Peanut allergy treatments are improving. Options like oral immunotherapy and biologics are helping lower the risk of severe reactions if you’re exposed to peanuts.

Living with a peanut allergy can be stressful and challenging. It requires constant vigilance to avoid exposure, affecting daily life and social activities.

As research continues, new treatments are emerging that offer hope for better management and potential relief from this common allergy.

The approach to managing allergic reactions to peanuts varies significantly between mild and severe cases.

Antihistamine pills, such as cetirizine or loratadine, can be effective for mild allergic reactions like slight hives or itching. These drugs block histamine, a chemical released during an allergic reaction that causes symptoms.

In cases of severe allergic reactions to peanuts, including anaphylaxis, an epinephrine auto-injector (EpiPen or Auvi Q) is required to manage this medical emergency.

Epinephrine can reverse the anaphylactic reaction by constricting blood vessels, relaxing airway muscles, and reducing swelling. This should be followed by emergency medical attention.

Depending on the severity of the allergic reaction, additional treatments, such as intravenous fluids or corticosteroids, may also be needed.

Immunotherapy regulates the immune system’s response to allergens, like peanuts, aiming to reduce the severity of allergic reactions over time.

For peanut allergies, immunotherapy may involve gradually increasing exposure to peanut proteins and using biologics (medications) to target specific immune responses in the body. Over time, the body may react less intensely to peanuts.

Immunotherapy for peanut allergy is available and effective for children and adolescents, and is often used in adults with severe peanut allergies to improve tolerance.

Oral immunotherapy

Oral immunotherapy involves consuming small, gradually increasing amounts of peanut protein by mouth to build tolerance. The therapy may last weeks or months.

The treatment uses peanut powder or a peanut protein solution mixed with food or a capsule containing peanut protein.

  • Goal of treatment: Raise the threshold for allergic reactions, making accidental exposure less likely to cause severe symptoms.
  • Dosage frequency: Daily. Start with a minimal dose and incrementally increase the amount over several months.
  • At home vs. doctor’s office: Initial doses are administered in a doctor’s office to monitor for reactions. Once stabilized, they may ask you to take daily doses at home.
  • Common side effects: Gastrointestinal symptoms like nausea or stomach pain, itching, or mouth swelling.
  • Generic name: You may hear different versions of the oral immunotherapy method, but peanut protein powder is the most common.
  • Brand name: Palforzia (peanut allergen powder – PTAH)

Sublingual immunotherapy

Sublingual immunotherapy is a type of immunotherapy where allergens are administered under the tongue and absorbed into the bloodstream to help the immune system build tolerance.

While sublingual immunotherapy is widely used for other allergens like pollen, dust mites, and grass, it has not yet been developed or approved for peanuts.

Ongoing research and clinical trials are exploring its potential, but no sublingual immunotherapy products for peanuts are available commercially.

Epicutaneous immunotherapy

Epicutaneous immunotherapy involves using a skin patch containing a small amount of peanut protein to desensitize the immune system gradually. Over time, this reduces the severity of allergic reactions to accidental peanut exposure.

  • Goal of treatment: Desensitize the immune system to peanut allergens through slow, controlled exposure.
  • Dosage frequency: Typically involves wearing a patch for several hours daily until improvement is noted.
  • At home vs. doctor’s office: Patches are generally used at home, though the initial setup and monitoring need to be in a doctor’s office.
  • Common side effects: Skin reactions at the patch site, such as changes in skin color or texture, itching, or rashes.
  • Generic: Peanut protein patch.
  • Brand names: Viaskin Peanut; currently under trial and not yet widely available in the United States.

In a 2023 study involving children ages 1 to 3 years with peanut allergies, epicutaneous immunotherapy was more effective than a placebo in desensitizing children to peanuts over 12 months.

About 67% of children in the treatment group showed improved peanut tolerance compared with 33.5% in the placebo group. However, the treatment group had higher rates of serious side effects, including anaphylaxis.

Biologics

Biologics for peanut allergies are advanced medications designed to target specific immune system components involved in allergic reactions.

Doctors typically administer biologic drugs by injection. Doctors usually prescribe the treatment for cases of severe peanut allergies that do not respond well to other therapies.

  • Goal of treatment: Reduce the overall allergic response to peanuts by targeting specific molecules involved in the allergy when other therapies have not succeeded.
  • Dosage frequency: The frequency depends on the specific biologic and treatment plan for your needs.
  • At home vs. doctor’s office: Due to its complexity, the therapy is used in a healthcare setting only.
  • Common side effects: Injection site reactions, potential for systemic allergic reactions, or flu-like symptoms.
  • Generic: Not widely available as of now.
  • Brand names: No specific biologics for peanut allergy are approved yet, but research is ongoing.
  • Off-label medications: Omalizumab (Xolair) is used off-label in severe cases. “Off-label” means a drug is used for purposes other than those it has been officially approved for.

Research indicates that when used before or alongside oral immunotherapy, omalizumab helps individuals tolerate higher amounts of peanuts and speeds up reaching maintenance doses.

Studies are ongoing to better understand its long-term benefits and effectiveness compared with newer treatments like ligelizumab.

Is there a cure for peanut allergy?

No cure is currently available for peanut allergies. However, immunotherapy, including oral, epicutaneous, and sublingual methods, has helped some people achieve remission (no symptoms) or decreased sensitivity to peanuts.

For managing peanut allergy, consider these strategies:

  • Strictly avoid foods containing peanuts and peanut products.
  • Always check food labels for peanut ingredients and potential cross-contamination.
  • Notify restaurants, caregivers, and schools about the allergy.
  • Always carry epinephrine auto-injectors and know how to use them.
  • Use a medical alert bracelet to inform others of your allergy in an emergency.
  • Learn more about peanut allergies and ensure that those around you understand the severity and management of the condition.

Managing peanut allergy today involves strict avoidance and careful planning. However, new treatments are offering hope.

Oral and epicutaneous immunotherapy are showing promise in increasing tolerance and reducing reactions. Biologics like omalizumab are also being studied for their potential to improve treatment outcomes.

These advancements bring optimism for better management and possibly even overcoming peanut allergies in the future.