Wearing a skin patch for toddlers with peanut allergies could reduce the intensity of allergic reactions. A year-long placebo-controlled trial of 362 1-, 2-, and 3-year-olds found that about 67% of participants who wore a patch “could safely consume at least 300 mg and 1000 mg of peanut protein” by the end of the study. Fewer than 2%of patch-wearers experienced anaphylactic shock. 

The skin patch has yet to be approved by the Food and Drug Administration and is not currently available for doctors to prescribe. If and when it is FDA-approved, allergists say the skin patch could give children with food allergies (and their families) a new option for risk reduction but would not serve as a cure for peanut allergies.

“For years and years, all we've had to offer these patients is avoidance and to carry their epinephrine auto-injectors,” says Jeanne Lomas, DO, allergist and director of allergy and immunology at WellNow Allergy, who was involved in research on the patch and an earlier oral treatment a few years back. “Now, we have other treatments to offer.”

 

Patches should be for people already diagnosed with allergies

 

The patch is being studied to reduce reaction risks for children with peanut allergies and not prevent allergy development in children without allergies.

This protocol has been recommended since 2015 when the Learning Early About Peanut Allergy (LEAP) trial discovered that children who did not consume peanuts or peanut products at an early age were more likely to develop allergic reactions than those who had consumed, and consistently consumed, the food sooner.

 

Peanut patches could reduce risks of allergic reactions, but won’t cure allergies

 

There is no medicinal cure for peanut allergies, but therapies exist to curb reaction risks or remedy extreme reactions after they occur. 

Epinephrine auto-injectors (EpiPens) are commonly used to remedy anaphylactic shock, which can occur during an extreme reaction to a food allergen, including peanuts, in some patients. If patients use a patch in the future, they will likely need to continue to carry their EpiPens, says Lomas. 

“They still have to practice avoidance, they still have to carry their auto-injectors, but it does decrease the risk of having a life-threatening reaction, and for a lot of patients and parents, that can be really powerful for peace of mind,” Lomas adds.

 

Comparing patches to oral therapies

 

Patches are similar to oral therapies, like peanut oral immunotherapy (OIT), which is used to help desensitize patients to the allergen.

“It does seem that you can get to higher doses with the oral immunotherapy—you're essentially feeding someone who's allergic to peanut peanut—so there are more reactions to that medication versus the patch,” says Lomas.

Further, many children with peanut allergies have aversions or distastes for peanuts in addition to their allergy, Lomas says. As a result, not everyone is enthusiastic about taking an oral peanut-flavored medicine, she adds.

“You can imagine being told your entire life you're allergic to peanuts, and probably the smell of peanuts makes you want to vomit,” says Lomas. “They hate it.”

Some of Lomas’s patients refuse to take the oral treatment without mixing it into something sweet—like a daily serving of ice cream—which brings up other dilemmas for parents or caretakers trying to do their best for their children’s health, she says.

In addition to bad taste and unintentionally inducing an allergic reaction, some children could be at risk of inflammation of the esophagus, or eosinophilic esophagitis, with the oral product, she adds. Because the patch doesn't go in or near a child’s mouth, it is less likely than the oral product to produce a reaction in the esophagus, Lomas says.

“A large part of the problem with oral immunotherapy for peanut has been the gastrointestinal side effects that patients can experience and the higher risk of having allergic reactions,” Farah Khan, MD, a board-certified allergist and immunologist at the Nationwide Children's Hospital and a member of the American Academy of Allergy, Asthma & Immunology. “This study shows a significant reduction in those risks.”

Khan adds that there is a risk of skin rashes, but this risk can be reduced by moving the placement of the patch. Overall, she says the results are encouraging.

“Immunotherapy options—whether it’s sublingual, oral or epicutaneous—will probably not eliminate peanut allergy development altogether, however, there will continue to be a need for treatment options because children will continue to get diagnosed with peanut allergies,” Khan says. “These kinds of therapies will hopefully become a part of standard of care for peanut-allergic patients who qualify.”