PEANUT allergy is a potentially life-threatening condition that affects children globally, with varying prevalence rates across different regions. Lower prevalence rates are observed in Asia (0.4%–1.0%) and South Africa (0.8%–1.6%), while higher rates are seen in Western countries, including Canada (1.2%), Europe (2.0%), the USA (2.2%), and Australia (up to 3.0%). Peanut allergy often persists into adulthood and significantly impacts the quality of life of affected individuals and their caregivers, leading to social isolation, anxiety, and depression.
Current management strategies for peanut allergy include strict allergen avoidance, allergen-specific oral immunotherapy, and the use of adrenaline to treat acute allergic reactions. While oral immunotherapy provides an avenue for treatment, its side effects and loss of desensitization upon treatment cessation highlight the need for alternative therapies.
Peanut allergy is an immunoglobulin (Ig)E-mediated type 1 hypersensitivity reaction driven by interleukin (IL)-4 and IL-13, which play central roles in type 2 inflammation. Dupilumab, a fully human monoclonal IgG4 antibody, blocks IL-4 and IL-13 by targeting the IL-4 receptor α (IL-4Rα). It is currently approved for treating various type 2 inflammatory diseases, including atopic dermatitis, asthma, and eosinophilic esophagitis.
A proof-of-concept study was conducted to explore whether dupilumab could induce desensitisation to peanut in children with peanut allergy. The study also aimed to assess its impact on allergy-related biomarkers, such as allergen-specific IgE and IgG levels. Results showed that dupilumab was well tolerated, but after 24 weeks of treatment, only 8.3% of participants (2 out of 24) successfully passed an allergen challenge. However, there was a numerical reduction in allergic reactions of grade 2 or higher during the food challenge, suggesting a potential decrease in peanut reactivity.
Dupilumab treatment led to approximately a 50% reduction in total IgE and peanut-specific IgE after 36 weeks. However, it did not eliminate IgE, indicating that long-term treatment might be required. Additionally, reductions in peanut skin prick test wheal size and basophil sensitivity were observed but were insufficient to prevent allergic reactions.
Despite some promising immunological changes, 24 weeks of dupilumab monotherapy did not significantly improve peanut desensitization, underscoring the need for further research into combination approaches for treating peanut allergy.
Katie Wright, EMJ
Reference
Sindher SB et al. Efficacy and safety of dupilumab in children with peanut allergy: a multicenter, open-label, phase ii study. Allergy. 2025;80(1):227-37.
