Study of Australian Children Points to Possible Clue in Curing Peanut Allergy

Australian researchers say they may have come up with a potential treatment for peanut allergy that combines eating peanuts with a probiotic. More studies are needed and parents should not try this at home, the scientists say.
Probiotics are sometimes called “good bacteria” and are found in dietary supplements and in yogurt. They contain live bacteria and act as a way to “reset” the digestive system. The study took over 60 children between the ages of 1 and 10 and split them into two groups. About half got the treatment – in this case, a daily dose of a probiotic, as well as a small amount of peanut protein. That amount increased bit by bit over 18 months so that by the end of the study the children were eating 2 grams of peanuts every day. (That equals about a quarter of a tablespoon of peanut butter). The other half of the group, known as the control or placebo group, received neither peanut protein nor the probiotic.

peanuts-in-shell
The children eating the peanuts stopped eating them. They ate the peanuts again in a medical office at least two weeks after not having either the peanuts or the probiotic. Over 80% of children (23 of the 28 treated children) who received the probiotic/peanut treatment were still able to eat the peanuts.

This study is known as an oral immunotherapy study. In oral immunotherapy, you eat tiny but increasing amounts of something you are allergic to in the hopes that you can eventually force the body to accept it. Oral immunotherapy studies can be risky, leading to allergic reactions, which is why they are done under a doctor’s supervision. In this study, close to half of the children had reactions, ranging from minor reactions to more severe allergic reactions, including anaphylaxis. The study did not include children who had suffered severe allergic reactions to peanut in the past.

 

"This is an exciting study that offers a new twist on a potential treatment for food allergy,” said Dr. David Stukus, chair of the Kids With Food Allergies Medical Advisory Team. “Additional research is needed to better understand the risks and benefits, and especially to confirm if tolerance is maintained for longer periods of time. As exciting as this is, parents must be warned about the dangers of doing this on their own."

 

Given the allergic reactions of children during the study, Stukus, who is Assistant Professor of Pediatrics, Section of Allergy/Immunology at Nationwide Children's Hospital in Columbus, Ohio, also said more research is needed to determine who would make the best candidates to join future studies.

 

Researchers say the next step is to see if children are still able to eat peanuts after avoiding peanuts and the probiotic for two whole months. Typically, children who pass a peanut challenge are told to keep peanuts in the diet on a weekly basis. Otherwise, the allergy might return. Scientists want to see how long the protection of a probiotic will last. However, researchers do not know exactly how the probiotic works to keep someone from reacting to peanut.

This study is unique in that it is the first to include probiotics and peanuts with a control group. Results were published in a recent issue of the Journal of Allergy and Clinical Immunology.

 

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Is this a published study and do you have a citation? All I can find are new clips like this (that will probably get kids sent to the hospital.)I can't tell from any of the articles I've read say if the study was controlled for peanut component since kids are allergic to different proteins.  I also wonder what the side effects were to ingesting that much bacteria.  Gut flora is an ecosystem of it's own, and disrupting it may have consequences.

Hi, thank you for noticing! This is the citation; I read the study and I don't recall if they looked at different components, I would have to check again. We tried to make it clear that this is really just a first step and that parents should never, ever attempt to replicate medical studies at home!

The citation is:

  1. Administration of a probiotic with peanut oral immunotherapy: A randomized trial

    Tang, Mimi L.K. et al.
    Journal of Allergy and Clinical Immunology 

A press release to the research center that conducted the study is here.

The study was published online 1/13/15 but the news was not publicized until this week.

Thank you for sharing the citation.  I read the abstract as the full text wasn't available.  They did not control for peanut component, just skin test wheal size. I wonder why since such a difference has been shown with the components... I'd like to open up a question too as I noticed the study included very young children.  I'm a mom with a peanut allergic kid and I want there to be research done, but I'm in an ethical conundrum when it comes to putting my kid in a study.  I'm just not sure it is right as she cannot truly give informed consent but all the consequences are on her.    Does anyone know why these studies aren't done on adults with allergies first?

Hmmm. Good question! I'm not a doctor, but I can throw out some theories based on conversations I have had with doctors, plus my family's own experience with medical studies. I'm thinking that there may be a difference in how food allergy works or presents in children vs. adults, so the results would not be the same. Logistically, depending on the study, visits may require you to see a doctor somewhat often - it varies on the study. One I just looked at was every two weeks. If you work FT and don't have a flexible schedule or can't telecommute while you sit there (a lot of waiting is involved), it may be difficult to get that time off of work. If you are a young child or can bring your schoolwork in, it may not matter if you miss school as much.

 

Regarding giving consent for your child - I personally feel that is a decision every family has to make based on the risk and benefits they perceive, whether on an individual or collective basis or however you want to make that decision. My child is multiple food allergic, and we live within commuting distance to a major research center. When he was younger, we tried a couple of them because we thought it was worth it, whether it would be of immediate benefit, or whether it would contribute to a body of knowledge that might help in the future. (They didn't work, BTW). 

