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Oral immunotherapy effective in desensitizing peanut allergy
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Children with peanut allergy of any severity could be desensitized with oral immunotherapy, according to recent study findings published in The Lancet.
Andrew Clark, MBBS, MRCPCH, MD, of the department of medicine at the University of Cambridge, and colleagues evaluated 99 children aged 7 to 16 years (median age, 12.4 years) with an immediate hypersensitivity reaction after peanut ingestion, positive skin prick test to peanuts, and who were positive by double blind placebo-controlled food challenge to determine whether oral immunotherapy can desensitize children with peanut allergies. Patients were randomly assigned to active oral immunotherapy (active group) or peanut avoidance (control group). Desensitization was measured after 6 months (first phase) in the active group after they were given 1,400 mg protein in a double blind placebo-controlled food challenge. The control group was given oral immunotherapy during the second phase.
After the first phase, 62% of the active group had no reaction to 1,400 mg peanut protein compared with 0% of the control group (P<.001). Daily ingestion of 800 mg protein, or roughly five peanuts, for 26 weeks was tolerated in 84% of the active group at the end of the first phase and 91% of the control group after the second phase.
Oral itching was the most common adverse event. Twenty-two patients experienced wheezing. However, no serious adverse reactions or cardiovascular events occurred.
“Since, to our knowledge, this is the first study of its type, our findings are relevant to the population studies, but will need confirmation in other subgroups of patients,” the researchers wrote. “Because of the significant risks involved, [oral immunotherapy] should be restricted to specialist centers.”
In an accompanying editorial, Matthew J. Greenhawt, MD, an Infectious Diseases in Children Editorial Board member, wrote that although evidence was provided that oral immunotherapy could treat food allergy, more evidence is needed.
“It is important to understand that [oral immunotherapy] research cannot be rushed, and is years away from routine clinical use,” he wrote. “Investigative groups need time to refine protocols, revalidate data, understand the mechanisms of [oral immunotherapy], and minimize adverse effects. This must be done without added pressure or heightened expectations to quickly produce a marketable therapy.”
For more information:
Anagonostou K. Lancet. 2014;doi:10.1016/S0140-6736(13)2301-6.
Greenhawt MJ. Lancet. 2014;doi:10.1016/S0140-6736(13)62671-9.
Disclosure: See study for a full list of disclosures.