Boiled peanut has reduced Ara h 2, 6 and 7 compared with roasted and raw peanut and the potential for reduced allergenicity.
The reason I am focusing on this particular kind of immunotherapy is that I intend to start soon in my Allergy Service.
Peanut allergic children underwent oral immunotherapy (OIT) to peanut using daily boiled peanut, with increasing dose and decreased boiling time over a 6 month period.
These children were predominantly sensitised to Ara h 2.
Once tolerating 8 boiled peanuts, they were transitioned to whole roasted‐peanut OIT.
A 4 weekly updosing schedule with roasted‐peanut OIT was undertaken, and children were monitored for any allergic side effects and need for rescue medication.
All children successfully transitioned from 8 boiled peanut (boiled for 30 min) to whole roasted peanut (commencing at 1/2 roasted peanut (220 mg peanut protein) following a successful open challenge to at least one whole roasted peanut (440 mg).
24/32 participants achieved the primary outcome of desensitisation to >1.4g peanut protein; of those 14 tolerated >4.4g peanut protein. 13/24 participants achieved 4-SU (4 weeks of sustained unresponsiveness).
Participants underwent repeat DBPCFC (Double-blind placebo controlled food challenge) at 12 months to assess response, following which peanut OIT was stopped, and sustained unresponsiveness was assessed after 4 weeks.
There were 17 cases of anaphylaxis in 9 patients while taking their doses at home. Currently, there are other 2 methods of peanut immunotherapy.
I will discuss them at some point if anyone is interested.