Refined peanut oil to treat peanut allergy?

[APV]

Many patients allergic to milk/egg can consume baked goods containing
milk/eggs as most of the proteins are broken down by baking. And since
it is not completely free of intact milk/egg proteins, it also
apparently acts as a sort of OIT to help develop tolerance.

Refined peanut oil apparently is safe for many people with peanut allergy.
And since refined peanut oil also contains small amounts of peanut
protein, one would expect it to also act as an OIT for peanut allergy.

Have you heard anyone try it/discuss it?

[rebekahc]

I'm not positive there are enough proteins left in refined peanut oil to build tolerance in people in whom it doesn't cause a reaction. It might be possible for it to be used in those most sensitive individuals who do react to it, but I think it would be too dangerous to try desensitization in those individuals. Plus, desensitization requires carefully monitored and measured doses - no real way to do that with a product like peanut oil. You'd be better off making a solution with just the right dose.

[CMdeux]

Yeah-- speaking as both a scientist and someone who VERY carefully did a home-brewed low-level desensitization to egg in a child who was anaphylactic to trace amounts (contact, aerosol sensitivity)--

Measurement and dosing is a pretty high precision endeavor here, and PN oil (hot processed) just doesn't have the tolerances.  According to a private communication from Dr. Taylor, who runs the specialty analytical lab in Nebraska, such oils run between 1 and 10 ppm.  My guess is that this reflects a 95% confidence interval with a limit of determination of about 1ppm, so who knows what the actual low end is there.

A teaspoon is about 5mL, so that would be 5mL X (~1 ug/ mL)= 5ug of protein at the low end, but might be as much as 50ug pretty routinely, and probably some excursions well beyond it.  Also no guarantee on the fractionation of the proteins involved, either, is my guess as an experienced PhD bioanalytical chemist.

For all of those reasons (in other words, the more technical explanation of what Rebekah just stated) this is NOT a good idea without a physician on board approving it.

I realize that SLIT operates on similiarly VERY low level exposures, and it does seem to work pretty well-- but again, highly controlled concentration and dosing involved there, and a very long slow curve to updose.

I'm familiar with that.  We started egg desensitization with about 5mg of protein, well-baked, DAILY.  That eventually went to 120 mg daily, and stayed there for 3 years.  Could another parent have even done it with that level of accuracy?  Well, no-- probably not.  I knew more about how to get that dose dialed in than our physician did.  I weighed ingredients and did a WHOLE LOTTA math and then weighed out portioned doses.    It wasn't "food" so much as medication.

Allergist said I was as good as the nutrition staff at the Jaffe.  LOL.  He should know.  I wouldn't trust most allergists to be partnered in that kind of effort, either, however-- in all seriousness.  My allergist is a GURU for immunotherapy protocol development.  Not for foods, which is unfortunate, but for rush desensitization protocols.  He and I work as a team, in other words, and we both know what we're about.


I still wouldn't attempt peanut desensitization with someone like my DD, who very definitely reacts robustly to amounts in that 50ug range.  I definitely would NOT NOT NOT do it with peanut oil, because it's effectively an unknown concentration.

[APV]

Looks like for a majority of the patients, ordinary kitchen measurements are good enough (1 -3 servings a day is a very wide range).

DIETARY BAKED EGG ACCELERATES RESOLUTION OF EGG ALLERGY IN CHILDREN
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3428057/

Allergen quantity used to prepare the food is only one variable. The rest of the food matrix interacting with the allergen, temperature variation in various parts of the food while cooking, how well the food is chewed, acid/enzyme levels in the stomach are probably much bigger factors influencing how much allergen actually gets delivered to the gut mucosa where the tolerance development happens.


Allergenicity of refined vegetable oils.
http://www.ncbi.nlm.nih.gov/pubmed/10722892

Of course a doctor should always be involved. But it seems like the "overwhelming majority" (per paper above) of peanut allergy patients can benefit from refined peanut oil.

On another note, I see here an emphasis on precision of allergen content for desensitization. Why is it that no one cares about precisely how much allergen goes into our vaccines/injections?

[hedgehog]

Just how much do you know about the desensitization process?  I went through peanut desensitization with my son.  Even so, I would not say I am an expert, but know quite a bit from having gone through the process.  I have to agree with CM on the need for tightly controlled doses, at least in the early stages.  Now hat he is in the maintenance dose, and has been for a few years, that tight control is not important, but it is still a very similar amount each day. 

Desensitization is very dangerous if not done by an expert, with carefully controlled doses. Even when done by an expert, and controlled doses, it can be dangerous.  My nephew's wife attempted a desensitization study last year.  She had to drop out after experiencing anaphylaxis twice.  Since the dose increases are always done in the office (in her case at a hospital), she was in as little danger as possible during the reactions, and came out of it fine, other than being back at square one.

[Macabre]

We are doing SLIT, and it is a very carefully measured dose. We do not have an increase without blood work (ImmunoCAP testing every six months) and an in office challenge. And then it is very carefully measured out.

[Mfamom]

desensitization for food allergy is not a DIY project! 

[maeve]

I have a daughter doing OIT with baked egg. It is not something you can start to do on your own. We follow a well defined protocol. We see an allergist at a major East Coast teaching hospital who is definitely one of the top food allergy gurus. While I don't have to do quite the math CM did, it's still not just done just using usual baking tools. There's a bit more precision involved.

Honestly, the best way to educate yourself about OIT is by seeing a reputable allergist and not by reading medical literature online (for which you do not know or understand the context).