New Approach for Peanut Allergy in Children Holds Promise [NCCAM Research Results]

New Approach for Peanut Allergy in Children Holds Promise

A new treatment may be a safe and effective form of immunotherapy for children with peanut allergy, according to researchers at Duke University Medical Center and Massachusetts General Hospital. Currently, there are no treatments available for people with peanut allergy. The double-blind, placebo-controlled study, funded in part by NCCAM and published in The Journal of Allergy and Clinical Immunology, investigated the safety, clinical effectiveness, and immunologic changes with sublingual immunotherapy—a treatment that involves administering very small amounts of the allergen extract under a person’s tongue.

Researchers randomly assigned 18 children (ages 1 to 11 years) with known peanut allergy to receive either peanut sublingual immunotherapy or placebo. Participants in the peanut group received increased doses of peanut extract every 2 weeks for 6 months. Following each dose increase, participants continued the same daily dose at home. Once a maximum dose of 2,000 micrograms of peanut protein was reached, participants continued to take this daily maintenance dose at home for approximately 6 more months.

After a total of 12 months of sublingual immunotherapy, participants underwent a food challenge, which involved taking increasing doses of peanut protein in the form of peanut flour mixed with food. The food-challenge placebo consisted of oat flour mixed with food given in the same increments. Allergy skin prick tests were performed, and participants’ blood samples were taken at different points throughout the study.

The researchers found that the participants who had received peanut sublingual immunotherapy could safely consume 20 times more peanut protein than those who had received the placebo (1710 mg vs. 85 mg). This level of desensitization is clinically significant because it represents protection from accidental ingestion of peanut, which is often less than 100 mg (or one peanut). In addition, allergy skin prick tests showed a decreased allergic response to peanut in the treatment group. The blood tests showed immunologic changes in the treatment group, suggesting a significant change in allergic response.

The researchers concluded that these findings are promising, but more study is needed to determine whether sublingual immunotherapy can increase long-term tolerance to peanuts in children with peanut allergy.

Reference
Kim EH, Bird JA, Kulis M, et al. Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization. The Journal of Allergy and Clinical Immunology. 2011. ► Sublingual immunotherapy for peanut allergy: clini... [J Allergy Clin Immunol. 2011] - PubMed result


Additional Resources

Food Allergy (NIAID)► Food Allergy

Food Allergies (CDC) ► Food Allergies - DASH/HealthyYouth

Allergies and Food Sensitivities (USDA) ► Allergies and Food Sensitivities : Diet and Disease : Food and Nutrition Information Center

New Approach for Peanut Allergy in Children Holds Promise [NCCAM Research Results]


J Allergy Clin Immunol. 2011 Mar;127(3):640-6.e1. Epub 2011 Feb 1.
Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization.
Kim EH, Bird JA, Kulis M, Laubach S, Pons L, Shreffler W, Steele P, Kamilaris J, Vickery B, Burks AW.
SourceDepartment of Pediatrics, Division of Allergy and Immunology, Duke University Medical Center, Durham, NC 27710, USA.

Abstract
BACKGROUND: There are no treatments currently available for peanut allergy. Sublingual immunotherapy (SLIT) is a novel approach to the treatment of peanut allergy.

OBJECTIVE: We sought to investigate the safety, clinical effectiveness, and immunologic changes with SLIT in children with peanut allergy.

METHODS: In this double-blind, placebo-controlled study subjects underwent 6 months of dose escalation and 6 months of maintenance dosing followed by a double-blind, placebo-controlled food challenge.

RESULTS: Eighteen children aged 1 to 11 years completed 12 months of dosing and the food challenge. Dosing side effects were primarily oropharyngeal and uncommonly required treatment. During the double-blind, placebo-controlled food challenge, the treatment group safely ingested 20 times more peanut protein than the placebo group (median, 1,710 vs 85 mg; P = .011). Mechanistic studies demonstrated a decrease in skin prick test wheal size (P = .020) and decreased basophil responsiveness after stimulation with 10(-2) μg/mL (P = .009) and 10(-3) μg/mL (P = .009) of peanut. Peanut-specific IgE levels increased over the initial 4 months (P = .002) and then steadily decreased over the remaining 8 months (P = .003), whereas peanut-specific IgG4 levels increased during the 12 months (P = .014). Lastly, IL-5 levels decreased after 12 months (P = .015). No statistically significant changes were found in IL-13 levels, the percentage of regulatory T cells, or IL-10 and IFN-γ production.

CONCLUSION: Peanut SLIT is able to safely induce clinical desensitization in children with peanut allergy, with evidence of immunologic changes suggesting a significant change in the allergic response. Further study is required to determine whether continued peanut SLIT is able to induce long-term immune tolerance.

Copyright © 2011 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

PMID:21281959[PubMed - in process] PMCID: PMC3052379[Available on 2012/3/1]