 

On the flip side of things, I have a somewhat risk-averse friend who won't even take her child for a peanut IOFC although there might be a decent chance the child is no longer allergic. 

 

I think it depends on what your comfort level is.

 

I have seen FA studies recruiting adults, too - I think it just depends on the type of study, and what exactly it is that is being studied. By the time people have grown to fully mature adulthood with food allergies, or have developed adult-onset food allergies, I don't know that immunotherapy as a way to force tolerance is being looked at in that instance. But I could be wrong.

 

You could check www.clinicaltrials.gov...

Thanks for your thoughtful response!  We parents are faced with some difficult choices aren't we?  How did you discover you child was allergic to things like mustard and chickpeas? My kid is swearing a Twizzler made her throat hurt, but she's not real trustworthy right now, she eats another flavor of them all the time and the ingredients are identical. I thin she didn't like this flavor and wanted the "yummy medicine" like her brother had moments before when dinner made his mouth itch.  We are talking to the doctor but I'm not sure what to think.

Mustard - he had a hot dog, which included it as a hidden spice. He threw it up within the hour and had profuse rhinitis as well (sneezing/discharge from nose). We added that to the testing list at his next appointment.

 

Chick peas, I honestly don't remember, it was so long ago. It may have been a rash around his mouth and itchiness.

 

Shellfish is new. He was eating shrimp ok. He didn't really like it but I chopped it up small and gave it to him about once a month. Then I sort of fell off that schedule (long story) and then the last two times I gave it to him, he said his throat was "itchy and grainy." So the last time we went in they did blood and skin for shrimp, crab and lobster. It all came back pretty positive. So now we are avoiding that until we can do an IOFC to confirm.

 

I was talking recently to another friend whose daughter is PN and has always strictly avoided TN on that basis alone, but who might be able to eat most if not all of them. Like my other friend - family is very scared and risk averse of the IOFC, and said the girl probably does not even want to eat the food even if she passes it. My friend was sort of looking to me to talk her into it. I pointed out to her that her daughter is nearing college years, and what if she knew for sure that TN were safe, and this way she would not have to worry if a boy ate almonds before he kissed her? Then a light bulb seemed to go off, so now I think she is going to talk her daughter into it.

 

I don't know if that is thoughtful or long-winded!

 

As to your daughter - maybe it was a texture thing, or maybe she was getting a sore throat or dry heat was bothering her from the winter/cold?

Would be more helpful if they came with instructions and manuals!

Wow!  What a tough journey.  I love shrimp but am kind of afraid to try it with my kid.  We had a bad experience with trying TN at home. I would advise your friend with the PN daughter to take it in careful steps.  I thought my DD was PN only and gave her almonds, it went fine.   Then I gave her cashews and we called 911....  First step is peanut component blood test.  Apparently there are several different proteins in the peanut one can be allergic to.  Some proteins track towards "outgrowing" it, if you are allergic to some of the other proteins you are looking a life long. The other thing I didn't know till after we met the local paramedics was that about 60% of people who are allergic to PN are also allergic to cashew.  My DD is allergic to PN, cashew and pistachio. No matter what your friend decides, if she does nut challenges they have got to be at a doctors office. That is what our allergist recommends, (our pediatrician had OKed the home challenge.)  On top of the DD with PN/TN have a DH and a DS with oral allergy syndrome  - I definitely feel your pain when it comes to meal planning!

Yes, there is what is called "component testing" which can help predict the chances of outgrowing and/or passing an oral challenge based on which proteins you react to.

 

All tree nuts are lumped together, but botanically/allergenically, there are different categories.  The big problems is that they are all often processed together making everything cross contaminated.  That's why a lot will recommend avoiding all tree nuts and peanuts if you are allergic even to just one.  The chances of cross contamination are very high.  You can find single supplier things like Barney Butter (almond) though.

 

My dd is allergic to pistachios and no other nuts.  Pistachios and cashews are closely related (also to mango, so just be aware if you haven't tried mango yet).  But she can eat all the other nuts and the doc wants her to.

 

My dd deals w/ OAS too - she developed that as a teen.  It stinks!  How old is your dd?  Can she help w/ the meal planning and prep??  If you haven't already, I encourage you to check out our Community Forums for lots of ideas on meal planning and just dealing w/ the day to day struggles of managing food allergies!

She is 6 and loves cooking with me.  She's also a great reader and we practice with labels.  One thing I've wondered.... Do you know of a book that teaches kids the different names of nuts in a fun way? I learned by eating them, but when you avoid nuts it is hard to teach a kid all the names and shapes to be alert for.  Thanks for all the feedback.  I can't tell you  how  much I appreciate this website.

I recently conducted a fake food tour via the Internet of various cheeses and nuts my son had to look out for. You could use Google Images....

 

We used to have a book but it was aimed at toddlers - I can't remember the name of the top of my head.

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