Patch Treatment May Prevent Peanut Allergies

Nearly half of patients on epicutaneous immunotherapy achieved treatment success.

A novel skin patch could be an effective way to treat young children with peanut allergies to prevent the allergy from continuing.

Current treatment for severe allergies includes an injection of epinephrine from a device such as an EpiPen, which has come under scrutiny from lawmakers and the general public for sharp price increases.The new wearable skin patch, called epicutaneous immunotherapy, delivers a small amount of peanut protein through the skin, and was generally well-tolerated in patients included in an ongoing trial published in the Journal of Allergy and Clinical Immunology.

“To avoid potentially life-threatening allergic reactions, people with peanut allergy must be vigilant about the foods they eat and the environments they enter, which can be very stressful,” said National Institutes of Allergy and Infectious Disease (NIAID) Director Anthony S. Fauci, MD. “One goal of experimental approaches such as epicutaneous immunotherapy is to reduce this burden by training the immune system to tolerate enough peanut to protect against accidental ingestion or exposure.”

Included in the study were 74 patients aged 4- to 25-years-old with peanut allergies who were randomized to receive a high-dose (250 micrograms peanut protein), low-dose (100 micrograms peanut protein), or a placebo patch. A new patch was applied each day to the skin between patients’ shoulder blades.

At the beginning of the study, the scientists supervised an oral food challenge to assess the severity of the patients’ allergies. After a year of treatment, the scientists evaluated the patients’ ability to consume 10 times more peanut protein than they were able to before treatment.

Approximately 46% of patients on the low-dose patch and 48% on the high-dose patch achieved treatment success, according to the study. Only 12% of patients on the placebo patch achieved this. A more significant effect was seen among younger children 4- to 11-years-old compared with patients age 12 and older.

Immune responses elicited by the patch were similar to other experimental forms of food allergy immunotherapy, scientists found.

“The clinical benefit seen in younger children highlights the promise of this innovative approach to treating peanut allergy,” said Daniel Rotrosen, MD, director of NIAID’s Division of Allergy, Immunology and Transplantation (DAIT). “Epicutaneous immunotherapy aims to engage the immune system in the skin to train the body to tolerate small amounts of allergen, whereas other recent advances have relied on an oral route that appears difficult for approximately 10 to 15% of children and adults to tolerate.”

After the first year of the therapy, all patients included in the study received high-dose patches, and will continue treatment for 2.5 years to assess long-term safety of the treatment.

A majority of the patients followed treatment protocol, and none reported serious adverse events related to the patch, according to the study. However, most patients reported mild skin reactions at the application site. Additional studies are needed to investigate the use of the patch in a larger group of patients.

“The high adherence to the daily peanut patch regimen suggests that the patch is easy-to-use, convenient and safe,” said Marshall Plaut, chief of DAIT’s Food Allergy, Atopic Dermatitis and Allergic Mechanisms Section. “The results of this study support further investigation of epicutaneous immunotherapy as a novel approach for peanut allergy treatment.”