By Amy Norton
HealthDay Reporter
THURSDAY, May 11, 2023 (HealthDay News) — A “peanut patch” worn on the skin could help protect young children with life-threatening peanut allergies, a new trial shows clinical.
The patch is a form of immunotherapy, meaning it exposes peanut-allergic children to small amounts of peanut protein over time, with the goal of training the immune system to better tolerate it.
In the trial, the researchers found that of young children who used the peanut patch every day for a year, two-thirds showed a significant reduction in their sensitivity to peanut protein: they were able to eat the equivalent of one to four peanuts without suffer an allergic reaction. reaction.
While that may sound silly, experts said tolerance level matters.
The goal of immunotherapy is to prevent a serious reaction if a child accidentally swallows a small amount of peanuts, said Dr. Alkis Togias, of the US National Institute of Allergy and Infectious Diseases.
“This is a positive study,” said Togias, who wrote an editorial published with the findings May 10 in the New England Journal of Medicine.
The patch tested in the trial, called Viaskin, is being developed by French biotech company DVB Technologies, which funded the research. It is not yet approved by the US Food and Drug Administration.
If he wins the nod, Togias said, “I think that would be a good thing.”
An estimated 2% of American children are allergic to peanuts, and in most cases, the allergy continues into adulthood. That makes it the most common food allergy among children and the third most common among adults, according to the nonprofit Food Allergy Research and Education (FARE).
People with a peanut allergy can suffer reactions, sometimes severe, from ingesting even a small amount of the food—the amounts that are commonly hidden in processed or prepared foods. Therefore, they (or their parents) should carefully read food labels and take other precautions to avoid exposure to peanuts.
But that’s not easy, Togias said, and accidents happen.
As for treatment, there is an oral form of immunotherapy approved by the US Food and Drug Administration for peanut allergy, called Palforzia. It is a peanut flour product that can be mixed into foods, such as applesauce. But it is only approved for children over 4 years of age.
“There are currently no FDA-approved treatment options for children younger than 4 years,” said Dr. Matthew Greenhawt, principal investigator of the new trial.
Oral immunotherapy is being studied for young children with a peanut allergy. But Greenhawt said it’s always good to have multiple options on the table.
“What works for one family may not work for another,” he said.
In addition, the patch approach may have fewer side effects, according to Greenhawt, a professor of pediatrics at Children’s Hospital Colorado/University of Colorado School of Medicine.
The patch, he said, “takes advantage” of the fact that the skin is the largest immune system organ in the body. That means a smaller dose of peanut protein can be used, helping to avoid the systemic side effects that oral immunotherapy sometimes causes, such as upset stomach, throat irritation, and shortness of breath.
Those kinds of problems rarely arise with the patch, said Greenhawt, who also serves as a medical adviser for DBV Technologies.
The trial involved 362 young children, ages 1 to 3 years, who were randomly assigned to wear either the peanut patch or a placebo (inactive) patch every day for one year. Overall, 67% of the children who received the actual treatment met the endpoint of the trial: Their immune tolerance developed to the point that they could ingest the equivalent of one to four peanuts without an allergic reaction.
That compared to 33% of the children in the placebo group.
Skin rash was the most common side effect with the peanut patch, while just under 2% of young children developed systemic symptoms that were considered “mild to moderate.”
How would that compare to peanut powder?
It’s hard to judge, Togias said, because no trial has compared the approaches against each other.
But he pointed to a trial published last year that tested oral immunotherapy for children ages 1 to 3 with peanut allergies. The findings, Togias said, suggest that the oral approach may have stronger effects in desensitizing the immune system.
On the other hand, he added, the skin patch might be safer.
A broader question about immunotherapy for peanut allergy, Togias said, is whether there is a point at which it can be stopped. Palforzia is taken daily indefinitely, to maintain the immune system’s tolerance to peanuts.
Greenhawt said the peanut patch is also designed for daily use, and trials so far (including one of older children) have followed patients for up to three years of use.
Jennifer Bufford, FARE’s vice president of clinical operations, agreed that having multiple types of immunotherapy would be good for families.
Bufford also noted that many people with a peanut allergy are also allergic to other foods. “It will be interesting to see if epicutaneous [via the skin] desensitization can be achieved for other common food allergens,” he said.
While there is positive news on the treatment front, Togias emphasized another point: Peanut allergies can also be prevented by introducing peanut products into babies’ diets once they start solid foods.
More information
FARE has more information on peanut allergies.
SOURCES: Matthew Greenhawt, MD, MBA, MSc, professor, pediatrics, section of allergy and immunology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora; Alkis Togias, MD, branch chief, allergy, asthma, and respiratory tract biology branch, US National Institute of Allergy and Infectious Diseases, Bethesda, Md.; Jennifer Bufford, MS, vice president, clinical operations, Food Allergy Research and Education, McLean, Va.; new england journal of medicine May 11, 2023
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