From the Guidelines
The primary treatment for peanut allergy is strict avoidance of peanuts and peanut-containing products, along with preparedness for emergency treatment with epinephrine in case of reactions. Individuals with peanut allergies should carry emergency medication, specifically epinephrine auto-injectors, at all times 1. For anaphylactic reactions, the standard dose is 0.3mg for adults and 0.15mg for children, injected into the outer thigh muscle, which can be repeated after 5-15 minutes if symptoms persist. Antihistamines like diphenhydramine (Benadryl) can help with mild symptoms but should not replace epinephrine for severe reactions.
Key Considerations
- For long-term management, oral immunotherapy (OIT) may be an option, which involves gradually introducing small amounts of peanut protein under medical supervision to build tolerance 1.
- A FDA-approved product called Palforzia is available for children ages 4-17, following a specific dosing protocol that increases gradually over months 1.
- Peanut allergies trigger an immune response where the body produces IgE antibodies that react to peanut proteins, causing symptoms ranging from mild skin reactions to life-threatening anaphylaxis.
Prevention and Introduction
- Introduction of peanuts to infants at a young age, around 4-6 months, may help prevent peanut allergy, especially in those with severe eczema and/or egg allergy 1.
- Peanut-specific immunoglobulin E should be measured or a skin prick test performed before introducing peanuts in high-risk groups 1.
- Proper education about reading food labels, communicating with restaurants, and having an emergency action plan is essential for managing this condition.
Treatment Overview
- The most effective approach to managing peanut allergy involves a combination of avoidance, emergency preparedness, and potentially, oral immunotherapy.
- Patients on Palforzia must continue with strict peanut avoidance and continue daily dosing to maintain protection 1.
From the FDA Drug Label
1 INDICATIONS & USAGE Adrenalin® is available as a single-use 1 mL vial and a multiple-use 30 mL vial for intramuscular and subcutaneous use. Emergency treatment of allergic reactions (Type I), including anaphylaxis, which may result from allergic reactions to insect stings, biting insects, foods, drugs, sera, diagnostic testing substances and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis.
The treatment for peanut allergy involves emergency treatment of allergic reactions, including anaphylaxis, with epinephrine (IM), such as Adrenalin® 2.
- The signs and symptoms of anaphylaxis that may result from a peanut allergy include:
- Flushing
- Apprehension
- Syncope
- Tachycardia
- Thready or unobtainable pulse associated with hypotension
- Convulsions
- Vomiting
- Diarrhea and abdominal cramps
- Involuntary voiding
- Airway swelling
- Laryngospasm
- Bronchospasm
- Pruritus
- Urticaria or angioedema
- Swelling of the eyelids, lips, and tongue
From the Research
Overview of Peanut Allergy Treatment
The treatment for peanut allergy primarily involves avoiding peanuts and peanut-containing foods, as well as being prepared to administer emergency medication, such as adrenaline, in case of accidental exposure 3.
Current Management and Challenges
Current management of peanut allergy is centered around meticulous avoidance of peanuts and the use of emergency medication when needed 4. However, this approach can impose a significant burden on patients and their families, including high healthcare utilization and economic costs, restrictions on daily activities, and a reduced health-related quality of life 3.
Oral Immunotherapy (OIT) as a Potential Treatment
Oral immunotherapy (OIT) has been explored as a potential treatment for peanut allergy, aiming to induce desensitization and tolerance to peanuts 4, 5, 6. Studies have shown that OIT can result in desensitization in children and adults, with an increase in the threshold dose of peanut allergen required to trigger a reaction 4, 5. However, OIT is associated with a risk of adverse events, although most are mild 4, 5.
Other Approaches for Mitigation
Other approaches for mitigating peanut allergy include the development of hypoallergenic peanut products and novel processing techniques, such as high-pressure processing, pulsed ultraviolet light, and enzymatic hydrolysis, which can reduce the immunoreactivity of peanuts 7.
Key Considerations
Key considerations in the treatment of peanut allergy include the risk of accidental exposure, the severity of reactions, and the potential for anaphylaxis 3. Education and informed shared decision-making between patients and healthcare providers are essential in optimizing treatment regimens and improving quality of life for individuals with peanut allergy 6.
Treatment Outcomes and Adverse Reactions
Studies have reported varying outcomes and adverse reaction rates for OIT, with some showing significant increases in the dose of peanut protein tolerated and others reporting mild to severe adverse reactions 4, 5, 6.
Future Directions
Future research will focus on identifying optimal OIT regimens, maintaining protection after therapy, and allowing for regular food consumption without allergic symptoms 6. Additionally, the development of new therapies, such as Palforzia, which was approved by the US FDA in 2020, may offer new treatment options for individuals with peanut allergy 6.