Immunotherapy for peanut allergy - and sensitisation via the skin

A study by Scott D Nash and colleagues at Duke University, Durham, NC using oral immunotherapy for peanut allergy, was reported at a recent meeting of the American Academy of Allergy, Asthma & Immunology.

The study included children with a clinical history of peanut allergy and was divided into three phases; a modified-rush initial day of multiple doses, a build up phase of daily doses, increasing the dose every two weeks, and a daily maintenance phase for four months followed by an open food challenge using peanut flour. Peanut-specific IgE, IgG, and IgG4 were measured at specific intervals.

Thirteen children completed the study and underwent open food challenge. All the children tolerated the full challenge of 7.8 gms of peanut flour. Eight children had no symptoms at all; five experienced mild symptoms with four being treated with diphenhydramine. During the modified-rush phase most children had mild allergic symptoms but two had significant, systemic allergic symptoms.

The researchers concluded that oral immunotherapy for peanut is effective for reducing the risk of a serious allergic reaction after accidental contact with peanut.

At the same meeting S M H Chan, MD and colleagues at King's College in London presented evidence to suggest that peanut sensitisation may occur by contact with allergen through the skin (via a skin cream containing peanut oil or proteins) explaining why peanut allergic children react to their first known contact with a peanut.

American Academy of Allergy, Asthma & Immunology

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First published in June 2008

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