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Health and Disease

OIT for Peanut Allergies

Food allergies. They’re a simple annoyance that you have to constantly worry about. There’s a likely chance that someone you’ve come across or even yourself have an allergy whether life-threatening or a micro level reaction that will only cause a rash at most. That’s where OIT comes in. This article focuses on the OIT for peanut allergies approved by the FDA on January 31, 2020.

Introduction

You felt a feeling of discomfort on your skin.  Not only could you feel your face itch increasing by the minute, but you could also feel a tightness around your throat. This is one of the results of a food allergy. Peanut allergies are responsible for allergies more than others as it tends to be the main propagator of life threatening reactions such as anaphylaxis. Since peanuts have ubiquitous uses, the FDA approved the existence of Palforzia, a product designed to mitigate the reactions caused by the peanut allergens. 

Peanut Allergies

Peanut allergies affect approximately 1 million children in the U.S. and are one of the primary food allergies associated with anaphylaxis [5]. The main symptoms of a peanut allergy are not confined to itching, swelling of the skin, redness, tightening of the throat, and anaphylaxis[1]. These symptoms can be caused by multiple forms of contact such as direct contact, wherein the person may have accidentally ingested the peanut allergen or had physical contact with it on the skin[1]. Another type of contact involves accidentally inhaling dust or aerosols containing peanuts[1]. The immune system responds to an allergy by recognizing the harmless substances as something harmful. On a molecular level, the T helper cell is responsible for initiating the peanut allergy response, which is different from the ones of individuals who don’t have peanut allergies [2]. T helper cells for those without peanut allergies produce IFN-y and IL-10, which results in the toleration of peanut allergens, while the T helper cells of those with peanut allergies are deprived of this function as such leaving the individual with an IgE-mediated type I hypersensitivity reaction[2,3].

Oral Immunotherapy Treatment (OIT)

To tackle the extreme peanut allergen responses, an immunotherapy called Oral Immunotherapy Treatment or OIT was developed. OIT lessens the immune response to food allergies by building a level of tolerance to allergens[4]. It is beneficial as it may then lower the risk of anaphylaxis. The procedure of OIT begins with the consumption of peanut allergens closely observed by health professionals[4]. Later on, the same dosage is sent home to be taken for two weeks on a daily schedule. This creates a system in which the person participating in the treatment consistently repeats the in-office and at home dosage use[4].  

On January 31, 2020, the FDA approved Palforzia, a peanut powder type of treatment that consists of three total phases[5]. The first stage is called the Initial Dose Escalation phase wherein it is administered in just one day[5]. The second stage occurs over several months but unlike the first phase, it increases by 11 dose levels over that time[5]. The last stage involves management which is a daily maintenance dose[5]. Palforzia consists of capsules for the first two stages and a satchel for the third[5]. As for the consumption of powder, it is taken out of the capsule and/or satchel and mixed into a semisolid[5]. 

Conclusion

Peanut allergens are one of the primary reasons for life-threatening responses for many Americans, driving the need for finding a definite treatment for managing these allergy responses. Palforzia helps to reduce that risk and although Palforzia is not the first of its kind, as an OIT, it is one step closer to helping those at risk of peanut allergies live better and healthier lives. 

Diana Manzanes, Youth Medical Journal 2021


References

[1]“Peanut Allergy – Symptoms and Causes.” Mayo Clinic,  , 2020, http://www.mayoclinic.org/diseases-conditions/peanut-allergy/symptoms-causes/syc-20376175#:~:text=An%20allergic%20response%20to%20peanuts,stomach%20cramps%2C%20nausea%20or%20vomiting. Accessed 2 Jan. 2021.

[2]Shah, Faisal, et al. “Peanut Allergy: Characteristics and Approaches for Mitigation.” Comprehensive Reviews in Food Science and Food Safety, vol. 18, no. 5, 25 June 2019, pp. 1361–1387, onlinelibrary.wiley.com/doi/full/10.1111/1541-4337.12472, 10.1111/1541-4337.12472. Accessed 2 Jan. 2021.

[3]‌Al-Muhsen, Saleh, et al. “Peanut Allergy: An Overview.” CMAJ : Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, vol. 168, no. 10, 2003, pp. 1279–85, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC154188/. Accessed 2 Jan. 2021.

[4]“New FDA-Approved Oral Immunotherapy Marks Important Milestone in Peanut Allergy Management | Norwalk.” Westernconnecticuthealthnetwork.org, 3 Feb. 2020, http://www.westernconnecticuthealthnetwork.org/newsroom/article-listing/peanut-allergy-treatment. Accessed 2 Jan. 2021.

[5]‌Office of the Commissioner. “FDA Approves First Drug for Treatment of Peanut Allergy for Children.” U.S. Food and Drug Administration, 2020, http://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-treatment-peanut-allergy-children. Accessed 2 Jan. 2021.‌

By Diana Manzanes

Diana Manzanes is a student in The Delta High School in Pasco, Washington. Her current interest is in the field of aerospace engineering.

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