A new study suggests that pre-school children who are allergic to peanuts can be treated safely by eating small amounts of peanut protein with instructions from a specialist in medicine.
The findings offer guarantees of allergies in clinics and hospitals that oral immunotherapy does not have to be confined to research settings alone.
The senior author and pediatric allergist Dr. Edmond Chan says many allergologists are moving away from the technique for fear they could cause a serious allergic reaction. But he and other scientists and pediatric allergologists at the University of British Columbia and the Children's Hospital for Adult Children say the risk is actually small.
Their study showed that only 0.4 per cent of 270 children who received oral immunotherapy had a serious reaction. In the meantime, 11 children, or four percent, received epinephrine. The researchers said that almost 68 percent of children experienced at least one allergic reaction, but 36.3 percent were mild and 31.1 percent were moderate.
The children were aged nine months to five years old and were treated from April 2017 to November 2018.
The findings in Canada were published in the "Journal of Allergy and Clinical Immunology: in Practice".
Oral immunotherapy is a relatively new approach in which the patient is eating to eat small amounts of allergenic foods to create tolerance. The dose gradually increases to a certain maximum, known as the maintenance level, which lasts for at least one year or even two.
At that moment, the child can be prepared for a food challenge to determine if they have become desensitized to their allergen, for example, eating a serving of peanuts.
Success has been achieved in clinical trials, but Canadian allergists remain divided in opinion, says Chan.
"There are some allergens who think that this should be done only within the research, and then there are other allergists who consider that carefully selected patients may be offered out of the research," said Chan, who adds that the treatment should be offered only by an allergy specialist, and not just a family doctor.
"I followed the few of my patients who flew to the United States and went to remote clinics to receive this treatment and I felt very confused …" An allergist told them: "Oh, yes, it's quite affordable and it's time to we do it, "and then other allergologists (said) that it is not. And some (families) were left on their own devices. "
Chan is among those who offer oral immunotherapy, believing that peanut allergies are highly healed, especially in young children.
He thinks the study is a "game changer" in encouraging other allergists to think about OIT and hopes to move the conversation to the establishment of national guidelines that can provide safe practice.
"Since the ship has sailed already and has a number of allergies that are already out of the research, we may need to try to make sure it is safe for patients to get them into those offices by having more unified criteria and guidelines on how to offer it. "
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