By Adem Lewis / in , , , , , , , , , , /


Peanut allergies are a common and severe type
of food allergy. In people who are allergic, peanuts can cause
skin reactions, itching in the mouth and throat, digestive problems, shortness of breath, and
even anaphylaxis, which requires a shot of adrenaline with an EpiPen and a trip to the
emergency room. A promising treatment for peanut allergies
is oral immunotherapy—and the way it works is by giving someone with the allergy tiny
traces of peanuts and increasing the dose gradually over time so that they can slowly
get desensitized to them. Doing this can trigger mild symptoms, and
sometimes those symptoms make a person quit the treatment, but the symptoms may actually
be a sign that the treatment is working. So how these mild symptoms are perceived really
matters. To better understand how patients’ perception
of these mild symptoms can affect the outcome of the treatment researchers recruited 50
families with children aged 7 to 17 years old with peanut allergies, who were about
to undergo oral immunotherapy. The families were randomized into two groups. In the first group, the families were told
that the mild symptoms should be interpreted as evidence that the treatment is working. In the second group, the families were told
that the symptoms were an unfortunate side effect of the treatment. Families came for a total of 8 visits over
the course of seven months, to participate in small-group activities that are related
to the treatment. At each of these visits the messaging about
the mild symptoms was reinforced. Importantly, both groups were given identical
instructions for oral immunotherapy and training in recognizing dangerous side-effects and
how to use an EpiPen. They also had equal access to helpful resources
like over-the-phone staff support. The only difference between the groups was
the messaging about the symptoms. At the end of the study, the researchers asked
the families about their views on the symptoms, and looked at how well the children adhered
to the treatment and at their blood work. So, what’d they learn? Well, the group that was told that the side
effects were a positive sign felt less anxious about the symptoms, and the difference in
anxiety between the two groups grew over the course of the study. The less anxious group also made about half
as many calls to the clinical staff about non-life-threatening symptoms. Interestingly, near the end of the intervention,
as the dose of peanuts increased, this group also reported fewer symptoms. That may explain why only ~4% of this group
skipped peanut doses, compared to ~21% of the group that believed the symptoms were
side effects. Also, in all, 48 of the 50 participants completed
the treatment in 24 weeks, while 2 participants in the symptoms-as-side-effects group—the
more anxious group—took 35 weeks to complete the treatment. Finally, the group that was told the symptoms
were a positive sign had a significantly greater increase in peanut specific IgG4 antibodies,
which are known to decrease the peanut allergic response, relative to the other group. So, what does this study tell us? Well, welcoming the uncomfortable symptoms
seems to have helped these children ultimately have a better outcome. The trick is defining for families what are
mild symptoms and what are severe ones—which may need medical attention. That disclaimer aside, it’s really interesting
that the group that was told the symptoms were a positive sign had improved blood work
over the symptoms-as-a-side-effect group. It may be because that group got more doses
of peanuts and therefore the immune system had a more robust response. It also may somehow be related to lower rates
of anxiety or stress, which can also have an effect on the immune system. Regardless, instilling a positive mindset
towards side effects had a measurable effect on the children, and helped them overcome
their peanut allergy.


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