Peanut protein

How it works

It works by oral immunotherapy: graded, escalating exposure to peanut allergen induces immune desensitisation, raising the threshold dose that triggers an allergic reaction.

Prescribing in practice

• Allergic reactions including anaphylaxis can occur during treatment, so initiation and dose escalations must take place under specialist allergy supervision with resuscitation facilities and an adrenaline auto-injector available.
• It induces desensitisation rather than cure and does not remove the need for ongoing peanut avoidance, as protection is lost if regular dosing stops.
• Use only within a specialist-led programme according to the SPC; certain factors such as intercurrent illness or exercise around dosing can increase reaction risk.

Monitoring

Monitor closely for allergic and gastrointestinal reactions (including eosinophilic oesophagitis) during initiation, escalation and maintenance.

Counselling the patient

• Explain that treatment aims to make accidental exposures less dangerous, not to allow free eating of peanut.
• Continue strict peanut avoidance and always carry the prescribed adrenaline auto-injector.
• Give doses with food and avoid vigorous exercise, hot baths or dosing during illness, and seek help if a reaction occurs.

Evidence & guidelines

Randomised trials of peanut oral immunotherapy (such as the PALISADE study) demonstrated increased reaction thresholds in allergic children, alongside an increased frequency of treatment-related allergic events.