In a world-first national approach to treating babies aged 0-12 months with a peanut allergy, 10 paediatric hospitals across five states have introduced a peanut oral immunotherapy (OIT) program.

The aim is to safely raise young children’s peanut tolerance threshold, explains paediatric allergist and immunologist Dr Tim Brettig, Program Medical Lead. Currently most peanut allergy management involves complete avoidance, so this represents a major shift.

The program, dubbed ADAPT OIT, is free for families and coordinated and funded through the National Allergy Centre of Excellence (NACE).

How it works

Eligible babies first complete a food challenge at the hospital to confirm the allergy. Then they are given a very small dose of peanut powder under supervision and, if tolerated, continue taking that dose at home each day for one month.

All going well, the dose will be gradually increased over about six months.

“It’ll be slightly different for each child because it’s individualised,” Dr Brettig says. “But we’re building up that dose very slowly to get to a maintenance dose.”

Treatment lasts about two years overall, then children complete a standard peanut food challenge to determine where their threshold is.

“In some instances that threshold might get quite high, such that they can eat peanuts freely in their diet,” he says. “Whereas for others, it may get them to a level where the risk of a reaction from accidental exposure significantly reduces.”

Families will receive support from the hospital allergy department throughout the program, Dr Brettig says, “because we understand this is tricky.”

“They’re going to be very closely followed by these hospitals, as far as a lot of education about when or when not to give a dose, how to monitor, how to identify and manage allergic reactions.”

Children on the program are prescribed an Australasian Society of Clinical Immunology and Allergy (ASCIA) Action Plan for Anaphylaxis and an adrenaline injector and have access to an on-call allergist.

While oral immunotherapy is not new, this is the first oral immunotherapy program in the world to take a coordinated national approach.

Hospitals taking part in the program

• Victoria – The Royal Children’s Hospital
• Western Australia – Perth Children’s Hospital and Fiona Stanley Hospital
• Queensland – Queensland Children’s Hospital
• South Australia – Women’s and Children’s Health Network
• New South Wales – Sydney Children’s Hospital, Randwick; The Children’s Hospital at Westmead; John Hunter Children’s Hospital, Newcastle; Campbelltown Hospital; Royal Prince Alfred Hospital, Camperdown.

Referring patients into the program

GP referral will be the entry point for most families, Dr Brettig says.

You can refer them directly to participating services, clearly stating the child’s age (they must be under 12 months old) and that they have a suspected peanut allergy.

“Participating sites have agreed to prioritise these patients to get them through and get them assessed,” Dr Brettig says.

An allergist will see them to confirm the allergy and discuss with the family whether the program is right for them.

The hospital will also look after any queries or issues related to the program, Dr Brettig adds.

“GPs shouldn’t feel like they’re needing to solve the problems for those on treatment; they should be advising them to contact their hospital allergy department.”

Patients can find more information on the NACE website.

Evaluation for safety and effectiveness

The program is a standard of care rather than a clinical trial, but a team from NACE will evaluate it.

“We’re going to follow these patients through and look at the outcomes, so particularly looking at safety data, looking at quality of life on families, looking at effectiveness… so how easy is it to complete the program? And obviously then long-term outcomes for the participants,” Dr Brettig says.

Depending on results, the approach may be applied to other allergies or age groups.

“There’s research internationally that says this is a reasonable approach for children with peanut and egg or milk allergies,” Dr Brettig explains.

“We chose peanut to start with because it’s one of the most common food allergies, but also one of the ones that is most likely to be persistent. So only 30% will outgrow that naturally,” he says.

“And the idea is that if we can build that evidence to say this is a feasible way of doing it, we can either improve on that or we can look at broadening that. So that may involve other foods, it could involve different age group, but they’re things more for the future as it gets rolling.”

More information:

NACE | National ADAPT OIT Program and NACE Evaluation Study