A recent trial found that boiling peanuts for up to 12 hours could help overcome allergic reactions, with up to 80% of children with allergies to the nuts becoming desensitised to eating them.
The clinical trial at Flinders University, Adelaide, and the South Australian Health and Medical Research Institute (SAHMRI) was built on previous research by senior author and Flinders University’s College of Medicine and Public Health Associate Professor Tim Chataway showing that heat affects the protein structure and allergic properties of peanuts, meaning they were less likely to cause a severe allergic reaction.
The clinical trial tested whether a therapy delivering sequential doses of boiled peanuts, followed by roasted peanuts, could help children overcome their peanut allergies. This novel two-step therapy was tested in anticipation of achieving daily targets of participants consuming 12 roasted peanuts without allergic reactions.
Small and increasing doses of boiled nuts were first given to children to partially desensitise them, and when they showed no signs of an allergic reaction, increasing doses of roasted peanuts were then provided to increase their tolerance in the next stage of treatment,” said Chataway.
To achieve this multi-step process known as oral immunotherapy, the researchers asked 70 peanut-allergic children (six-18 years) to consume peanuts boiled for 12 hours for 12 weeks, two-hour boiled peanuts for 20 weeks, and roasted peanuts for 20 weeks.
The results showed 56 of the 70 (80%) participants became desensitised to the target dose of peanuts. Treatment-related adverse events were reported in 43 (61%) of participants, however, only three withdrew from the trial as a result, demonstrating a favourable safety profile.
Flinders University’ College of Medicine and Public Health and SAHMRI Professor Luke Grzeskowiak, the lead author of the study, says with up to 3% of children in Western countries grappling with peanut allergies, this clinical trial could help develop a novel treatment pathway to reduce the risk of accidental peanut exposure and significantly improve quality of life for peanut allergic children and their carers.
“The trial shows promising early signs in demonstrating that boiling peanuts may provide a safe and effective method for treating peanut allergic children with sequential doses of boiled and roasted peanuts over an extended period of time,” he said.
“With no currently approved treatment for peanut allergy in Australia there is a lot more research to be done. Unfortunately, oral immunotherapy doesn’t work for everyone and we are in the process of improving our understanding of how these treatments work and what factors can influence how people respond to treatment. This will be really important for assessing individual suitability for treatment and improve treatment decisions in the future.”
The study, published in Clinical & Experimental Allergy, was undertaken in collaboration with paediatric allergist Dr Billy Tao, who has been developing the novel desensitisation process to treat peanut allergies for the past decade after being inspired by similar research in the 1990s.
The study authors conclude that while these findings hold great promise that current approaches to oral immunotherapy could be made safer and more effective, this requires confirmation in a larger definitive clinical trial.
Study details
Oral immunotherapy using boiled peanuts for treating peanut allergy: An open-label, single-arm trial
Luke Grzeskowiak, Billy Tao, Kamelya Aliakbari, Nusha Chegeni, Scott Morris, Tim Chataway.
Published in Clinical & Experimental Allergy on 11 January 2023
Abstract
Background
Peanut allergy affects 1%–3% of children in Western countries. Boiling peanuts has been demonstrated to result in a hypoallergenic product that may provide a safer way of inducing desensitisation in peanut-allergic patients by first inducing tolerance to boiled peanut. We aimed to assess the efficacy and safety of oral immunotherapy (OIT) using sequential doses of boiled peanuts followed by roasted peanuts for treating peanut allergy in children.
Methods
In this open-label, phase 2, single-arm clinical trial, children aged 6–18 years with a positive history of peanut allergy and positive peanut skin prick test ≥ 8 mm and/or peanut-specific IgE ≥ 15 kU/L at screening underwent OIT involving sequential up-dosing with 12-hour boiled peanut for 12 weeks, 2-hour boiled peanut for 20 weeks and roasted peanut for 20 weeks, to a target maintenance dose of 12 roasted peanuts daily. Primary outcome: proportion of children passing open-label oral food challenge involving cumulative administration of 12 roasted peanuts (12 g peanuts; approximately 3000 mg peanut protein) 6–8 weeks after reaching the target maintenance dose. Secondary outcomes included treatment-related adverse events and use of medications for treating allergy symptoms.
Results
Between 1 July 2017 and 22 June 2018, 70 participants were enrolled and commenced OIT. Desensitisation was successfully induced in 56 of 70 (80%) participants. Withdrawal due to treatment-related adverse events was infrequent (n = 3). Treatment-related adverse events were reported in 43 (61%) participants, corresponding to a rate of 6.58 per 1000 OIT doses. Medication use associated with treatment-related adverse events was infrequent, with rescue epinephrine use reported by three (4%) participants (0.05 per 1000 doses).
Conclusion
Oral immunotherapy using boiled followed by roasted peanuts represents a pragmatic approach that appears effective in inducing desensitisation and is associated with a favourable safety profile.
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