Peanut immunotherapy has good long term outcome

Dr Wesley Burks, Chief of the Division of Pediatric Allergy and Immunology at Duke and Arkansas Children's Hospital and his colleagues began enrolling children five years ago to determine if incremental doses of peanut protein could change how the body's immune system responds to its presence. The doses start as small as 1/1000 of a peanut. Eight to 10 months later, the children could tolerate amounts of up to 15 peanuts per day without reaction. The children stay on that daily therapy for several years and are monitored closely.

Nine of the 33 children participating in the study have been on maintenance therapy for more than 2.5 years. After a series of food challenges, four of those children were taken off the treatment and continue to eat peanuts. Some have been off treatment for more than a year. Doctors keep tabs on any potential changes in their immune system via skin, blood and immune studies. Children in this study generally started with IgE levels greater than 25; at the end of the study, their peanut IgEs were less than two and have remained that way since the treatment was stopped.

Because the pool of children now off treatment is so small, Burks says it's hard to say whether these children simply outgrew their allergies or whether the therapy did something to enhance that outcome. The next step is a blinded study in which children on treatment are compared to a control group but, meanwhile, he cautions parents and professionals against trying any version on their own and that some people are too sensitive to peanut allergens to be able to undergo the therapy at all.

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First published in June 2009

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