Increasing the threshold for peanut immunotherapy increases patient safety: A discussion with Dr. Joe Baumert

By John J. Murphy, MDLinx
Published July 21, 2017

Key Takeaways

Background
Immunotherapy studies aim to decrease sensitivity to an allergen, with an end goal of increasing an individual’s threshold for an allergic response. Researchers know that an immunotherapy trial can certainly increase the allergic threshold in those patients who respond to treatment, but what they don’t know is the actual threshold that provides a clinically-relevant outcome.

To that end, food allergy researchers sought to quantify the clinical benefit of increasing the threshold for peanut-allergic patients. "Quantitative risk modeling ... is needed to describe exposure doses of peanut protein that peanut-allergic consumers may encounter," they explained in a recent study in The Journal of Allergy and Clinical Immunology: In Practice. For this investigation, the researchers performed risk assessment studies using food consumption data combined with information on the amount of peanut content in matching food products. As a result, they were able to quantify specific, clinically-relevant thresholds for peanut immunotherapy.

In this interview, Joe Baumert, PhD, lead investigator of the study and Co-Director of the Food Allergy Research & Resource Program at the University of Nebraska-Lincoln, explains what the clinically-relevant thresholds are, and how this information can help people with a peanut allergy to decrease their risk for a reaction.

MDLinx: What was the reason for undertaking this study?

Dr. Baumert: Several clinical immunotherapy studies that are currently ongoing aim to increase the threshold to which peanut-allergic consumers react. This is commonly referred to as desensitization. So far, it was unknown what threshold level should be achieved to have a clinically relevant benefit from therapy.

MDLinx: Why is it necessary to measure the threshold of an allergic reaction?

Dr. Baumert: The threshold of a peanut-allergic consumer provides insight in this person's sensitivity for peanut.

MDLinx: For a person with a peanut allergy, what is a "safe" threshold for ingesting peanut?

Dr. Baumert: From our quantitative risk assessment study described in this publication, we conclude that reaching a threshold of 300 mg peanut protein provides a very strong reduction of risk–more than 95%–in experiencing a reaction to peanut protein residue that may occasionally be present in packaged foods such as cookies, ice cream, doughnuts, snack cakes, and snack chips. Further increasing to an individual threshold of 1,000 mg peanut protein provides some additional risk reduction.

MDLinx: Why did you include cookies, ice cream, snack cakes, etc., in your analysis?

Dr. Baumert: Packaged food products are not commonly contaminated with peanut; however, based on information from the FDA Reportable Food Registry, food product recalls, and analytical surveys of packaged food products, it has been reported that these product categories have a greater chance to be contaminated with food allergens such as peanut.

MDLinx: Why are people starting to ignore warnings on product labels such as "May Contain Peanut" or "Processed in a Facility that Also Processes Peanut"?

Dr. Baumert: The proliferation, inconsistent use, and lack of transparency associated with precautionary allergen labeling has led to confusion among allergic individuals and the clinicians who advise them on managing their food allergies. As a result, consumers are making their own decisions regarding whether or not to eat foods that have precautionary statements based on which terms they believe convey more risk than others. However, this practice does pose a risk to allergic consumers as studies have shown that the level of risk associated with various precautionary statements does not correlate to the type of statement used on the packaged food product.

MDLinx: Is the ultimate goal of the study to help people eat products that contain peanuts?

Dr. Baumert: The greatest concern of peanut-allergic consumers and their caregivers is reactions due to traces of peanut that are difficult to avoid in daily life, such as contamination of food products with peanut. This study provides quantitative information on the benefit of increasing one's threshold to peanuts, which in turn provides an additional margin of safety if a peanut-allergic individual happened to consume a product that contains peanut residue due to contamination during processing or preparation of the food.

Many peanut-allergic individuals can successfully become desensitized to peanuts, which does have a profound benefit to increasing the safety of peanut-allergic individuals as discussed in the study. However, not all peanut-allergic individuals may be able to consume products that contain peanuts as an ingredient, so they must remain diligent in their avoidance diets.

MDLinx: To your knowledge, what is the latest word on prevention of peanut allergy (eg, introducing peanut during infancy, per new guidelines from the National Institute of Allergy and Infectious Diseases)?

Dr. Baumert: These are promising new developments that may be beneficial for certain at-risk children; however, this will not help patients who are already peanut allergic. Immunotherapy studies provide the most promising advancement in increasing the safety for those who already have a peanut allergy.

About Dr. Baumert:Joe Baumert, PhD, is an Associate Professor in the Department of Food Science & Technology and is the Co-Director of the Food Allergy Research & Resource Program at the University of Nebraska-Lincoln.

This study was supported in part by DBV Technologies (manufacturer of the Viaskin® immunotherapy patch) and the University of Nebraska Food Allergy Research & Resource Program (a research venture between the University of Nebraska and a consortium of 90 food industry companies).

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