Jan. 21, 2022 -- Young children may be able to overcome their peanut allergy if treated at an early age, according to a new study published in the journal The Lancet.

Researchers gave small amounts of peanut protein powder to toddlers to build up their tolerance for peanuts. The approach seemed to work best for the youngest kids and those with mild allergies.

Study findings suggest there is a “window of opportunity” for young kids to build a tolerance that could have lasting effects, Stacie Jones, MD, one of the study authors and a pediatrician at the University of Arkansas for Medical Services, told The Associated Press.

At the same time, she said, more research is needed to determine how long the effects could last. The research team found that about three-fourths of the kids could tolerate the equivalent of 16 peanuts without an allergic reaction after about 2.5 years of treatment. About six months after treatment stopped, roughly one-fifth still had the same tolerance.

Another peanut protein powder treatment for peanut allergies already exists, the AP reported, but it’s only approved for age 4 and older. The protection it provides is meant for accidental exposure to small amounts of peanuts, so children are still advised to avoid eating nuts and carry an EpiPen or medicine for allergic reactions. When children stop the peanut powder regimen, the protection stops.

Jones helped to lead a study of the current treatment, Aimmune Therapeutics’ Palforzia, and has consulted for the company, the AP reported. In the most recent study, she and colleagues tested a similar approach on younger children to understand whether their immune systems could adapt at an earlier age.

The study included 146 children between ages 1 to 3 across five locations in the U.S. They were given daily doses of the peanut powder mixed in food or a dummy (non-peanut) powder — oat flour. They ate larger doses over a 30-week period and then continued a maximum daily dose.

When the treatment ended, about 71% of those who received the peanut powder could tolerate the equivalent of 16 peanuts without a reaction. Six months later, 21% could still tolerate that amount. In the oat flour group, 2% could tolerate 16 peanuts after the treatment and six months later.

Most of the children had at least one reaction during the study, mostly mild to moderate cases. Some in the peanut group required treatment with an EpiPen.

About 2% of children in the U.S. have peanut allergies, which can cause severe reactions. Some children outgrow the allergy, but many people have to avoid peanuts for life.

The study “really supports something that we thought for a while in the field,” Joyce Hsu, MD, an allergy specialist at Brigham and Women’s Hospital in Boston, told the AP.

Hsu was not involved with the study. But her clinic offers an allergy treatment with peanut protein for ages 4 months and older, which is intended to protect against accidental ingestion. Hsu told the AP that there has been a lack of strong data about treating peanut allergies in younger children and infants.

“Children’s immune systems are generally more malleable when they are younger,” she said.

In a commentary published alongside the study, other allergy experts said the treatment is a reasonable option, and the wide availability of the peanut powder is helpful. However, it should be done under the guidance of an allergy specialist due to potential reactions, they noted.

The findings should give doctors more confidence about trying the treatment with toddlers and offering the option to parents, John Kelso, MD, an allergy specialist at Scripps Clinic in San Diego, told the AP.

Even still, the data is unclear on whether the tolerance provided by the treatment has a limit or how the effects could change over time.

“There still needs to be some caution about thinking of this as a cure,” he said.

 

Show Sources

The Lancet: “Efficacy and safety of oral immunotherapy in children aged 1-3 years with peanut allergy (the Immune Tolerance Network IMPACT trial): a randomised placebo-controlled study.”

The Associated Press: “Early treatment could tame peanut allergies in small kids.”

The Lancet: “Peanut oral immunotherapy in very young children.”

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