- A new clinical trial has found that 80% of child participants became desensitized to peanuts after receiving boiled, followed by roasted peanut oral immunotherapy.
- The promising results suggest this unique form of oral immunotherapy is effective for inducing desensitization and appears safe — but further research is still needed.
- If you have a peanut allergy, allergists agree it’s best to avoid any exposure to peanuts.
- For mild allergic reactions, antihistamines are recommended. For severe allergic reactions, epinephrine should be injected.
Peanut allergy is one of the most common food allergies, affecting an estimated 1.6 million children. Only 15% to 20% will outgrow a peanut allergy by the time they reach adulthood.
A new study published on Jan. 11 in Clinical & Experimental Allergy examined the effects of heat on the immunoreactivity of peanuts.
Researchers conducted a clinical trial with 70 children ages 6 to 18 years old with peanut allergies. They used subsequent doses of boiled peanuts followed by roasted peanuts to see if the protocol could help child participants overcome their peanut allergies.
The results show that 80% of the children became desensitized to peanuts.
“The biggest takeaway from the study is that using boiled followed by roasted peanut oral immunotherapy in peanut-allergic children appeared effective for inducing desensitization in 80% of study participants and was associated with a favorable safety profile, with only 4% of participants experiencing severe allergic reactions during treatment,” Luke Grzeskowiak, PhD, study author and associate professor in the College of Medicine and Public Health at Flinders University in Adelaide, Australia, told Healthline.
“These findings raise the potential that including a boiled peanut phase as part of oral immunotherapy could help to improve its safety and effectiveness, but this requires confirmation in a larger definitive clinical trial.”
Heat affects peanut immunoreactivity
For the study, child participants were given 12-hour boiled peanuts for 12 weeks, 2-hour boiled peanuts for 20 weeks, and roasted peanuts for 20 weeks. The children received 12 roasted peanuts daily.
“Boiling peanuts alters the protein structure and allergic properties, meaning it is less likely to cause an allergic reaction but maintains its ability to help build tolerance toward consuming peanuts,” Grzeskowiak explained.
“We hypothesized that commencing oral immunotherapy with boiled peanut could help reduce the risk of allergic reactions that can be quite common in the early phases of treatment.”
To that end, it was important the subjects ate boiled peanuts before the roasted peanuts.
“Boiled peanuts are less allergenic than roasted peanuts,” Dr. Sonia Cajigal, FAAAAI, an allergist and immunologist with St. Louis Family Allergy, told Healthline.
“If boiled peanuts were introduced before the more allergenic, roasted peanuts, it may help desensitize a child to the allergen, and their body can become more used to it,” she added.
Precautions and treatment for peanut allergies
The current recommendation for people with peanut allergies is strict avoidance.
Using boiled peanuts as part of oral immunotherapy requires confirmation in a large definitive controlled trial, as Grzeskowiak noted.
This means the novel oral immunotherapy treatment used in the study is not yet available for use in routine clinical practice, nor should it be attempted at home.
“It is not recommended to consume any foods that contain peanuts or could have been cross-contaminated by peanuts,” Cajigal said.
“Many allergists offer oral immunotherapy, which is a process of teaching the body to become tolerant (not have reactions to) peanuts. This should only be done under a physician’s supervision.”
What to do if an allergic reaction occurs
Allergic reactions can range from mild to severe, which will determine the best course of action.
“If a reaction from eating peanuts does occur, treatments include antihistamines (i.e., Benadryl) and epinephrine (i.e., EpiPen or Auvi-Q),” Cajigal explained.
“If a person is having a mild reaction (i.e., mouth itching), they can take an antihistamine.”
For severe reactions, it is advised to use an epinephrine auto-injector.
“If severe symptoms are occurring, like throat swelling, severe vomiting, or facial swelling, then the epinephrine auto-injector should be administered,” Cajigal said.
“If there are symptoms in two different body systems (i.e., lungs with cough and skin with hives), even if the symptoms are mild, they should use the epinephrine auto-injector.”
If epinephrine is required, you should call 911 or immediately go to the emergency room.
Epinephrine does not always treat the whole reaction, Cajigal explained, and further care and monitoring may be needed.
A new clinical trial demonstrated the effectiveness of boiled followed by roasted peanut oral immunotherapy, with 80% of child participants becoming desensitized to peanuts.
The findings are promising, suggesting that including a boiled peanut phase as part of oral immunotherapy could help to improve its safety and effectiveness.
Still, a larger definitive clinical trial is required. Researchers estimate it will be years before treatment can become available.
For people with peanut allergies, allergists recommend total avoidance.
If you experience a mild allergic reaction, antihistamines are advised. For severe allergic reactions, an epinephrine injection is recommended.
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