Practice Guidelines for Peanut Allergies

Celeste Sitton, RN, BSN, CMSRN; Heide S. Temples, Phd, APRN, PPCNP-BC


J Pediatr Health Care. 2018;32(1):98-102. 

In This Article

Future Considerations

Nearing Readiness for Practice

Food oral immunotherapy (OIT). Patients receive a small dose of the food to which they are allergic. Over a period of months, this dose is increased incrementally until a goal dose is reached. The objectives of this therapy re to have the patient become less sensitive to the allergen and to potentially eliminate adverse reactions to the food allergen. This therapy had an 86% desensitization in subjects (Wood, 2016).

Food sublingual immunotherapy. Small amounts of liquid drops containing the food allergen are placed under the patient's tongue. As seen in the OIT method, these doses are increased gradually, with the goal of desensitization. This method has not been as successful as OIT (Wood, 2016).

Epicutaneous immunotherapy. A small amount of the offending antigen is absorbed through the skin via a patch containing small amounts of the allergen. Similar to medication patches, the food allergen is slowly released into the body. The goal of this therapy is a patient's eventual development of tolerance to the allergen, thus minimizing or eliminating future allergic reactions (Wood, 2016).

Theoretic Therapies Needing Further Research

Modified food allergens. Genetically altered food products are given to patients. The offending allergen's amino acid chain is altered, and the body's response to the protein is also altered. The goal of this intervention is for the immune system to be unable to easily recognize the new substance and, therefore, for the reaction to be minimized. Research is in the early phases; the safety profile is unknown.

Probiotics. Similar to their use in eczema, probiotics are given for food allergies with the goal of altering the gastrointestinal immune system and thereby altering the immune response. Consumption of probiotics is theorized to help improve the host's balance of bacteria intestinal flora. According to the Journal of Allergy and Clinical Immunology, a 2015 double blind placebo controlled study has shown that probiotic use reduced the cutaneous reaction to some food antigens. Insufficient evidence exists to support widespread adoption of this practice (Wood, 2016).

Anti-IgE medication. By prescribing medications that are specific to the body's IgE antibodies, the body's threshold for the allergen increases. These medications prevent IgE from binding to mast cells and basophils, thereby minimizing the allergic response to the offending agent. The end result is a reduction in freely circulating IgE, a minimized release of histamine and inflammatory mediators, and a significantly higher dose of the allergen needed to trigger an adverse reaction. Research is still ongoing (Berin, 2014).