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Abstract and Introduction
Abstract
Peanut allergy is a life-threatening, IgE-mediated allergic disease. In developed countries, the prevalence rate of peanut allergy in school-aged children is reported to be in excess of 1% and continues to rise, representing a major public health concern. Peanut allergy is diagnosed on the basis of a relevant clinical history combined with results of skin-prick testing and/or peanut-specific IgE levels. A double-blind placebo-controlled oral food challenge is the gold standard for diagnosis. Currently, there is no approved treatment or disease-modifying therapy for peanut allergy. This review discusses recent advances in molecular diagnostic techniques for peanut allergy and highlights advances in peanut allergy therapeutics, discussing allergen-specific and allergen-nonspecific treatments that are currently in Phase I/II clinical trials.
Introduction
Peanut allergy is a life-threatening, IgE-mediated allergic disease. The prevalence of peanut allergy in school-aged children in developed countries is estimated to be in excess of 1% and continues to increase. Compared with other food allergies, peanut allergy is less likely to be outgrown and is estimated to resolve for only 20% of children by school age. All peanut-allergic individuals are counseled about strict dietary avoidance and given self-injectable epinephrine. Despite constant parent and patient vigilance, accidental ingestions of peanut are common and are estimated to be 15–40% annually. These accidental ingestions in peanut-allergic individuals may result in severe and fatal reactions. The first step in taking care of peanut-allergic patients is arriving at an accurate diagnosis, which is critical in order to identify patients at risk of having an allergic reaction. Unfortunately, current diagnostic tests have limitations such as the fact that they are unable to predict the severity of an allergic reaction and that positive tests to tolerated foods can be seen.
There has been much discussion and debate about risk factors for development of peanut allergy. The majority of peanut-allergic children react on their first known exposure to peanut; however, the route by which sensitization occurs is unclear. Several studies have focused on the role of maternal consumption of allergen during pregnancy or lactation; however, interventional studies have failed to demonstrate any benefit of dietary elimination. It has been hypothesized that peanut sensitization may occur as a consequence of environmental exposure through cutaneous or inhalational routes rather than from maternal or infant allergen. While peanut allergy appears to have strong heritability, its genetic basis is unknown. Given that loss-of-function mutations within the filaggrin gene are associated with atopic diseases such as atopic dermatitis, it is felt that filaggrin may also be a candidate gene in the etiology of peanut allergy. In the past few years, much effort has been dedicated to the development of more sensitive and accurate diagnostic tools for the diagnosis of peanut allergy and this review discusses some of those advances (Box 1). There is a strong recognition of the unmet need to develop effective treatments for peanut allergy, and much progress has been made in the development of novel therapies, which are showing promise. While there is currently no approved treatment available for peanut allergy beyond allergen avoidance, it is probable that the current work in the field will soon lead to the development of a disease-modifying therapy for peanut allergy.
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