Oral peanut immunotherapy in children with peanut anaphylaxis

• Published in: Journal of allergy and clinical immunology 2010-07, Vol.126 (1), p.83-91.e1
• Main Authors: Blumchen, Katharina, MD, Ulbricht, Helen, Staden, Ute, MD, Dobberstein, Kerstin, Beschorner, John, de Oliveira, Lucila Camargo Lopes, MD, Shreffler, Wayne G., MD, PhD, Sampson, Hugh A., MD, Niggemann, Bodo, MD, Wahn, Ulrich, MD, Beyer, Kirsten, MD
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adolescent; Allergies; Allergy; Allergy and Immunology; anaphylaxis; Arachis hypogaea; Biological and medical sciences; Child; Child, Preschool; children; Colorectal cancer; Desensitization, Immunologic - adverse effects; Desensitization, Immunologic - methods; Double-Blind Method; Female; food; Food allergies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunopathology; Interleukin-4 - biosynthesis; Interleukin-5 - biosynthesis; Male; Medical sciences; oral immunotherapy; peanut; Peanut Hypersensitivity - immunology; Peanut Hypersensitivity - therapy; Peanuts; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; specific oral tolerance induction; tolerance
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2010.04.030

Background The only treatment option for peanut allergy is strict avoidance. Objective To investigate efficacy and safety of oral immunotherapy (OIT) in peanut allergy. Methods Twenty-three children (age, 3.2-14.3 years) with IgE-mediated peanut allergy confirmed by positive double-blind, placebo-controlled food challenge (DBPCFC) received OIT following a rush protocol with roasted peanut for 7 days. If a protective dose of at least 0.5 g peanut was not achieved, patients continued with a long-term buildup protocol using biweekly dose increases up to at least 0.5 g peanut. A maintenance phase for 8 weeks was followed by 2 weeks of peanut avoidance and a final DBPCFC. Immunologic parameters were determined. Results After OIT using the rush protocol, patients tolerated a median dose of only 0.15 g peanut. Twenty-two of 23 patients continued with the long-term protocol. After a median of 7 months, 14 patients reached the protective dose. At the final DBPCFC, patients tolerated a median of 1 g (range, 0.25-4 g) in comparison with 0.19 g peanut at the DBPCFC before OIT (range, 0.02-1 g). In 2.6% of 6137 total daily doses, mild to moderate side effects were observed; in 1.3%, symptoms of pulmonary obstruction were detected. OIT was discontinued in 4 of 22 patients because of adverse events. There was a significant increase in peanut-specific serum IgG4 and a decrease in peanut-specific IL-5, IL-4, and IL-2 production by PBMCs after OIT. Conclusion Long-term OIT appears to be safe and of some benefit in many patients with peanut allergy. With an increase in threshold levels and a reduction of peanut-specific TH 2 cytokine production, the induction of tolerance may be feasible in some patients.