound counterintuitive, but a groundbreaking new study suggests just that. In the first clinical trial of its kind, scientists tested whether adults allergic to peanuts can be desensitised using peanuts.
The Grown Up Peanut Immunotherapy (GUPI) trial, led by researchers at King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, studied whether peanut allergy could be treated with the allergen, which in this case is peanuts itself. Published in the journal Allergy, the trial has shown great success with two-thirds of the test subjects consuming the equivalent of five peanuts without reacting. This is the first study in adults with severe allergy to test whether daily doses of peanuts taken under strict supervision can be safely tolerated.
This method is known as oral immunotherapy, has seen success in trials in infants and children worldwide. The new findings of the first trial in adults.
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“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 desensitised and that this improves quality of life. The average tolerated dose of peanuts increased 100-fold over the course of the trial,” Chief Investigator Professor Stephen Till, Professor of Allergy at King’s College London, said in a statement.
21 adults aged 18 to 40 with clinically diagnosed peanut allergies were included in the Phase II trial. They confirmed the allergy via 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. Those who were able to tolerate 1.5mg or 3mg of peanut flour were given a daily dose at home for 2 weeks. This is the equivalent of 0.5-1% of a whole peanut. They were monitored in 2-week intervals and were given supervised doses of more peanut protein, increasing from 6mg (around 1/40th of a whole peanut) to 1g (four whole peanuts).
The participants who were tolerant to 50-100mg of peanut protein were switched to eating whole peanuts, peanut butter, or peanut products, with the first dose supervised by the clinical team.
Participants continued the daily dosing for at least three months before exiting the trial, as well as the option of continuing post-study. The findings revealed that 67% of participants were able to consume at least 1.4g of peanut protein, which is equivalent to five peanuts, without reaction. The participants of the trial were asked to consume peanuts every day at home to remain desensitised.
“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,” Professor Till said.
Lead author specialist Allergy Dietitian Hannah Hunter from Guy’s and St Thomas’ NHS Foundation Trust noted, “Living with peanut allergy is a huge burden due to the need for constant vigilance and the risk of accidental exposures. 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.”
Chris, 28, a participant in the trial, who was diagnosed with a peanut allergy as a baby said, “I’m so proud to have been part of this trial and so happy to say that I used to be allergic to peanuts but thanks to this trial, this is no longer a concern. Me and my family were always anxious that even a trace of peanut could be life-threatening. The trial was an interesting experience because all of my life, I had associated the taste and smell of peanuts with fear and death. I started with a small amount of peanut flour with yoghurt, and by the end of the trial, I could eat four peanuts in one sitting. Now, I have four peanuts every day with my breakfast to maintain my immunity. Before, a tiny mistake could have life-threatening impacts, but now I don’t have the fear that I might collapse and die from eating a takeaway.”
