This article is more than 5 years old. Information may no longer be current.
OIT desensitized children with peanut allergy of any severity
Click Here to Manage Email Alerts
Oral immunotherapy yielded positive desensitization among children with peanut allergy of any severity, with a clinically meaningful increase in peanut threshold, according to a recent study.
“Daily doses of peanut [oral immunotherapy] of up to 800 mg protein had a clinically meaningful effect, shown by a high incidence of desensitization, large absolute and fold increases in threshold (NOAEL), and a significant improvement in quality-of-life score; 84% of participants in the first phase and 91% in the second phase could tolerate daily ingestion roughly equivalent to five peanuts per day,” Katherine Anagnostou, PhD, of Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK, and colleagues wrote.
Katherine Anagnostou
They conducted a randomized controlled crossover trial to compare the efficacy of active oral immunotherapy (OIT) using a novel up-dosing regimen of 2 mg, 5 mg, 12.5 mg, 25 mg, 50 mg, 100 mg, 200 mg, 400 mg, and 800 mg of peanut flour (light roast flour; Golden Peanut Co.), compared with a control arm of peanut avoidance (n=46), according to data.
Patients aged 7 to 16 years (n=39) with an immediate hypersensitivity reaction after peanut ingestion, positive skin prick test to peanuts and positive by double blind placebo-controlled food challenge were randomly assigned in a 1:1 fashion.
Data indicated that desensitization was recorded for 24 patients (62%; 95% CI, 45-78) in the active group and none of the controls after the first phase (P<.001). They also reported that 84% (95% CI, 70-93) of the active group tolerated daily ingestion of 800 mg protein (ie, five peanuts).
The median increase in peanut threshold following OIT was 1,345 mg (95% CI, 45-1,400) or 25.5 times (95% CI, 1.82-280).
Further improvements were recognized after the second phase, including 54% (95% CI, 35-72) who tolerated 1,400 mg challenge (ie, 10 peanuts); and 91% (95% CI, 79-98) of whom tolerated daily ingestion of 800 mg protein.
In addition, quality of life scores improved following OIT (–1.61; P<.001), according to data.
Adverse events were mild; the most common were nausea, vomiting, and diarrhea. Oral pruritus and wheezing also were observed.
Matthew J. Greenhawt
In an accompanying editorial, Matthew J. Greenhawt, MD, MBA, MSc, of the University of Michigan Food Allergy Center in the division of allergy and clinical immunology, wrote that the study by Anagnostou and colleagues provides further evidence that OIT is a potential treatment for food allergy, but that more high-quality data are required.
“It is important to understand that OIT research cannot be rushed, and is years away from routine clinical use,” Greenhawt wrote. “Investigative groups need time to refine protocols, revalidate data, understand the mechanisms of OIT, and minimize adverse effects. This must be done without added pressure or heightened expectations to quickly produce a marketable therapy.”
For more information:
Anagnostou K. Lancet. 2014;383:1297-1304.
Greenhawt MJ. Lancet. 2014;383:1272-1274.
Disclosure: Greenhawt is a member of the Educational Advisory Council for the National Peanut Board and has consulted for Deerfield Industries. Pamela Ewan, MD, and Andrew Clark, MD, are inventors on a patent application mentioned in this study. All other researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts