World-first program could reverse peanut allergies in babies

A world-first program is treating peanut allergies in babies under twelve months, aiming to induce remission and transform allergy care.

The National Allergy Centre of Excellence (NACE), hosted at Murdoch Children’s Research Institute (MCRI), is partnering with ten paediatric hospitals across five Australian states, to provide free, standardised oral immunotherapy to babies aged under one year who have been diagnosed with peanut allergy.

The ADAPT OIT Program is the first nationwide program model of its kind.

A careful, coordinated approach to peanuts

The oral immunotherapy (OIT) treatment will be offered as a new standardised model of care, the first peanut allergy treatment program offered in Australian hospitals outside of a clinical trial setting.

Families whose children are eligible for the program will follow a carefully planned daily dosing schedule of peanut powder, taken at home, over two years. While on the program, children are prescribed an Australasian Society of Clinical Immunology and Allergy (ASCIA) anaphylaxis action plan and adrenaline injector and families are given a comprehensive plan to address symptoms and have access to an allergist on-call.

Dr Tim Brettig is a paediatric allergist, immunologist, and the medical lead of the ADAPT OIT Program. He says that the program is closely monitored by the team, and that it’s important it be done under medical supervision.

“We’re giving a daily dose of the allergen at a dose where the child won’t react, and then slowly, increase that under medical supervision to help build their tolerance,” said Dr Brettig.

“It’s been shown through research that this can be an effective treatment option for children that live with food allergy,” said Dr Brettig.

Allergies on the rise

According to NACE, Australia is the allergy capital of the world. Peanut allergy is the most common allergy in children, affecting 3.1% of children aged 12 months in Australia, according to MCRI-led research.

Dr Brettig says that coordinated treatments for nut allergy have been a long time coming.

“We know that nut allergies are one of the leading causes of morbidity and mortality from food allergy,” says Dr Brettig.

“Over time, and for a long time, there’s been a rise in the number of food allergies. But also, there’s been a rise in the number of hospital presentations, emergency department presentations, with food allergic reactions. So, we know that it’s an increasing burden on our health system,” he says.

“Living with the food allergy, there is an ever-present concern about having a reaction – be that anaphylaxis, or another type of allergic reaction. It means being really careful about food choices, reading labels; having to be quite careful at kids’ parties and social events. So having ways to improve quality of life is significant,” says Dr Brettig.

A coordinated approach

Dr Brettig says that there are countries that are implementing immunotherapy into clinical practice, including the US, Canada and countries within Europe. The program methodology, however, has been quite diverse.

“For peanut allergy, there’s a 30% chance of natural resolution (that the symptoms will resolve for the child) before school age. But for 70%, this allergy will persist. Parents are aware of what happens overseas, and there’s been a real demand for [a program like] this. The challenge is to meet that demand, but also make sure that we’re taking the right, evidence-based approach,” said Dr Brettig.

“Oral immunotherapy is being implemented around the world using different approaches making it difficult to assess the results, including the long-term outcomes for children, their families and the health system,” he says.

Dr Brettig says that the unique aspect of this program is that it will be administered via ten paediatric tertiary hospitals that have come together with an agreed approach.

“It means that we can look at these outcomes on a much bigger, national scale,” he says.

“The flow-on effects for the family are [the benefits of] a consistent approach, with teams that are experts in their fields, with experience, working collaboratively, nationally. These things will hopefully lead to a safe and effective experience for families,” he says.

A common goal to tackle allergies

Dr Brettig says that he is most impressed by the size of the coordination effort from so many stakeholders in the health industry coming together for this project.

“We’ve been really fortunate in getting a lot of groups together. We’ve collaborated with heads of department in each of the hospitals, OIT specialists across Australia and globally, nursing staff and consumers. We’ve had input from the NACE international scientific advisory board and consumer advisory group as well as representatives from Allergy & Anaphylaxis Australia. There’s been a lot of coordination and it’s a motivated group driven to try an improve the lives of children with Australia’s most common food allergy,” says Dr Brettig.

“This is also a huge commitment for each family. Being on the program means taking a daily dose of an allergen. There’s a lot of safety measures we put in place to make sure that we’re reducing risk wherever possible. While on the program, children are prescribed an Australasian Society of Clinical Immunology and Allergy (ASCIA) action plan for anaphylaxis and adrenaline injector, families receive a comprehensive education pack and have access to an allergist on-call,” says Dr Brettig.

“Food allergy is such a big issue now, unfortunately, and there’s such great scope for improving that,” said Dr Brettig.

The program is limited to children being treated by an allergist at one of the ten participating hospitals. Program capacity at each hospital will depend on demand and resources.

GPs can find out more about referrals on the NACE ADAPT OIT Program webpage.

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