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.
RCT Entities:
BACKGROUND: There are no treatments currently available for peanutallergy. Sublingual immunotherapy (SLIT) is a novel approach to the treatment of peanutallergy. OBJECTIVE: We sought to investigate the safety, clinical effectiveness, and immunologic changes with SLIT in children with peanutallergy. 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 peanutallergy, 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.
Authors: H S Skolnick; M K Conover-Walker; C B Koerner; H A Sampson; W Burks; R A Wood Journal: J Allergy Clin Immunol Date: 2001-02 Impact factor: 10.793
Authors: Laurent Pons; Usha Ponnappan; Renée A Hall; Pippa Simpson; Gael Cockrell; C Michael West; Hugh A Sampson; Ricki M Helm; A Wesley Burks Journal: J Allergy Clin Immunol Date: 2004-10 Impact factor: 10.793
Authors: G Patriarca; E Nucera; C Roncallo; E Pollastrini; F Bartolozzi; T De Pasquale; A Buonomo; G Gasbarrini; C Di Campli; D Schiavino Journal: Aliment Pharmacol Ther Date: 2003-02 Impact factor: 8.171
Authors: Corinne A Keet; Pamela A Frischmeyer-Guerrerio; Ananth Thyagarajan; John T Schroeder; Robert G Hamilton; Stephen Boden; Pamela Steele; Sarah Driggers; A Wesley Burks; Robert A Wood Journal: J Allergy Clin Immunol Date: 2011-11-30 Impact factor: 10.793