Allergies, Author Interviews, NEJM, Pediatrics / 11.02.2025
Mount Sinai Study Emphasizes Importance of Personalizing Peanut Allergy Immunotherapy in Children
Editor's note: Do not attempt immunotherapy for peanut or other allergens without the express direction of your health care provider. Life-threatening reactions may occur.
MedicalResearch.com Interview with:
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Dr. Sicherer[/caption]
Scott H. Sicherer, MD
Elliot and Roslyn Jaffe Professor of Pediatrics, Allergy and Immunology
Director, Jaffe Food Allergy Institute
Division Chief, Pediatric Allergy
Medical Director, Clinical Research Unit
Icahn School of Medicine at Mount Sinai
Jack and Lucy Clark Department of Pediatrics
Mount Sinai Kravis Children’s Hospital
New York, NY 10029
MedicalResearch.com: What is the background for this study?
Response: About 2% of people have a peanut allergy. While many of them are exquisitely allergic to tiny amounts, about half can tolerate a half a peanut kernel or more before they have symptoms, although the symptoms can be severe.
Current studies and FDA approved treatments for peanut allergy have typically focused on people reacting to about half a peanut or less. We thought that those with higher threshold may be more easily treated.
We focused on children ages 4-14 years who we identified through a medically supervised feeding test as having allergic reactions from 443 to 5043 mg of peanut protein. A peanut kernel is about 250 mg of peanut protein. The 73 children were randomized to a treatment (oral immunotherapy, OIT) using home-measured, store bought peanut butter versus continuing the standard of care, avoidance. OIT involves medically supervised dosing going from a small amount to gradually increasing larger amounts. The increases are done under direct allergist supervision, then the tolerated dose is taken at home daily. Families are given instructions about avoiding things that can cause a reaction from dosing, such as exercise after a dose, and to skip dosing for illness. Dosing can cause reactions and they were instructed on how to recognize and treat any such reactions. We did increases every 2 months.
Most of the children (62) stayed in the study to be tested after the period of treatment, that aimed for having a level tablespoon of peanut butter each day. All of the treated children who completed testing (32) were able to eat 9 grams of peanut. Only 3 of 30 who continued to avoid peanut were able to do this.
Dr. Sicherer[/caption]
Scott H. Sicherer, MD
Elliot and Roslyn Jaffe Professor of Pediatrics, Allergy and Immunology
Director, Jaffe Food Allergy Institute
Division Chief, Pediatric Allergy
Medical Director, Clinical Research Unit
Icahn School of Medicine at Mount Sinai
Jack and Lucy Clark Department of Pediatrics
Mount Sinai Kravis Children’s Hospital
New York, NY 10029
MedicalResearch.com: What is the background for this study?
Response: About 2% of people have a peanut allergy. While many of them are exquisitely allergic to tiny amounts, about half can tolerate a half a peanut kernel or more before they have symptoms, although the symptoms can be severe.
Current studies and FDA approved treatments for peanut allergy have typically focused on people reacting to about half a peanut or less. We thought that those with higher threshold may be more easily treated.
We focused on children ages 4-14 years who we identified through a medically supervised feeding test as having allergic reactions from 443 to 5043 mg of peanut protein. A peanut kernel is about 250 mg of peanut protein. The 73 children were randomized to a treatment (oral immunotherapy, OIT) using home-measured, store bought peanut butter versus continuing the standard of care, avoidance. OIT involves medically supervised dosing going from a small amount to gradually increasing larger amounts. The increases are done under direct allergist supervision, then the tolerated dose is taken at home daily. Families are given instructions about avoiding things that can cause a reaction from dosing, such as exercise after a dose, and to skip dosing for illness. Dosing can cause reactions and they were instructed on how to recognize and treat any such reactions. We did increases every 2 months.
Most of the children (62) stayed in the study to be tested after the period of treatment, that aimed for having a level tablespoon of peanut butter each day. All of the treated children who completed testing (32) were able to eat 9 grams of peanut. Only 3 of 30 who continued to avoid peanut were able to do this.
The reaction triggers the symptoms you recognize as your allergy, such as a runny nose and itchy eyes. 
Dr. Greenhawt[/caption]
Matthew Greenhawt, MD, MBA, MSc
Professor of Pediatrics
Section of Allergy and Immunology
Director, Food Challenge and Research Unit
Children’s Hospital Colorado
University of Colorado School of Medicine
Anschutz Medical Campus
Dr. Soriano[/caption]
Victoria Soriano PhD
Research Assistant/Officer, Population Allergy
University of Melbourne
MedicalResearch.com: What is the background for this study?
Response: Peanut allergy is one of the most common childhood food allergies, and children rarely grow out of it. The only proven way to prevent peanut allergy is to give infants age-appropriate peanut products in the first year of life.
We previously showed there was a dramatic increase in peanut introduction from 2007-11 to 2018-19, following changes to infant feeding guidelines. We wanted to know if earlier peanut introduction would reduce peanut allergy in the general population (in Melbourne, Australia).
Dr. Woodruff[/caption]
Carina M. Woodruff, MD
Department of Dermatolog
University of California, San Francisco
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Rigorous hand hygiene has been an important component of the CDC's COVID-19 guidelines. With millions of Americans now using hand sanitizers regularly, we are seeing many more cases of hand dermatitis. Our study evaluated the key product features and most common allergens in the top-reviewed, commercial hand sanitizers sold by major US retailers.
We found that the most common potential allergens were tocopherol, fragrance, propylene glycol and phenoxyethanol. Our study also showed that nearly 1 in 5 marketing claims on these products was misleading. For example, 70% of sanitizers with the marketing claim "hypoallergenic" included at least one common allergen in its formulation.
Dr. Blumenthal[/caption]
Kimberly G. Blumenthal, MD, MSc
Massachusetts General Hospital
The Mongan Institute
Boston, MA 02114
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Dr. Krantz[/caption]
Matthew S. Krantz, MD
Division of Allergy, Pulmonary and Critical Care Medicine
Department of Medicine,
Vanderbilt University Medical Center,
Nashville, Tennessee
MedicalResearch.com: What is the background for this study?
Response: During the initial COVID-19 vaccine campaign with healthcare workers in December 2020, there was an unexpected higher than anticipated rate of immediate allergic reactions after Pfizer and Moderna mRNA vaccines. This prompted both patient and provider concerns, particularly in those with underlying allergic histories, on the associated risks for immediate allergic reactions with the mRNA vaccines.
Because of the significantly improved effectiveness of two doses of an mRNA vaccine compared to one dose, it was important to determine if those who experienced immediate allergic reaction symptoms after their first dose could go on to tolerate a second dose safely.