Probiotics and peanut allergy: Mounting evidence points to positive impact of supplementation
Professor Mimi Tang and her colleagues from the Murdoch Children's Research Institute pioneered probiotic and peanut immunotherapy (PPOIT) treatment in order to try to combat the rising number of allergy cases, their impact on quality of life, and the burden it places on healthcare costs.
Speaking at the International Scientific Association of Probiotics and Prebiotics (ISAPP) conference in Singapore, Professor Tang detailed the findings of the original RCT in 2013 and the positive findings of a follow-up study published last year.
The initial RCT provided the probiotic Lactobacillus rhamnosus CGMCC 1.3724 and peanut oral immunotherapy — essentially small amounts of the allergen — (PPOIT) to allergic children aged one to 10.
The primary outcome was assessed to see if there was 'sustained unresponsiveness' to the allergy two to five weeks after the discontinuation of treatment.
At the end of the original trial in 2013, 82% of children who had received the PPOIT were deemed tolerant of peanuts.
The findings were published in the Journal of Allergy and Clinical Immunology and concluded: "This is the first randomised placebo-controlled trial evaluating the novel co-administration of a probiotic and peanut OIT, and assessing sustained unresponsiveness in children with a peanut allergy. PPOIT was effective in inducing possible sustained unresponsiveness and immune changes that suggest modulation of the peanut-specific immune response."
Professor Tang told the ISAPP conference that subjects' peanut intake and adverse reactions in the four years after treatment cessation were then systematically documented with a structured questionnaire administered by allergy nurses.
The study found that the majority of children who had gained initial tolerance were still eating peanuts as part of their normal diet (80% versus 4% in the placebo group) and that many had passed a further challenge test confirming long-term tolerance of the product (70%).
This led the researchers to conclude: "PPOIT provides long-lasting clinical benefits and persistent suppression of the allergic immune response to peanuts."
The team is now embarking on a third-phase multi-centre, RCT of PPOIT in inducing desensitisation or tolerance in children with peanut allergy, compared with OIT alone, and with placebo.
"Whereas in the past it was very much doom and gloom when it came to food allergies, we now have more options for treating children and should be aiming for sustained unresponsiveness or even tolerance," said Professor Tang.