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J Allergy Clin Immunol. 2014 Feb;133(2):468-75. doi: 10.1016/j.jaci.2013.11.007. Epub 2013 Dec 19.

Sustained unresponsiveness to peanut in subjects who have completed peanut oral immunotherapy.

Author information

1
Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC. Electronic address: bvickery@email.unc.edu.
2
Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark.
3
Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC.
4
Duke Translational Medicine Institute, Durham, NC.
5
Department of Pediatrics, Duke University School of Medicine, Durham, NC.
6
Section of Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College, London, United Kingdom.

Abstract

BACKGROUND:

Although peanut oral immunotherapy (OIT) has been conclusively shown to cause desensitization, it is currently unknown whether clinical protection persists after stopping therapy.

OBJECTIVE:

Our primary objective was to determine whether peanut OIT can induce sustained unresponsiveness after withdrawal of OIT.

METHODS:

We conducted a pilot clinical trial of peanut OIT at 2 US centers. Subjects age 1 to 16 years were recruited and treated for up to 5 years with peanut OIT. The protocol was modified over time to permit dose increases to a maximum of 4000 mg/d peanut protein. Blood was collected at multiple time points. Clinical end points were measured with 5000-mg double-blinded, placebo-controlled food challenges once specific criteria were met.

RESULTS:

Of the 39 subjects originally enrolled, 24 completed the protocol and had evaluable outcomes. Twelve (50%) of 24 successfully passed a challenge 1 month after stopping OIT and achieved sustained unresponsiveness. Peanut was added to the diet. At baseline and the time of challenge, such subjects had smaller skin test results, as well as lower IgE levels specific for peanut, Ara h 1, and Ara h 2 and lower ratios of peanut-specific IgE/total IgE compared with subjects not passing. There were no differences in peanut IgG₄ levels or functional activity at the end of the study.

CONCLUSIONS:

This is the first demonstration of sustained unresponsiveness after peanut OIT, occurring in half of subjects treated for up to 5 years. OIT favorably modified the peanut-specific immune response in all subjects completing the protocol. Smaller skin test results and lower allergen-specific IgE levels were predictive of successful outcome.

KEYWORDS:

DOFC; Desensitization oral food challenge; FAB; Facilitated antigen binding; OFC; OIT; Oral food challenge; Oral immunotherapy; Peanut allergy; SOFC; Sustained unresponsiveness oral food challenge; TF; TS; Treatment failure; Treatment success; desensitization; oral immunotherapy; sustained unresponsiveness; tolerance

PMID:
24361082
PMCID:
PMC3960331
DOI:
10.1016/j.jaci.2013.11.007
[Indexed for MEDLINE]
Free PMC Article
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