Children with peanut allergies may benefit from an unusual oral immunotherapy regimen: boiled peanuts. Use of a boiled peanut regimen led to desensitization in 80% of children with peanut allergies enrolled in an open-label, phase 2 trial, which was published in Clinical & Experimental Allergy. Few children withdrew from the trial because of adverse events.
“Small and increasing doses of boiled nuts were first given to children to partially desensitize them, and when they showed no signs of an allergic reaction, increasing doses of roasted peanuts were then provided to increase their tolerance in the next stage of treatment,” said coauthor Tim Chataway, who is an associate professor at Flinders University College of Medicine and Public Health in Adelaide, Australia. The findings build on previous research by Chataway showing that thermal processing affects the protein structure and allergic properties of peanuts.
Boiled Peanut Immunotherapy Regimen
The trial included 70 children aged 6 to 18 years (mean age, 10.5 years) with a positive history of peanut allergy who underwent oral immunotherapy involving a 52-week, up-dosing regimen (Table). The target maintenance dose was 12 roasted peanuts daily.
Table. Peanut Allergy Oral Immunotherapy Protocol
|Eat peanuts boiled for 12-hour for 12 weeks|
|Eat peanuts boiled for 2-hour for 20 weeks|
|Eat roasted peanuts for 20 weeks|
Efficacy of Boiled Peanut Immunotherapy
Desensitization occurred in 56 of the 70 children (80%) and was defined as passing a supervised oral food challenge that involved eating 12 roasted peanuts 6 to 8 weeks after reaching the target maintenance dose. The intervention led to a significant reduction in peanut skin prick test wheal size at the end of phases 2 and 3 of the dosing regimen (P <0.001 for both) but not after the end of phase 1.
Fourteen children withdrew from the trial most commonly for social reasons (n=10) such as trial-related burden or lifestyle changes (eg, family separation). Treatment-related adverse events resulted in 3 children withdrawing from the trial. One child withdrew because they disliked eating peanuts.
After a median of 150 days, 43 out of 45 participants who were successfully desensitized and were available for follow-up said they continued to eat peanuts, most of whom (63%) said they ate peanuts daily. Seven of the 45 participants (16%) said they had experienced allergy symptoms during the follow-up period and none reported anaphylaxis.
The rate of adverse events per dose of boiled peanuts was low at 6.6 per 1000 doses. Over the entire length of the trial, 42 children (61%) reported adverse events, which were typically mild (73%) and most commonly involved gastrointestinal symptoms (2.73 per 1000 doses). Three children required rescue epinephrine use, equating to a rate of 0.05 per 1000 doses.
Although the findings show promising early signs that the regimen is safe and effective “unfortunately, oral immunotherapy doesn’t work for everyone and we are in the process of improving our understanding of how these treatments work and what factors can influence how people respond to treatment,” said lead author Luke Grzeskowiak, PhD, associate professor at Flinders University College of Medicine and Public Health. “This will be really important for assessing individual suitability for treatment and improving treatment decisions in the future.”
The clinical trial was funded by the Channel 7 Children’s Research Foundation.
Grzeskowiak LE, Tao B, Aliakbari K, Chegeni N, Morris S, Chataway T. Oral immunotherapy using boiled peanuts for treating peanut allergy: an open-label, single-arm trial. Clin Exp Allergy. 2023 Jan 11. doi:10.1111/cea.14254
Boiled peanuts could help overcome child peanut allergy. News release. Flinders University. January 12, 2023. Accessed January 23, 2023. https://news.flinders.edu.au/blog/2023/01/12/boiled-peanuts-could-help-overcome-child-peanut-allergy/