Peanut oral immunotherapy may be safe, effective for infants

Key takeaways:

• All 22 infants in the study achieved a maintenance dose of 500 mg of peanut protein.
• Most reactions to treatment self-resolved.
• Eleven of 12 patients tested had negative oral food challenges.

Oral immunotherapy for peanut allergy was safe and effective for infants, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

All the participants tolerated an average dose of 500 mg of peanut protein, Sandra J. Hong, MD, allergist and director of Cleveland Clinic’s Food Allergy Center of Excellence, and colleagues wrote.

“We have been treating our babies and toddlers with early oral immunotherapy in the Food Allergy Center of Excellence for years and we noticed they were doing extremely well,” Hong told Healio. “We also noticed, the younger we treated them, the better the outcomes.”

The researchers then decided to examine their patients who were aged younger than 12 months to determine their response and found that they were able to tolerate the process better and more effectively than the patients who were aged older than 4 years.

Study design, results

The study involved 22 patients (68% boys; 68% white) with a mean age of 9.2 months (range, 7-11 months) at the beginning of OIT. Typically, doses began with 18 mg of peanut protein and then increased every 2 weeks until reaching a maintenance dose of at least 500 mg.

All 22 patients achieved the maintenance dose, and six (27%) experienced no reactions.

“This is particularly significant because now they do not need to worry about accidental exposure as much,” Hong said. “They do not need to worry about peanut oil or ‘may contain peanut’ since they are eating significantly more than that daily in their doses.”

Also, 13 (57%) reacted during in-office up-dosing, eight (36%) reacted at home during the buildup phase and four (18%) reacted at home during the maintenance phase. These reactions self-resolved in most of the patients, the researchers said.

One patient required epinephrine due to emesis and coughing during up-dosing in the office, but this patient also had a concurrent infection that the researchers believe likely augmented the reaction. This patient also tolerated subsequent up-dosing.

Another patient discontinued OIT after reaching maintenance due to family preference, including recurrent illnesses and difficulty with dosing logistics, but no patients stopped OIT because of adverse reactions.

After 6 months of maintenance OIT, the researchers measured peanut specific IgE (sIgE) for 14 patients, who all had peanut sIgE totals of 2 kU/L or less. Next, 11 of these 14 patients took part in oral food challenges.

Ten of these 11 patients (91%) had negative challenges, which included tolerance to cumulative doses of 2,000 mg in children aged younger than 24 months and 4,000 mg in children aged older than 24 months.

The remaining patient had an indeterminant challenge including mild cutaneous symptoms appearing 2 hours after the final OFC dose.

“We are finding after a relatively short period of time, these patients’ lab work, which can be an indication of tolerance, decreases dramatically,” Hong said. “We do not see that as frequently when they are older undergoing a similar process.”

Conclusions

Based on these findings, the researchers concluded that OIT can safely desensitize children aged younger than 12 months to peanut, although Hong encouraged doctors to engage in peanut allergy prevention practices as well.

“Doctors can help prevent food allergies by introducing peanut into the diet of babies at high risk of food allergies after they have starting successfully eating at 4 to 6 months of age,” Hong said. “Babies at high risk of a peanut allergy are those that have a previous history of egg allergy and/or moderate eczema that has needed to be treated.”

The researchers also said that they will follow patients in the long term to determine who else may qualify for OFCs.

“We hope to have more information soon on other treatments we have been researching,” Hong said.

Reference:

• Cleveland Clinic researchers confirm early intervention curbs peanut allergies in babies. Cleveland Clinic Researchers Confirm Early Intervention Curbs Peanut Allergies in Babies – Cleveland Clinic Newsroom. Posted Aug. 3, 2023. Accessed Aug. 8, 2023.