Peanut Allergy Clinic

Peanut Oral Immunotherapy Treatment

The Peanut Allergy Clinic is a specialist private allergy service at Southampton Children’s Hospital.

About Peanut Allergy Treatment

For so many years, no treatment existed for food allergies, families were simply told that they had to ‘wait and see’ if a child would outgrow their peanut allergy and, in the meantime, keep them safe from reactions but being very cautious about exposure. 

Now, after extensive research, the UK has approved the licence for Palforzia (Aimmune, Nestle) a treatment to help improve the threshold of how much peanut a person with an allergy can eat, before a reaction occurs. This offers children with peanut allergies a treatment option that prevents their risk of a serious reaction through accidental exposure.

Who can have peanut oral immunotherapy (OIT)?

Peanut immunotherapy is licenced for children aged 4 to 17years. There is hope that the age for peanut immunotherapy will be lowered as the treatment also looks beneficial for younger children. The team at Southampton Peanut clinic are directly involved in these trials and are also looking at its effectiveness in adults with a peanut allergy.

Some children who have peanut OIT only have a peanut allergy, whilst others have multiple allergies, but their families still feel that having treatment for one of their allergens would be beneficial as it lowers their risk of reactions, especially for peanut which is so common in foods these days.

If you are interested in peanut OIT for your child and they have asthma, it is vital that we ensure their asthma is well controlled. This is important to prevent the risk of severe reactions on treatment and to prevent asthma exacerbations. 

Unfortunately, if your child has a history of or current severe mast cell disorder, then peanut OIT will not be recommended. If your child has had an episode of severe anaphylaxis, treatment should not be started for 60 days. These are rare allergic disorders, and our team of experts will be able to advise you on its safety for your child.

Find out more about Peanut OIT

After an initial assessment with either Dr Helen or Dr Mich, your child will then be put forward for peanut OIT. 

Appointments take place on a Saturday morning at the Children’s Hospital in Southampton and clinics are led by an allergy doctor. There will also usually be several children’s allergy nurses present. Appointments tend to be relaxed and there is plenty of time to ask questions (and do some homework!).

Your first appointment will take around 4 hours and during this time, you receive a reminder about how to recognise and treat allergic reactions, information about Palforzia and plenty of support.

Peanut immunotherapy comes in capsules that contain set amounts of highly purified peanut flour. The capsules are carefully opened and mixed in a cold food like yoghurt, apple sauce or salsa. During the first appointment, your child will be given a tiny dose of peanut flour and monitored for 30minutes. In total through the morning your child will receive 5 doses at 30minute intervals which will amount to 6mg of peanut flour (1/50th of a peanut). Your child will be monitored at all times by our specialists and is in a safe environment if there are any reactions.  After the first appointment, your child will then return with you on the Tuesday (3 days later) to check that everything has been ok before being given your first pack of treatments to take home.

For the first stage, you child will take home a 3mg dose of peanut flour to be taken every day until your next appointment -2 weeks after the start (on a Saturday).

If at any point during treatment there are any questions or concerns, you have access to your specialist team by email seven days a week including bank holidays. So, you can relax that there is always a specialist available for advice. Our clinic email is monitored every day and you will receive a response from one of the allergy doctors the same day if you contact us by 5pm. This is helpful for dosing advice, as most children dose after school between 4-7pm.

Every 2 weeks for the first 6 months, your child will return to clinic  to receive a step wise increasing dose of peanut protein. Each follow up appointment will take approximately 90minutes. By the end of the 6 months, your child will be able to tolerate 300mg of peanut protein (the equivalent of one to two peanuts). 

Following this, your child will still require regular appointments for the first 2 years. After the first year of treatment, your child will be swapped from prescription OIT to a form of dietary peanut. This helps keep the treatment costs low for our families. Our payment plan is in place only whilst you need prescription peanut OIT. We will then ensure that you are established on dietary treatment for the next 12 months with regular contact, normally by video consult. The video calls are not charged and are part of our commitment to high quality care and the ongoing safety of your child.

