Radical new approach to treating food allergies rolled out across Australia

Australia has become the first country in the world to implement a national program to treat babies with peanut allergies by giving them a daily dose of peanut powder in the hope of overcoming the potentially life-threatening condition.

The new treatment, which will be offered for free to children under 12 months old through 10 public paediatric hospitals in Victoria, NSW, Western Australia, Queensland and South Australia, will involve eligible babies eating carefully planned doses of the powder at home to build up a tolerance to the allergen.

Hunter Chatwin, 10 months, and his mum Kirsten are involved in a new oral immunotherapy program at the Royal Children’s Hospital in Melbourne.Credit: Justin McManus

It represents a radical shift in the way the condition is managed in the allergy capital of the world, with families previously told to strictly avoid peanut in their diets.

Professor Kirsten Perrett, the director of the National Allergy Centre of Excellence, said the ADAPT Oral Immunotherapy program aimed to help hundreds of babies around the country build tolerance to the allergen and potentially achieve remission.

“This will be a real game changer,” she said.

“We know the immune system is more malleable at this young age so we hope to treat these children before they start school.”

Australian children have the highest rates of food allergy in the world, with an estimated one in 10 babies affected by the condition.

Peanut allergy affects 3.1 per cent of Australian 12-month-olds and is the most common food allergy among school-aged children. While most children outgrow their allergies to cow’s milk, egg, wheat and soy, just one in three children with a peanut allergy has outgrown it by the time they turn 10. It’s a potentially life-threatening condition that causes hospital admissions and anxiety for thousands of families.

Perrett, a paediatric allergist and researcher at Murdoch Children’s Research Institute, said that while oral immunotherapy had previously been offered to Australian children in clinical trials, this was the first time it had been offered as a standard model of care through hospitals.

The program will be offered to eligible babies who are receiving care from allergists at The Royal Children’s Hospital in Victoria, Sydney Children’s Hospital, Randwick, The Children’s Hospital at Westmead, John Hunter Children’s Hospital Newcastle, Campbelltown Hospital and Royal Prince Alfred Hospital in NSW, Perth Children’s Hospital and Fiona Stanley Hospital in Western Australia, Queensland Children’s Hospital and the Women’s and Children’s Health Network in South Australia.

Parents are still advised to see their GP if they suspect their child has a food allergy, and they may then refer them to a hospital participating in the program.

Dr Lara Ford, the allergist and program lead at the Children’s Hospital at Westmead in Sydney’s west, said babies involved in the program will first undertake a food challenge at hospital, where they ingest small quantities of their allergen under medical supervision. This will confirm their allergy and they can then start a dose of peanut powder.

Patients will continue take a carefully prescribed daily dose at home for one month before returning to hospital to increase their dose with the allergy team. They will continue this process over two years and then undertake another food challenge to determine if they are in remission.

“It gives them a pathway to potentially being able to eat peanuts and not feeling at such risk of reactions from cross contamination and accidental ingestion,” she said.

While it’s estimated the program will be in high demand across the 10 hospitals, capacity will depend on each hospital’s resources.

There are just a handful of private allergy clinics offering oral immunotherapy in Australia, with some families spending tens of thousands of dollars to access treatment interstate and even overseas.

The National Allergy Centre of Excellence, which is located at the Murdoch Children’s Research Institute and funded by the federal government, will assess the program’s results. If successful, it’s hoped the initiative will be expanded to more hospitals and private allergy clinics, including in regional and remote areas.

It’s also hoped that, over time, the program may be expanded to include older children and other common allergens.

Assistant Minister for Health and Aged Care Ged Kearney said it’s hoped the new care model can “stop this terrible allergy in its tracks”.

Hunter Chatwin is one of the first Australian babies to benefit from treatment at the Royal Children’s Hospital in Melbourne. The 10-month-old, from Mickleham in Melbourne’s north, had his first allergic reaction to peanut when he was six months old and his mother Kirsten fed him a quarter of a teaspoon of peanut butter.

“I immediately noticed a contact rash around his mouth,” she recalled. “About an hour and a half later he broke out in hives on his chest, neck and back.”

Hunter now tolerates small amounts of peanut powder each day mixed into a fruit purée before breakfast.

Kirsten said the program had been life-changing and reduced her anxiety about accidentally exposing her son to his allergen.

“Fingers crossed, one day he won’t have to worry about a peanut allergy, or at least we know that he can tolerate a small amount of peanut and not be in a life or death situation,” she said.

According to the Australian Society of Clinical Immunology and Allergy, oral immunotherapy carries risks including the potential for allergic reactions and a rare condition called eosinophilic oesophagitis which involves swallowing difficulties. This often resolves itself if the treatment is stopped.

Australian families are still advised to offer peanut and the other key allergens to their children during their first year of life.

Symptoms of a food allergy include hives, itching, tingling in the mouth, swelling of the lips and abdominal pain. Signs of anaphylaxis, which is a severe and life-threatening allergic reaction, include difficult or noisy breathing, swelling of the tongue, a wheeze or persistent cough and being pale and floppy.

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