Project Details

Achieving Remission of Peanut Allergy with Oral Immunotherapy: a head-to-head randomized trial

Mimi Tang, MBBS, PhD

Summary

There is an urgent unmet need to find an effective treatment for peanut allergy. Currently, management relies on food avoidance, which frequently fails. The unrelenting vigilance of avoidance and unpredictability of serious reactions cause severely reduced quality of life and psychological distress for patients and families. In 2020/2021, the first food allergy treatment, Palforzia, was approved in the US, EU and UK. Palforzia is a low-dose peanut oral immunotherapy (OIT) that desensitises patients i.e. protects against accidental exposure to small amounts of peanut. However, major drawbacks are that treatment causes frequent reactions, must be continued indefinitely, and does not improve quality of life compared with placebo therapy. Patients, physicians, and policy makers have called for a safer treatment that induces remission of allergy, which allows children to stop treatment, eat peanut freely and have improved quality of life. Our team has shown that a high-dose rapid escalation peanut OIT induces remission of peanut allergy in ~50% of patients and significantly improves quality of life. This randomised trial will compare the effectiveness of our high-dose rapid escalation peanut OIT with the Palforzia low-dose OIT regimen at inducing remission of peanut allergy in children aged 1-10 years. Secondary aims are to examine quality of life benefits and cost-effectiveness of these interventions.