Desensitization of the Peanut Allergy

Nishi Jain ’21

The notorious peanut allergy is frequently accompanied by the endless requirement of overly-expensive Epi-Pens, fear of encountering the allergen in the lunchroom, and the looming threat of severe anaphylaxis. Peanut allergies are frequently diagnosed at birth or early in life via the skin test, but soon after diagnosis, the allergy can plague the affected patient throughout their childhood and adult life. And while prevention and quick treatment have been the key to survival for patients with peanut allergies – so much so that these allergies are no longer considered a mortal threat – there has been little effort made thus far toward a more substantive cure of the condition.

An allergic reaction is triggered by the immune system starting to fight off non-threatening substances – such as peanuts – with the same force and vigor as it fights any virus or bacteria. The symptoms of a less severe reaction include hives, coughing, and edema (swelling); but when the patient moves from an allergic reaction to full anaphylaxis with wheezing, fainting, shortness of breath, and swelling in the throat, an allergy can be deadly.

To avoid these uncomfortable and sometimes deadly reactions, people who are diagnosed with peanut allergies must take great care to avoid the allergen. However, it has recently been shown that either ingestion or exposure to minute quantities of the allergen and a gradual increase in dose administered to the patient can allow for the complete (or nearly complete) attenuation of the condition1. Yet, clinical trials that assessed the efficacy of this practice showed adverse effects, leading many patients to withdraw. Some of the patients even had to resort to epinephrine to combat the symptoms of an allergic reaction that was brought on by exposure to the allergen1.

A recent study published in the UK showed positive findings for a “peanut-derived investigational biologic oral immunotherapy drug” that suppresses the symptoms associated with the common peanut allergy. When compared with a placebo, this drug allowed patients to be exposed to significantly more of the allergen before an allergic reaction was triggered1. Such a drug may lead to a significant decline in the frequency of allergic reactions by raising the threshold at which they are caused, allowing for an improvement of the quality of life for patients.

A comparison between the patients receiving placebo and those receiving the immunotherapeutic (termed AR101 by the research group) found that only 25% of those in the AR101 group exhibited symptoms of mild allergic reaction and 5% exhibited symptoms of severe allergic reactions (borderline anaphylaxis), compared to 59% and 11% with the placebo group, respectively. Although just an initial finding, the impacts of reducing sensitivity to one of the most pervasive food allergens provides hope for the hundreds of thousands of patients currently requiring the use of epinephrine to combat their allergies1. With prices climbing higher for the brand-name Epi-Pen (currently priced at a whopping $700) this new medicine could be a lifesaver and a money-saver. And while peanut allergies are not often viewed as a key topic of medical research, this drug certainly has the possibility to change millions of lives for the better.

 

References:

[1] “AR101 Oral Immunotherapy for Peanut Allergy.” New England Journal of Medicine 379, no. 21, 2018, pp. 1991–2001., doi:10.1056/nejmoa1812856.

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