Q&A: Australia first to introduce nationwide peanut oral immunotherapy program
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Key takeaways:
- Children in the program will follow a daily peanut powder dosing schedule for 2 years.
- This is the first program offered outside of a clinical trial setting in Australia.
The ADAPT OIT program builds peanut tolerance in babies with daily dosing of peanut powder administered by caregivers at home, according to a National Allergy Centre of Excellence and Murdoch Children’s Research Institute press release.
This is the first time a nationwide peanut oral immunotherapy program has been introduced into the mainstream, with program leaders hoping to transform allergy care globally, according to the release.
Healio spoke with Tim Brettig, PhD, ADAPT OIT program medical lead and Murdoch Children’s Research Institute (MCRI) senior research clinician, about the program and what it means for the future of peanut allergy.
Healio: What is the ADAPT OIT program, and how does it work?
Brettig: Sadly, Australia has the highest rate of childhood food allergy globally. There is no cure and — until now — no routinely available treatment.
The ADAPT OIT Program aims to change the way the most common food allergy among Australian school-aged children is treated, from strictly avoiding peanut in diets to safely building a tolerance to the allergen, and hopefully achieving remission.
Ten pediatric hospitals across five states have partnered with the National Allergy Centre of Excellence, hosted at MCRI, to introduce the first ever nationwide peanut oral immunotherapy program.
This means that babies with peanut allergies in Australia will be offered the treatment program as a new standardized model of care.
Healio: Who is eligible?
Brettig: The free program is only available to children aged younger than 12 months, diagnosed with peanut allergy, and who are receiving care by an allergist at one of the participating hospitals:
- The Royal Children’s Hospital in Victoria;
- Perth Children’s Hospital and Fiona Stanley Hospital in Western Australia;
- Queensland Children’s Hospital;
- Women’s and Children’s Health Network in South Australia; and
- Sydney Children’s Hospital, Randwick, The Children’s Hospital at Westmead, John Hunter Children’s Hospital Newcastle, Campbelltown Hospital and Royal Prince Alfred Hospital in New South Wales.
If families suspect their baby has a peanut allergy, the first step is to visit their general practitioner. The doctor may refer a baby to an allergist at one of the participating hospitals and, if their allergy is confirmed, the allergist will discuss the program will them.
Healio: What does the dosing/treatment look like in the program?
Brettig: Those eligible will follow a carefully planned daily dosing schedule of peanut powder, taken at home, over 2 years. Each family will also have regular appointments at the hospital allergy clinic.
While on the program, children are prescribed an Australasian Society of Clinical Immunology and Allergy Anaphylaxis Action Plan and adrenaline autoinjector. Families also receive a comprehensive education pack and have access to an allergist on-call at their hospital.
Healio: Can you tell us more about the methods and structure of the program?
Brettig: Patients who are diagnosed with their peanut allergy will be offered the program after a shared decision-making process between the clinician and the patient’s family. These patients will then undergo a supervised oral food challenge to confirm their allergy before starting the program. Changes in dose will be done under medical supervision at the hospital allergy clinic. The program duration is 2 years. Regular reviews will also occur throughout this time.
HealioHow is the program different from current early introduction methods?
Brettig: Australian guidelines recommend infants are introduced to common allergens, such as peanut in the form of peanut butter, in the first year of life. However, our research has shown that early introduction of peanut butter in the first year of life will not prevent all peanut allergy, and some children will experience reactions.
For those who do have a peanut allergy, this will be the first peanut allergy treatment program offered in Australian hospitals outside of a clinical trial setting.
Healio: What is the significance of the program being the first in the world to offer this kind of treatment?
Brettig: This is a world-first model aiming to transform allergy care.
OIT is implemented in several centers around the world using different approaches, which makes it difficult to assess the outcomes. By developing a national program, delivery of care can be improved with shared experience and the opportunity to evaluate several aspects of the program as it progresses.
The National Allergy Centre of Excellence will evaluate the safety and effectiveness of this Australia-wide program, as well as quality of life and long-term outcomes. The outcomes of this can help guide decision-making toward improvements in the program.
If successful, it’s hoped more hospitals and private allergy clinics will adopt the program, including in regional and remote areas. And, eventually, other common allergens and older age groups could be targeted.
Healio: How will the program bring early introduction into mainstream medicine?
Brettig: Public health messaging in Australia regarding early introduction of foods has been successful, as demonstrated in Australian population-based research studies since the introduction of the current guideline.
The ADAPT OIT program aims to intervene early after diagnosis of peanut allergy, focusing on an age group where both clinical outcomes and safety of a treatment program are likely to be optimal.
Healio: Do you have anything else you would like to add?
Brettig: It is important to remember that OIT is not a cure. But by following treatment, it may improve the chance of being able to safely eat a specific food allergen, such as peanut.
Children receiving OIT can experience some side effects. But in young children, the majority of these are mild and do not require treatment, according to global evidence.
OIT treatment takes time, and this program requires a long-term commitment from families to give their child daily doses of peanut powder at home along with regular visits to their hospital allergy clinic.
Families of peanut-allergic children are urged not to try OIT at home unsupervised.
For more information about the ADAPT OIT program, visit nace.org.au.
References:
- Babies offered peanut allergy treatment program under world-first national model. https://www.mcri.edu.au/news-stories/peanut-allergy-treatment-program. Published July 31, 2024. Accessed July 31, 2024.
- Soller L, et al. J Allergy Clin Immunol Pract. 2019;doi:10.1016/j.jaip.2019.04.010.
- Soriano VX, et al. J Allergy Clin Immunol. 2019;doi:10.1016/j.jaci.2019.07.032.
Perspective
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Prompt evaluation and diagnosis of a food allergy is key. The earlier the better. When there is a suspected allergic reaction, evaluation by an allergy team that is comfortable in managing infants is ideal. They can appropriately identify an IgE mediated allergy with history and testing with a skin test or blood testing and, in some cases, the use of an OFC.
With diagnosis, the family can be appropriately supported and taught to manage the food allergy. Management includes getting comfortable with learning how to read labels and avoid cross contact for the allergen. Also important is learning when a reaction requires treatment with an epinephrine auto injector and how to effectively use it.
Early diagnosis is key to preventing subsequent allergic reactions and supporting quality of life. Peanut OIT is a method increasingly used throughout the world to treat IgE mediated peanut allergy. Recent studies show improved safety and efficacy in younger populations as compared with older children.
Taking on peanut OIT is a worthy but heavy lift. At Mass General for Children, we are blessed to have a well-established program directed by David Pyle, MD, PhD. Over the last year, there has been a sharp rise in referrals for infant OIT. The current demand for OIT in general is huge and takes a multidisciplinary team to maintain. Although younger patients have been prioritized, ensuring access for consultations and updosing visits is a challenge, as our single institution only has finite resources.
The idea of a centralized program established in 10 collaborating institutions, all using similar protocols, sharing resources and gathering and analyzing data for quality improvement is exhilarating. I think that this program will have a positive impact at both the individual patient and population levels. I anticipate that they can see improved access and therefore earlier initiation of peanut OIT. Additionally, the standardized approach and concurrent data collection will allow for quality improvement measures and program evaluation that will refine and improve care delivery. I’m inspired and excited to learn from their experience.
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