Nearly 80 percent of peanut-allergic preschool children successfully incorporated peanut-containing foods into their diets after receiving peanut oral immunotherapy (OIT), a clinical trial has found. Peanut OIT involves eating small, gradually increasing amounts of peanut protein daily. Low-dose and high-dose OIT were safe and equally effective at suppressing allergic immune responses to peanut, investigators found. The work was partly supported by the National Institute of Allergy and Infectious Diseases (NIAID) and the National Center for Advancing Translational Sciences, both part of the National Institutes of Health.
Previous studies with older children showed that peanut OIT can offer some protection against potentially life-threatening anaphylaxis caused by peanut exposure. In this study, researchers led by Wesley Burks, M.D., of the University of North Carolina at Chapel Hill, assessed whether giving OIT to younger children whose duration of peanut allergy was short could alter the course of the allergy and allow safe introduction of peanut into the diet.
The study team enrolled 40 peanut-allergic children aged 9 to 36 months. They randomly assigned participants to either high-dose peanut OIT with a target daily dose of 3,000 milligrams peanut protein or a low-dose regimen with a target dose of 300 milligrams. Nearly all participants experienced some side effects, such as abdominal pain, but these were generally mild, and required little or no treatment. After receiving OIT for 29 months on average, participants avoided peanut completely for four weeks before attempting to reintroduce it into their diets.
Almost 80 percent of participants successfully reintroduced peanut with no allergic response, with no significant differences between the low-dose and high-dose arms. Comparison of the OIT-treated children with a control group of 154 peanut-allergic children who had avoided peanut showed that OIT-treated children were 19 times more likely to successfully incorporate peanut into their diets. The investigators are continuing to monitor the OIT-treated participants to assess the long-term treatment outcomes.
Currently, the NIAID-supported Immune Tolerance Network is conducting a randomized trial called IMPACT to determine whether peanut OIT can lower the risk of allergic reactions, induce tolerance and change the immune responses of peanut-allergic children aged 12 to 48 months.
BP Vickery et al. Early oral immunotherapy in peanut-allergic preschool children is safe and highly effective. Journal of Allergy and Clinical Immunology DOI: 10.1016/j.jaci.2016.05.027 (2016).
Marshall Plaut, M.D., chief of the Food Allergy, Atopic Dermatitis and Allergic Mechanisms Section in NIAID’s Division of Allergy, Immunology and Transplantation, is available to discuss the findings.