The world-first initiative will see babies exposed to increasing amounts of peanut powder over two years.
A slow and steady approach could win the peanut allergy treatment race.
The National Allergy Centre of Excellence, hosted at the Murdoch Children’s Research Institute in Melbourne, this week launched a new nationwide oral immunotherapy program aiming to change how peanut allergy is treated.
Instead of strictly avoiding peanut exposure in children with a known allergy, the ADAPT OIT program hopes to safely develop the child’s tolerance to peanuts – and hopefully put the allergy into remission – by putting them on a “carefully planned daily dosing schedule of peanut powder, taken at home, over two years”.
Professor Kirsten Perrett, a paediatric allergist and director of the NACE, said this would be the first peanut allergy treatment program to be offered as part of a model of care, rather than in a clinical trial setting.
“Oral immunotherapy is being variably implemented around the world using different approaches making it difficult to assess the results, including the long-term outcomes for children, their families and the health system,” Professor Perrett told media.
“Ultimately, we want to change the trajectory of allergic disease in Australia so that more children can go to school without the risk of a life-threatening peanut reaction.”
Children will initially receive a very low dose of peanut powder, which will be increased over the first four to six months of the treatment program until the individual maintenance dose has been identified. Dosages and tolerability will be reviewed and adjusted (if required) at monthly appointments.
The families of children enrolled in the program will receive an Australasian Society of Clinical Immunology and Allergy (ASCIA) anaphylaxis plan, an adrenaline injector and a comprehensive educational pack. They will also have access to an on-call allergist in case of emergency.
Children will also undergo an allergy test at the end of the two-year program to confirm whether remission has been achieved and will receive routine follow-up care for at least another 12 months to determine the acceptability, safety, effectiveness and long-term outcomes of the program.
Peanut allergy is the most common food allergy among school-aged children in Australia. It affects 3% of one-year olds, and more than two-thirds remain allergic to peanuts by age 10 years.
Children under 12 months who have been diagnosed with a peanut allergy and who receive care at one of the 10 participating hospitals may be eligible for the free program.
The hospitals participating in the trial are:
- The Royal Children’s Hospital (Victoria)
- Perth Children’s Hospital and Fiona Stanley Hospital (Western Australia)
- Queensland Children’s Hospital (Queensland)
- Women’s and Children’s Health Network (South Australia)
- John Hunter Children’s Hospital, Campbelltown Hospital and Royal Prince Alfred Hospital (New South Wales)
Additional hospitals and private allergy clinics, including those in regional and remote areas, may adopt the program in the future.
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ADAPT OIT program medical lead, Dr Tim Brettig, reminded clinicians and families that the new approach might not be for everyone, and that remission was not guaranteed.
“OIT treatment takes time and this program requires a long-term commitment from families to give their child daily doses of peanut powder at home along with regular visits to their hospital allergy clinic,” the Melbourne-based paediatric allergist and immunologist said in a statement.
Families are advised that the peanut powder doses should be delivered at home at approximately the same time each day. The dose should be delivered at least two hours before the child goes to nursery or daycare so parents can monitor them for the period where anaphylactic reaction risk is highest.
“It is important to remember, OIT is not a cure, but by following treatment it may improve the chance of being able to safely eat a specific food allergen, such as peanut,” said Dr Brettig.
The NACE and the post-treatment evaluation study are funded by the federal government.
