Australia, the 'allergy capital of the world', has launched a world-first free nationwide treatment programme for children with peanut allergies. The aim is to safely build up tolerance to the problematic nut so that children don't have to worry about the possibility of a life-threatening reaction.
Oral immunotherapy treatment, OIT, has emerged as an option to treat food allergies in children. This involves gradually increasing the child's daily intake of the allergenic food under medical supervision until a targeted maintenance dose is reached. This dose is then consumed daily at home as treatment over a long period of time. The aim is desensitization to the allergen or, at best, so-called 'sustained unresponsiveness' or remission.
Importantly, OIT is not a cure; instead, it is designed to help a child’s body get used to foods that would normally cause an allergic reaction. While some food allergies disappear by 12 months of age, others – particularly peanut, tree nut, sesame and shellfish allergies – are less likely to resolve naturally and are often lifelong. This makes the announcement that Australian babies will be offered access to the world’s first peanut OIT program all the more significant.
“Oral immunotherapy is administered across the world using different approaches, making it difficult to assess outcomes, including long-term outcomes for children, their families and the healthcare system,” said Professor Kirsten Perrett, director of the National Centre of Excellence in Allergy (NACE), leader of the Population Allergy Group at the Murdoch Children’s Research Institute (MCRI) and head of the ADAPT OIT Programme.
Why was Australia chosen for this program? The country has been given the unenviable title of ‘allergy capital of the world’. It is estimated that one in 10 Australian children develop a food allergy in their first year of life, while around six in 100 children develop a food allergy by the age of 10. But Australian children are not alone; food allergies are on the rise worldwide. The exact cause of the increase is unknown. Possible factors include changes in mothers’ and babies’ diets, and increased disinfection, which reduces exposure to ‘good’ bacteria and therefore prevents the immune system from developing immunity. In Australia in particular, increasing levels of vitamin D deficiency have been linked to food allergies in children.
NACE has partnered with 10 children’s hospitals across five Australian states to launch the first rollout of the ADAPT OIT program. The program aims to use OIT to safely build children’s tolerance to peanuts and hopefully achieve remission, rather than requiring them to strictly avoid the problem food. If successful, the program will likely be expanded to more hospitals and specialty clinics.
The ADAPT OIT Program, funded by the Federal Government, is offered free of charge to children under one year of age who have been diagnosed with a peanut allergy and are receiving care from an allergist at one of the participating hospitals. Over a two-year period, they will follow a carefully planned daily dosing schedule of peanut powder taken at home and regular visits to a hospital allergy clinic.
While peanut OIT has been shown to be safe, while in the program, children are prescribed an action plan to deal with anaphylaxis (a severe, life-threatening allergic reaction) and are given an adrenaline (epinephrine) syringe. And parents are given a comprehensive education package and access to an allergist on call at their hospital.
“In this Australia-wide model, a food allergy test at the end of treatment will help determine whether remission has been achieved,” Perrett said. “These children will then be followed in routine clinical care for at least 12 months to help us assess acceptability, safety and efficacy, quality of life and long-term outcomes. Ultimately, we want to change the course of allergic disease in Australia so that more children can go to school without the risk of a life-threatening peanut reaction.”
Parents who enroll their children in the program should note that OIT will not cure a peanut allergy, may not be appropriate for everyone, and requires a long-term commitment.
“Treatment for OIT takes time, and this program requires a long-term commitment from families to give their children daily doses of peanut powder at home and to make regular visits to the hospital allergy clinic,” says Dr. Tim Brettig, a pediatric allergist and immunologist and medical leader of the ADAPT OIT Program. “It’s important to remember that OIT is not a cure, but following treatment can increase the chance of being able to safely eat a particular food allergen, such as peanuts.”
Australian parents who suspect their child has a peanut allergy should first visit their GP who can refer their child to an allergist at one of the hospitals participating in the ADAPT OIT Program. Then, once the allergy has been confirmed and the child is eligible, they can be enrolled in a treatment programme.
Source: NACE