Tots with peanut allergies benefit greatly from oral immunotherapy

Peanut oral immunotherapy (OIT)—at both low and high doses—resulted in rapidly suppressed allergic immune responses in almost 80% of young children with peanut allergies who were aged 9 months to 36 months, with significant reductions in peanut-specific IgE levels, as well as the safe dietary re-introduction of peanuts, according to results from a recent clinical trial published online and currently in press in the Journal of Allergy and Clinical Immunology.

OIT for peanut allergy consists of the consumption of small, but gradually larger amounts of peanut protein each day. After previous studies had shown that peanut OIT conferred some protection against anaphylaxis due to peanut exposure in older children, researchers from the University of North Carolina-Chapel Hill, Chapel Hill, NC, and Duke University School of Medicine, Durham, NC, set out to discover whether OIT in younger children, in whom the duration of peanut allergy is relatively short simply because of their age, could change the course of their peanut allergy and allow them to successfully consume peanuts.

For this double-blind, placebo-controlled, randomized trial, these researchers led by Wesley Burks, MD, of the University of North Carolina at Chapel Hill, enrolled 37 children with suspected or known peanut allergy, who ranged in age from 9 to 36 months. Children were randomized (1:1) to early OIT at goal maintenance doses of 300 or 3,000 mg/d, and researchers compared their outcomes with those of 154 matched controls who received standard care.

After cessation of early intervention OIT over a median of 29 months, intent-to-treat analysis revealed that a full 78% of children had achieved sustained unresponsiveness at 4 weeks: 85% of the 300-mg group (17 of 20), and 71% of the 3,000-mg group (12 of 17)(P=0.43).

In children treated with early OIT, peanut-specific IgE levels declined significantly, and they were 19 times more likely to successfully eat peanuts compared to their matched controls, in whom peanut-specific IgE levels significantly increased during this time (RR: 19.42; 95% CI, 8.7-43.7; P < 0.001).

Children treated with early OIT commonly had allergic side effects, but these were all mild-to-moderate in severity.

“This study provides critical evidence supporting the safety and effectiveness of peanut oral immunotherapy in treating young children newly diagnosed with peanut allergy. Encouragingly, low-dose therapy was effective at suppressing allergic responses,” commented Marshall Plaut, MD, chief of the Food Allergy, Atopic Dermatitis and Allergic Mechanisms Section, National Institute of Allergy and Infectious Diseases (NIAID) Division of Allergy, Immunology and Transplantation.

The work was supported, in part, by the NIAID and the National Center for Advancing Translational Sciences, both part of the National Institutes of Health.