Allergist discusses recent progress in peanut allergy immunotherapy

November 29, 2018 by Hanae Armitage, Stanford University Medical Center
Credit: CC0 Public Domain

Any parent of a child with a severe peanut allergy knows the peril of a PB&J. For those with the condition, just sitting next to someone eating peanut butter can trigger a life-threatening reaction.

Now, scientists have established the validity of what could become the first oral anti-- drug. Stanford was one of 66 sites to participate in a phase-3 clinical trial of the therapy. The results were published Nov. 22 in the New England Journal of Medicine. Sharon Chinthrajah, MD, clinical associate professor of medicine and of pediatrics, was the principal investigator at the Stanford site. Chinthrajah is a member of the Sean N. Parker Center for Allergy and Asthma Research at Stanford, which is led by Kari Nadeau, MD, Ph.D., professor of pediatrics.

Participants in the trial ingested a dose of a peanut-derived called AR101 each day. They began with a small dose and gradually increased the amount, conditioning their immune systems to tolerate peanut proteins. The goal was to dampen the —which can result in swelling, itching and difficulty breathing—so it would no longer be life-threatening.

In a with science writer Hanae Armitage, Chinthrajah discussed the trial in more depth, highlighting the value it brings to those with peanut allergies, and how it advances allergy research overall.

1. What's the main thing that parents of children with severe peanut allergies should understand about the outcome of the trial?

Chinthrajah: Two out of three patients who were treated with daily AR101 oral were able to tolerate two peanuts after one year of therapy. Now, this isn't a permanent cure, but taking roughly the equivalent of one peanut every day can change a patient's and family's quality of life. AR101 has the potential to be the first FDA-approved therapeutic for , paving the way for more treatment options and greater access.

2. Do you think allergy immunotherapies could ever fully cure a food allergy?

Chinthrajah: As researchers, we continue to investigate the mechanisms behind the pathogenesis of and potential therapeutic options in the quest for an approach to permanently change the immune system so that it no longer reacts to in an abnormal way. Although we don't yet have a cure, the field of food allergy research has made leaps and bounds over the last decade, and we hope that momentum will only increase.

3. The majority of participants in the study were children and adolescents, with only a small subset of adults. Is age a factor in the efficacy of allergy immunotherapy?

Chinthrajah: In my experience, I've seen that oral immunotherapy can be successful in all if participants continue in the desensitization program and adhere to taking a regular dose of the food. However, pilot studies have shown that oral immunotherapy may have more lasting effects on the if started at an early age. But as you might expect, many questions still remain: How long does an individual have to maintain a daily oral immunotherapy regimen? What is the best maintenance dose? And how long-lasting are the effects of oral immunotherapy?

4. What do you say to people who may want to try to desensitize themselves or their children to a food allergen on their own?

Chinthrajah: We highly discourage desensitization at home without the guidance of trained allergists and clinical staff. The Parker Center at Stanford provides tremendous education and training about how to make this a safe process and how to take precautions with dosing. There is still a lot we are trying to understand.

5. Can you speak to some of the other work that's being pursued in food allergy desensitization? Is there ongoing research to see if oral immunotherapy could work for other allergy-triggering foods, like eggs or shellfish?

Chinthrajah: Multiple therapies are currently being explored, such as a phase-3 study investigating a peanut patch that delivers very small amounts of peanut via the skin. Other trials include under-the-tongue immunotherapy with peanut combined with another compound that may stimulate the efficiency of the immunotherapy process. There are also a large number of phase-2 studies showing success in oral immunotherapies for eggs, dairy, wheat, shellfish, tree nuts—even for multi-allergen oral immunotherapy, where patients are treated for multiple food allergens simultaneously.

Our center has investigated combining certain drugs targeting allergic pathways with oral immunotherapies for patients with peanut, milk and multiple food allergies. Our goal is to identify approaches and markers that can help clinicians best deliver safe and efficacious therapy for food-allergy patients, and we're excited to continue applying these principles in studies we're designing for the future.

Explore further: New treatment to protect people with peanut allergies ready for FDA review

More information: AR101 Oral Immunotherapy for Peanut Allergy, New England Journal of Medicine (2018). DOI: 10.1056/NEJMoa1812856

Related Stories

New treatment to protect people with peanut allergies ready for FDA review

November 18, 2018
The final research results for a new treatment for protection against accidental exposure to peanut was presented today at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting and published ...

Building tolerance helps kids with wheat allergy

October 30, 2018
(HealthDay)—Giving trace amounts of wheat to children with wheat allergy shows promise in treating the allergy, according to new research.

Reducing peanut allergy risks in children—The Nurse Practitioner presents update

February 15, 2018
New prevention and treatment approaches can reduce serious health risks due to peanut allergy in children, according to an article in the March issue of The Nurse Practitioner.

Drug increases speed, safety of treatment for multiple food allergies

December 11, 2017
In a randomized, controlled phase-2 clinical trial, an asthma medication increased the speed and safety of a protocol used to treat children for several food allergies at once, according to a study by researchers at the Stanford ...

Study suggests potential to predict peanut allergy immunotherapy outcomes

January 25, 2016
Oral immunotherapy for peanut allergy induces early, distinct changes in immune T-cell populations that potentially may help researchers determine which people will respond well to the therapy and which immune mechanisms ...

DNA of peanut-allergic kids changes with immune therapy, study finds

January 31, 2014
Treating a peanut allergy with oral immunotherapy changes the DNA of the patient's immune cells, according to a new study from the Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford. The ...

Recommended for you

HIV vaccine protects non-human primates from infection

December 14, 2018
For more than 20 years, scientists at Scripps Research have chipped away at the challenges of designing an HIV vaccine. Now new research, published in Immunity, shows that their experimental vaccine strategy works in non-human ...

RNA processing and antiviral immunity

December 14, 2018
The RIG-I like receptors (RLRs) are intracellular enzyme sentries that detect viral infection and initiate a first line of antiviral defense. The cellular molecules that activate RLRs in vivo are not clear.

The 'greying' of T cells: Scientists pinpoint metabolic pathway behind age-related immunity loss

December 13, 2018
The elderly suffer more serious complications from infections and benefit less from vaccination than the general population. Scientists have long known that a weakened immune system is to blame but the exact mechanisms behind ...

Scientists create most accurate tool yet developed to predict asthma in young children

December 13, 2018
Scientists at Cincinnati Children's Hospital Medical Center have created and tested a decision tool that appears to be the most accurate, non-invasive method yet developed to predict asthma in young children.

New genetic study could lead to better treatment of severe asthma

December 12, 2018
The largest-ever genetic study of people with moderate-to-severe asthma has revealed new insights into the underlying causes of the disease which could help improve its diagnosis and treatment.

Researchers discover unique immune cell likely drives chronic inflammation

December 11, 2018
For the first time, researchers have identified that an immune cell subset called gamma delta T cells that may be causing and/or perpetuating the systemic inflammation found in normal aging in the general geriatric population ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.