This article is more than 5 years old. Information may no longer be current.

Early intervention peanut OIT drives greater long-term response

HOUSTON ─ Early intervention peanut oral immunotherapy appeared safe and yielded a significantly high rate of sustained unresponsiveness, according to data presented at the American Academy of Allergy, Asthma and Immunology Annual Meeting.

“It’s fairly well established in the field now that [oral immunotherapy] is gaining momentum as an experimental treatment for peanut allergy,” Brian P. Vickery, MD, FAAAAI, an allergist and immunologist with the University of North Carolina at Chapel Hill, said during a press conference. “Despite its promise, there are still problems with it. To address this, we had the idea to start the therapy earlier in children.”

According to the literature, 80% of patients allergic to peanuts will not outgrow their reactions, Vickery said.

He and colleagues conducted a study that included 40 children aged 9 to 36 months. All children had peanut-specific IgE (psIgE) greater than 5kUa/L or previously had an allergic reaction to peanut. All participants underwent an oral food challenge to peanut prior to the study and then were randomly assigned to either low- or high-dose oral immunotherapy (OIT), with goal maintenance doses of 300 mg or 3000 mg daily, respectively. All participants consumed 3,000 mg to maintain blinding; in the low-dose group, 2,700 mg of placebo filler was added to the 300 mg of peanut flour.

Of the 40 children enrolled, three patients did not qualify and five patients withdrew for nonadherence or adverse events, including one who developed eosinophilic esophagitis.

Of the remaining 32 participants, 29 met the primary endpoint of sustained unresponsiveness (78% by intent-to-treat), Vickery said. Of those, 80% reported adverse events (mean, 2.8% per dose; 95% CI, 0.8%-4.8%).

The researchers observed a decline in psIgE from baseline to the final oral food challenge, and an increase in peanut-specific IgG₄ (P < .0001).

“These findings help to support that early intervention may be more useful,” Vickery said. “Safety data show that using the product in young children is just as safe as when used in older children.” – by Samantha Costa

Reference:

Vickery BP, et al. Abstract 506. Presented at: American Academy of Allergy, Asthma and Immunology Annual Meeting; Feb. 20-24, 2015; Houston.

Disclosure: Vickery reports no relevant financial disclosures.