Is Preventing Fatal Peanut Anaphylaxis Finally Possible?

Arefa Cassoobhoy, MD, MPH


December 13, 2018

Hello. I'm Dr Arefa Cassoobhoy, a primary care internist, Medscape advisor, and senior medical director for WebMD. Welcome to Medscape Morning Report, our 1-minute news story for primary care.

You probably know someone with a peanut allergy. It's common; 2% of children are allergic to peanuts. And it's serious. Peanut allergy is the leading cause of death among all food-allergic reactions.

A recent study, called PALISADE,[1] showed that peanut immunotherapy was highly effective in preventing severe reactions to peanuts. The placebo-controlled study included 551 children and teens (and a few adults), most of whom had a history of peanut allergy.

The goal was to build tolerance over time by ingesting precisely controlled graduated doses of peanut protein powder. After 1 year of immunotherapy, both groups underwent a double-blind peanut challenge.

In those aged 4-17 years, 67% of the immunotherapy group was able to tolerate the equivalent of two peanuts with no more than mild symptoms, compared with 4% of the placebo group. Also, only 10% of the immunotherapy group required epinephrine during the final peanut challenge compared with 53% of the placebo group. Overall, when symptoms of a peanut allergy occurred, they were much milder in the immunotherapy group.

This is great news. Future research will look to understand whether the effects persist without continued peanut intake, as well as the long-term effects of exposure to an allergen to which the body has produced IgE antibodies.

In the meantime, we could soon have an immunotherapy that protects many kids and teens from an accidental—and life-threatening—exposure.

Follow Dr Cassoobhoy on Twitter at @ArefaMD


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