A Combination Of Probiotics And Immunotherapy Could Overcome Lethal Peanut Allergy

• New research suggests coupling probiotic bacteria with ingestion of tiny doses of peanut could help the vast majority of children deal with food allergies.
• The technique however is not a cure for peanut allergy !

A new study published in The Lancet Child & Adolescent Health journal reports on an immune-based therapy with probiotics and that allowed children allergic to peanuts to eat them without reaction for four years. No cure was mentioned or intended but the method is seen as a way of allowing children to manage what is a serious allergy. The study shows that tolerance to the peanut allergens was significantly improved and allowed the children to retain this immunity.

Peanut allergies are debilitating and can often provoke such a serious immune reaction that death follows. Peanuts as with many nuts possess molecular markers which stimulate the immune system to respond in a manner which is virtually described as anaphylactic shock. As with any allergy, the care required to exclude them can be extreme. Schools are often excluding them from meals and friends are prevented from certain social interactions if the allergen is likely to be passed around.

The examined technique relied on increasing doses of peanuts along with the probiotic to develop and literally train the immune systems of the children so they did not reject the nuts. They began to accept the peanut allergen as any person not allergic would. The approach signifies a shift in techniques for managing allergies and a way to educate the gut to accept and tolerate foods which were previously seen as a risk.

The use of the probiotic which are considered ‘good’ bacteria was thought to help modify the digestive system, especially the immunity that develops. It also suppresses other bacteria and can literally replace them in many instances. They are often consumed by those needing to replace gut flora and fauna after heavy doses of chemotherapy, illness and antibiotic treatment.

The study was conducted with the support of various institutes and groups in Melbourne, Australia. The objective was to assess long-term outcomes in children who completed a randomised, double-blind, placebo-controlled
trial of combined probiotic and peanut oral immunotherapy (PPOIT).

Fifty-six children with a recognised peanut allergy were involved in the study. These were divided into two groups. One group was given a placebo whilst the other group received the probiotic, a bacteria called Lactobacillus rhamnosus as well as carefully controlled doses of the peanut protein. The time period of dosing was 18 months.

Following the treatment period, there was a 1 month rest period when the probiotic group were given peanuts to see an allergenic reaction occurred. The study found 82 per cent of those children receiving the combination therapy had no immune reaction to these peanuts. This compared to 4 per cent of children who showed a similar level of improvement in tolerance to peanuts. The researchers then returned to the same children four years later to examine whether the therapy wa still producing the same level of protection. These children were asked to stop eating peanuts for eight weeks and then rechecked for allergenic reactions. of the twelve chosen from the original study, seven remained allergen free.

Clearly, larger scale studies with more children are needed to allow the possibility to explore variations in the technique to quell the immune reaction. A number of factors are involved in an immune response and it would be interesting to know how the probiotic might be affecting the gut’s reaction given the level of understanding available on these micro-organisms. It has long been speculated that shifts in gut microflora and fauna are at the heart of the increasing allergen issues afflicting children as is clean and more sanitised processing. The speculation has led to the development of the hygiene hypothesis which marries the nature of foods with the environment and allergenic responses including asthma and gut allergy. Young children and babies not exposed to a variety of infectious agents and micro-organisms simply do not have the capacity to develop an immune response to them or even possess those organisms which could be beneficial in their guts. Their vulnerability to allergens has been thought to rise as a result of this lack of exposure so early on. The other aspect is that allergenic reactions have risen amongst the young of industrialised societies where food hygiene is much more regulated and practised.

The current guidelines on managing allergens in the young have also been adjusted to reflect new thinking. The National Institute of Allergy and Infectious Diseases which is part of the NIH (USA) does not recommend that pregnant mothers and babies should not be kept from being exposed to known and suspect allergens. Some allergy specialists advise parents to offer small amounts of peanut-containing foods as an extract or powder to their infants when they are as young as 4 to 6 months old. It allows the children’s immune system to grow up with the allergens and develop a tolerance to that food.

The final word is that the technique should not be viewed as a cure. There is still plenty of research needed to verify and make secure statistical inferences about the success of the method. A few leading allergen charities have reacted quite understandably with caution although their interest is piqued because of the increasing number of other studies involving probiotics that are coming to attention.

Reference

DOI: http://dx.doi.org/10.1016/S2352-4642(17)30041-X