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Sustained unresponsiveness to peanut in subjects who have completed peanut oral immunotherapy
- Source :
- Journal of Allergy and Clinical Immunology. 133:468-475.e6
- Publication Year :
- 2014
- Publisher :
- Elsevier BV, 2014.
-
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 IgG 4 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.
- Subjects :
- medicine.medical_specialty
Adolescent
Arachis
Oral immunotherapy
medicine.medical_treatment
Immunology
Peanut allergy
Administration, Oral
Immunoglobulin E
Article
Double-Blind Method
Internal medicine
Multiple time
medicine
Humans
Immunology and Allergy
Peanut Hypersensitivity
Child
Glycoproteins
Plant Proteins
Skin Tests
Desensitization (medicine)
biology
Oral food challenge
business.industry
Infant
Membrane Proteins
food and beverages
Total ige
Antigens, Plant
medicine.disease
Clinical trial
Desensitization, Immunologic
Child, Preschool
biology.protein
business
2S Albumins, Plant
Subjects
Details
- ISSN :
- 00916749
- Volume :
- 133
- Database :
- OpenAIRE
- Journal :
- Journal of Allergy and Clinical Immunology
- Accession number :
- edsair.doi.dedup.....12f9e4eaad1b6671586f102aef2c5221