Double‐blind placebo‐controlled challenge showed that peanut oral immunotherapy was effective for severe allergy without negative effects on airway inflammation

Aim This study examined the efficacy and the safety of peanut oral immunotherapy (OIT). Methods We recruited 60 patients aged six years to 18 years who had a moderate‐to‐severe reaction to a double‐blind placebo‐controlled peanut challenge: 39 received OIT during an eight‐month build‐up phase and ma...

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Bibliographic Details
Published in:Acta Paediatrica 2017-02, Vol.106 (2), p.274-281
Main Authors: Kukkonen, Anna Kaarina, Uotila, Riikka, Malmberg, Leo Pekka, Pelkonen, Anna Susanna, Mäkelä, Mika Juhani
Format: Article
Language:English
Subjects:
Administration, Oral
Adolescent
Airway inflammation
Ara h 2
Arachis hypogaea
Bronchial hyper‐responsiveness
Bronchial Provocation Tests
Child
Desensitization, Immunologic - adverse effects
Desensitization, Immunologic - methods
Double-Blind Method
Female
Humans
Inflammation - immunology
Male
Methacholine Chloride
Oral immunotherapy
Peanut allergy
Peanut Hypersensitivity - therapy
Young Adult
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Summary:Aim This study examined the efficacy and the safety of peanut oral immunotherapy (OIT). Methods We recruited 60 patients aged six years to 18 years who had a moderate‐to‐severe reaction to a double‐blind placebo‐controlled peanut challenge: 39 received OIT during an eight‐month build‐up phase and maintenance phase and 21 controls avoided peanuts. We measured specific immunoglobulin E and G4 (IgE and IgG4) to peanuts and to Ara h 1, 2, 3, 8 and 9 and monitored adverse events, bronchial hyper‐responsiveness (BHR) to methacholine and fractional concentrations of exhaled nitric oxide (FeNO). The median follow‐up period was 30 months. Results Most (85%) of the OIT patients passed the build‐up phase and 67% tolerated 5 g of peanuts during the post‐treatment challenge. No controls were desensitised, with a risk ratio of 29 and 95% confidence interval of 1.9–455. During OIT, IgE to peanut, Ara h 1, 2 and 3 decreased and IgG4 increased. Consuming peanuts had no harmful effects on BHR or FeNO. The annual incidence rate of emergency visits during the follow‐up period was 11% or 3.0 per 10 000 patient‐days. Conclusion Peanut OIT was efficacious in severe allergies without negative effects on airway inflammation, but unpredictable long‐term reactions might occur.
ISSN:0803-5253
1651-2227
DOI:10.1111/apa.13668