Why This Promising New Treatment for Peanut Allergies May Not Be for Everyone

With no official treatment, the best advice for people with peanut allergies is usually to strictly avoid the offending legume and to keep rescue medications (like an EpiPen) on hand. But an experimental treatment–if approved–could become the first drug to prevent potentially deadly peanut allergy reactions in children.

In new research published in the New England Journal of Medicine and presented at the annual scientific meeting of the American College of Allergy, Asthma, and Immunology, the treatment–called AR101 and manufactured by Aimmune Therapeutics–was shown to increase the amount of peanut protein a child could tolerate before displaying allergy symptoms.

Just under 500 kids and teens between the ages of 4 and 17 were randomized to get a placebo or a peanut powder-filled capsule that was mixed in with their food. Slowly but surely, researchers increased the amount of peanut powder until by the end of the year-long trial, 67% were able to consume 600 mg of peanut protein (about the equivalent of two peanuts) without having a severe allergic reaction. Around half of those kids could tolerate up to 1000 mg of peanut protein. 

This strategy is called oral immunotherapy, Purvi Parikh, MD, an allergist and immunologist with Allergy & Asthma Network, explains to Health. “By introducing small, increasing doses of an allergen,” she says, “the immune system [becomes] less reactive to that specific allergen.”

This type of medication wouldn’t make it so people with peanut allergies could finally enjoy a PB&J. Rather, it would lower their risk of severe or potentially life-threatening reactions to accidental encounters. “It will lessen their chances of life-threatening reactions, which not only will help them from a health standpoint, but will hopefully alleviate their anxiety,” says Dr. Parikh, who was not involved in the new research. “For them, any situation with food can turn deadly if there is accidental exposure.”

However, as you might expect, giving peanut protein to people with peanut allergies wasn’t without incident. “Desensitization was not easy on the patients,” writes Michael R. Perkin, PhD, of the Population Health Research Institute in London in an accompanying editorial published alongside the new study.

More than 11% of the kids and teens originally assigned to get small doses of peanut powder dropped out of the study before the end. Of those who continued on, 14% needed to use epinephrine shots to quiet allergic reactions to the treatment (although most of those reactions were mild). One child experienced a severe allergic reaction, called anaphylaxis. For that reason, experts say, even though peanut powder may sound like something you could DIY, it’s essential not to try oral immunotherapy unsupervised at home.

It’s possible, Dr. Parikh says, that people with worse allergies to begin with might not be the best candidates for oral immunotherapy. “No two patients have the exact same immune system. [For] those who are highly allergic, it may be more difficult to desensitize as they may not tolerate the buildup phase.”

Aimmune Therapeutics plans to submit an application to the FDA in December to bring the new treatment to market. It’s expected that there will be high demand for the drug, and, the New York Times reported, advocates are already asking questions about pricing and insurance coverage.

However, it’s still unclear how long the protection from severe peanut-related reactions would last, Perkin wrote. People may need to literally eat a peanut every day to ensure they won’t react to one in the future. “Sustained, potentially lifelong, regular consumption may be needed to maintain allergen tolerance,” he wrote–although, he added, most parents would probably consider that “a very small price to pay.”

Despite the caveats, the treatment is exciting to experts and parents alike, considering peanut allergies have tripled over the last couple decades. Three million Americans are thought to be allergic to peanuts and tree nuts, and only 20% of kids outgrow their peanut allergies. 

In the meantime, the best way to avoid a severe allergic reaction to peanuts is to avoid them altogether. If you or your child has a peanut allergy, you may be cautiously optimistic about the AR101 news, but you’ll also need to keep reading food labels for now.

“Unfortunately, the mainstay of treatment right now is avoidance and carrying an epinephrine auto-injector,” Dr. Parikh says. “Even with careful measures, accidents do occur, and food that is safest is that which you prepare yourself.”

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