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.