Understanding Why Some Children Successfully Tolerate Peanut Allergy Desensitization

Peanut allergy remains one of the most prevalent and potentially severe food allergies affecting children worldwide. Even minimal exposure to peanut proteins can trigger reactions ranging from mild itching and swelling to life-threatening anaphylaxis. Traditionally, the primary approach has been strict avoidance, which is challenging due to the prevalence of peanut traces in many foods and the constant need for emergency medication.

Recently, oral immunotherapy (OIT) has emerged as a promising treatment, involving gradual exposure to increasing amounts of peanut allergen to build tolerance. However, not all children respond equally well; some achieve desensitization, while others experience adverse reactions, including severe allergic episodes.

A recent study published in the journal Allergy sheds light on the reasons behind these different responses. Led by Young-Ae Lee from the Max Delbrück Center for Molecular Medicine and in collaboration with Kirsten Beyer from Charité—Universitätsmedizin Berlin, the research investigates the molecular and immune factors influencing treatment outcomes. The study was spearheaded by Dr. Aleix Arnau-Soler.

The research team analyzed blood samples from 38 children undergoing peanut desensitization therapy. They measured levels of allergy-related antibodies and inflammatory cytokines before and after treatment. The findings revealed that children who responded well to therapy initially had a less reactive immune system, characterized by lower immunoglobulin and cytokine levels. Furthermore, genetic and epigenetic differences, particularly in immune cells primarily found in the gut, played a role in treatment success. These cells included specialized T cells and innate immune cells involved in body's initial defense.

Importantly, the study identified potential biomarkers—such as specific gene expression patterns and DNA methylation profiles—that could predict which children are more likely to benefit from desensitization and which are at greater risk of adverse reactions. This opens avenues for personalized treatment strategies, tailoring the therapy's duration and allergen dose to each child's immune profile.

The research team plans to validate these findings further, aiming to develop a simple blood test that can predict individual responses. Such tools could make peanut allergy treatment safer, more effective, and less daunting for families.

Ultimately, this research indicates that gut-associated immune cells and molecular markers are critical factors in determining treatment outcomes. A better understanding of these mechanisms paves the way for more personalized and secure allergy therapies, reducing the health and emotional burden faced by children with peanut allergies.

Source: Medical Xpress