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The first clinical trial to test whether adults with peanut allergies can be desensitized has shown great success—with two-thirds of participants able to consume the equivalent of five peanuts at the end of the study without reacting.

Known as oral immunotherapy, the approach has been successful in infants and children worldwide, but this first-of-its-kind study—the Grown Up Peanut Immunotherapy trial—shows adults can benefit too.

“The only way to manage a peanut allergy is strict avoidance,” said Chief Investigator Professor Stephen Till, Professor of Allergy at King’s College London. “Constant fear of life-threatening reactions places a huge burden on people with peanut allergy.”

The team tested whether daily doses of peanuts taken under strict supervision can be safely tolerated—and, in fact, the average tolerated dose of peanuts increased 100-fold over the course of the trial.

The Phase II trial, published this week in the journal Allergy, recruited 21 adults between 18 and 40 with a clinical diagnosis of peanut allergy confirmed via skin prick test and blood test.

In a clinical setting, the research team from King’s College London and ‘Guy’s and St Thomas’ NHS Foundation Trust’ gave the participants an introductory dose of 0.8mg of peanut flour mixed with food, then 1.5 mg 30 minutes later, followed by 3mg a further 30 minutes later.

Participants who tolerated 1.5mg or 3mg of peanut flour continued on a daily dose at home for 2 weeks—the equivalent of around 1% of an entire peanut. Then participants returned at 2-weekly intervals for supervised doses of more peanut protein, increasing from 6mg to 1 gram (four whole peanuts). If participants could tolerate 50-100mg of peanut protein, they were switched to eating whole peanuts or peanut products.

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Once participants achieved a daily dose of 1 gram they remained on this dose for four weeks before undergoing a double‐blind placebo‐controlled food challenge. This involved being given increasing doses of either peanut or placebo (dummy) on separate days under close supervision to test their tolerance. Participants then continued daily dosing for at least three months before exiting the trial.

Results showed that 67% of participants were able to consume at least the equivalent of five peanuts without reacting. They then could consume peanuts every day at home to remain desensitized.

“Many participants who completed the trial told us that the treatment had been life-changing and they were no longer living in fear,” said the lead author, Allergy Dietitian Hannah Hunter with the Trust.

Chris jumped at the chance to take part in the trial, 28 years after being diagnosed with a peanut allergy as a baby.

“I’m so happy to say that I used to be allergic to peanuts but thanks to this trial, this is no longer a concern. All of my life I had associated the taste and smell of peanuts with fear and death. Now, I have four peanuts every day with my breakfast to maintain my immunity.

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“Previously, a tiny mistake could have life-threatening impacts but now I don’t have the fear that I might collapse and die from eating a takeaway food.”

“We are very pleased with the results,” said Professor Till. “The efficacy rate is broadly in line with peanut oral immunotherapy trials in children.”

“Everyday situations such as eating in restaurants and social events are anxiety–provoking,” said study author Hunter in the team’s press release. “The condition also affects travel choices and career options. We found that quality of life significantly improved after oral immunotherapy.”

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The next stage of the research will be confirming this in larger trials and seeing whether it can lead to long-term tolerance in this age group.

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