Peanuts are some of those the most inconspicuous dangers in the world. According to Food Allergy Research & Education, more than 6 million Americans have a peanut allergy. There is no cure and very few treatment options currently available. But a novel cure may be on the horizon, and it’s coming from an unlikely place.
A small, early-stage clinical trial looked at the treatment of peanut allergy in humans with Fecal Microbiota Therapy (FMT). In a word: poop.
While the link between bowel movements and allergies may seem far-fetched, it’s not: Our gut is home to a variety of microorganisms, many of which play key roles in our health.
Here is the background – The legume we know and love can cause anaphylaxis, reactions ranging from difficulty breathing to death. In January 2020, the Food & Drug Administration approved the first treatment for peanut allergy in children.
It’s not so much that poop has healing properties, but that the gut is a bacterial wonderland involved in almost every major bodily function. The gut microbiome thrives on bacteria that keep the body healthy and break down food. Feces are the by-product that comes out of our gut, and it takes some of the bacterial utopias with it. Currently, fecal microbial transplants have a high success rate in treating intestinal infection C. diff.
Transplanting some bacteria from a non-peanut allergic gut into an allergic gut could help protect people from allergic reactions. The results of this study were presented this month at the annual meeting of the American Academy of Allergy, Asthma & Immunology.
If you think of the gut microbiome as a fertile ground for bacteria to thrive, FMT adds new bacteria that previously couldn’t thrive there. These new bacteria can affect the immune system.
What’s new – “A single FMT resulted in a significant increase in threshold reactivity to peanut at both 1 month and 4 months post-treatment, showing that the effect was prolonged. This study offers hope that microbiome interventions in food allergy could be effective,” said Dr. Rima Rachid, the study’s lead investigator, in a press release. “These results were very encouraging.” Rachid is also director of the Allergen Immunotherapy, Allergy and Asthma Program at Boston Children’s Hospital.
Rachid says this may even hold promise enough to help patients resist traces of peanuts. One of the reasons peanut allergies can be so dangerous is that even foods processed in the same facility as peanuts can contain enough peanuts to trigger a life-threatening allergic reaction.
To the knowledge of Liping Zhao, a professor of microbiology at Rutgers, this study is the first to test treating peanut allergy with FMT.
“I’m very happy about the success of this early experiment,” he says The opposite.
While feces might seem like a grotesque, bizarre starting point for allergy treatment, Zhao sees why. The gut is a key player in holistic health, and not surprisingly, gut bacteria can affect the immune system and allergies.
“It’s fortunate that we have such an important microbial organ that’s part of our immunity, our metabolism, our neuropsychology,” says Zhao. Gut microbiota, he says, play a role in almost every major human function.
Why it matters – Many foods, like candy, contain traces of peanuts. And the severity of some children’s peanut allergies raises the question of whether schools should even allow peanuts. Currently, some people with severe peanut allergies undergo some form of exposure therapy, gradually consuming larger amounts of peanuts and training their systems to build tolerance. However, this is not the most effective treatment in adults.
“The long-term effects of oral immunotherapy are not clear, and many patients discontinue therapy over time,” Rachid said in the press release. “Furthermore, it requires daily administration and is not without the risk of allergic reactions. Microbiome interventions are very promising alternatives for treating food allergies.”
In addition, this oral capsule can be administered at home. Traditionally, doctors performed FMT via colonoscopy and enema, which is neither fun nor quick.
To go into detail – This small study tested FMT in 15 adults with a peanut allergy, and the patients tolerated higher amounts of peanuts after their therapy. All participants were allergic to half a peanut or less. On the study start day, each participant took a total of 36 FMT capsules over three hours. This process took a year.
This study had two groups. The first group of 10 people received FMT in the form of an oral capsule over two days. The second group of five people also received the capsule but took antibiotics first to rid the gut of its existing metropolis of bacteria so any difference from the FMT would be clearer. After FMT, both of these groups faced dietary challenges that required them to consume higher amounts of peanut protein.
Feces come into play in the capsule. The capsule’s contents come from stool donated by someone without a peanut allergy – but it’s not a pill full of feces. Inside the pill is a concentrated dose of the bacteria extracted from the donor’s stool. Rachid’s team obtained their dispensers from the OpenBiome bench. In addition, they sought out donors without nut allergies and instructed them to avoid even trace amounts of tree nuts so the transplant had no chance of causing an allergic reaction in patients.
Years of preliminary work precede this process. Rachid and her colleagues started by comparing the gut bacteria in babies with and without food allergies. These studies were originally published in the journal in 2019 naturopathyfound that the stool bacteria in babies with food allergies were different from those in non-allergic babies.
The researchers then experimented with FMT in mice and transplanted fecal bacteria from the babies into allergy-prone mice. Mice given fecal bacteria from food-allergic babies suffered anaphylaxis when challenged with an allergen; those given fecal bacteria from healthy babies did not.
What’s next – Rachid and her team will continue to refine the treatment in future clinical trials. She envisions that the next phase will look at patients between the ages of 12 and 17. For this round, they would receive an antibiotic pre-treatment and an even more concentrated dose of human microbiota.
In this next attempt, the fecal microbiota goes through at least two cleaning cycles. “We end up with highly concentrated bacteria and very little feces,” Rachid said during her presentation.
Zhao first points out that commercialization is still a long way off and says he would like to see larger samples of both patients and donors in future studies. He is curious which gut bacteria might be particularly associated with strengthening the body against allergic reactions. He also hopes Rachid and her team investigate how long the potential benefits of FMT will last.