Peanut OIT needs to be taken at the same time every day so that a dose is never missed. Adaptions need to be made to daily life to fit in peanut OIT in a safe manner, and this will mean factoring treatment around schools, clubs and sporting events. 

Exercise, hot baths or hot showers should not take place 3 hours before or after treatment as this can increase the likelihood of a reaction occurring. A child taken peanut OIT should also not go to sleep for 2 hours after treatment so that they can be monitored. Many families therefore factor peanut OIT into their morning, pre-school routine or it is given immediately after school. 

Throughout treatment, two adrenaline autoinjectors must be carried at all times so that emergency medication is available if a reaction ever occurs. If the child is unwell, having a vaccination or having dental treatment, then adaptions may need to be made to the treatment so please let the team know.

Taking peanut OIT requires both a short- and long-term commitment. In the short term, families will be required to travel to appointments at Southampton Children’s Hospital every 2 weeks on a Saturday. Whilst we can be flexible with times of the appointments, and we can slow up dosing to accommodate holidays etc, we cannot change the day the appointments are held. 

In the long term, it is likely that the child who has undergone peanut OIT will need to eat some form of dietary peanut each day in order to maintain tolerance. At this stage it is not known whether peanuts will eventually be able to be consumed periodically. It is likely to be safer to eat peanuts regularly, to prevent any loss of benefit that the treatment offers.

As with any medication, peanut OIT can cause side effects. Common side effects that can occur are an itchy mouth or abdominal pain. Taking an anti-histamine before or after daily treatment is likely to help improve these symptoms. Usually, we would expect that these side effects will improve in time. In studies, 13% of children had to stop treatment during up dosing, and although side effect play a role for some, most of the time lifestyle factors were the main problem.

Eosinophilic Oesophagitis – a small proportion of individuals taking peanut OIT may experience this, less than one in twenty. This is a condition which affects the food pipe and can cause difficulty swallowing, food getting stuck in the throat, indigestion symptoms, stomach pain or loss of appetite. If this occurs, then treatment may need to be stopped.

Anaphylaxis – one of the risks of taking peanut OIT, as you might imagine, is that your child may suffer a serious allergic reaction. This is still a rare event and you will be trained to recognise and treat it by our team. We also teach you about other risks or cofactors that make anaphylaxis more likely, so that you can be especially careful at those times. This minimises the risk in our hands, but clinical studies have shown that the risk of anaphylaxis are 3 times more likely on peanut OIT compared to those in children with penut allergy who just avoid peanut.  This should be balanced against the benefits, the chances of ‘passing’ a peanut oral food challenge are 12 times more likely for someone who has undergone peanut OIT than a child who avoids peanut and has not been treated, who is more likely to react at challenge.

Peanut oral immunotherapy is not for every child and the risks and benefits need to be carefully weighed up. Dr Mich and Dr Helen will talk this through with you at your initial assessment and we will make a shared decision on whether to progress to treatment or not, with an individualised discussion of risk and benefit for you child.

Children who have undergone peanut OIT are less likely to have a reaction to peanuts if they are accidentally exposed. This often means that life changes dramatically for that child and their families. Children who have avoided foods with precautionary labelling will now be able to eat these products without worry. Families find confidence to travel abroad and eat out. Many parents also feel empowered to allow their teenager to go to parties, hang out with friends, go to university, without worrying daily about a fatal allergic reaction.

Throughout your child’s treatment journey with us, you will have regular opportunities to ask questions. The two weeks up dosing means that you will have face to face contact with the team on a regular basis, you also have full training during the 5 dose initial dose escalation phase of treatment, and written instructions are also provided. Before each appointment our doctors or nurses will ask how things have been and if there have been any difficulties. You will then have an opportunity to ask questions before your child is given their next increased dose of peanut OIT. 

If any questions or difficulties occur at home, you can email into our peanut hotline and one of our allergy doctors will answer the same day if you contact us before 5pm.

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