Thursday, March 26, 2009

Oral Immunotherapy for Peanut Allergy- On the Horizon, but Not Ready for Prime-Time

Since the recent American Academy of Allergy, Asthma & Immunology conference in Washington D.C., much has been made of studies describing oral immunotherapy for peanut, egg and milk. These studies have demonstrated that some food allergic children can eventually tolerate ingestion of significant amounts of their trigger food after a protocol or gradually increasing oral doses of that food.

You may have seen this story on the morning/evening news programs, or read about it in your local paper or online. Certainly, parents of my patients have been coming in asking if I can provide this therapy for their food-allergic children in my office.

They are invariably somewhat disappointed when my answer is: "Sorry, not yet."

Let me explain why.

Although the prospect of inducing some measure of tolerance to a food allergen is exciting, there are a number of things to keep in mind:

1) To date, the peanut immunotherapy studies have evaluated relatively small numbers of children (<40), although larger controlled studies are in the works.

2) Of the 33 children enrolled in the initial phase of the peanut study, 4 (~12%) dropped out due to allergic adverse events (as determined by either the parents or investigators). This is not something that should be attempted in the home setting!

3) We're still not completely sure if the tolerance induced by food allergen oral immunotherapy is temporary (effective for only as long as the maintenance therapy is continued) or permanent (with lasting benefit after the discontinuation of maintenance administration). Until these questions are answered, it is inaccurate to say that oral immunotherapy "cures" food allergy. At best, we can state that oral ummunotherapy appears to increase the threshhold for food reactivity, potentially reducing the risk to a child from accidental exposure. This is not a license to consume peanuts with abandon...

4) Oral immunotherapy is still considered investigatonal, and the major insurance plans specifically state in their policies that oral immunotherapy is not a covered procedure. FDA approval is probably ten years away, because large-scale, placebo-controlled studies will be needed, and long-term effects of the treatment will need to be evaluated before the therapy can be considered safe for widespread use.

That said, as an allergist, and as the mother of a peanut-allergic child, I do believe that oral immunotherapy holds great promise. When it is ready for prime-time, I will be pleased to offer it to my patients.

For more information, please visit the American Academy of Allergy, Asthma & Immunology at http://www.aaaai.org

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