The Journal of Allergy and Clinical Immunology
Volume 126, Issue 1 , Pages 83-91.e1, July 2010

Oral peanut immunotherapy in children with peanut anaphylaxis

  • Katharina Blumchen, MD

      Affiliations

    • Department of Pediatric Pneumology and Immunology, University Hospital Charité, Berlin, Germany
    • ,
  • Helen Ulbricht

      Affiliations

    • Department of Pediatric Pneumology and Immunology, University Hospital Charité, Berlin, Germany
    • ,
  • Ute Staden, MD

      Affiliations

    • Department of Pediatric Pneumology and Immunology, University Hospital Charité, Berlin, Germany
    • ,
  • Kerstin Dobberstein

      Affiliations

    • Department of Pediatric Pneumology and Immunology, University Hospital Charité, Berlin, Germany
    • ,
  • John Beschorner

      Affiliations

    • Department of Pediatric Pneumology and Immunology, University Hospital Charité, Berlin, Germany
    • ,
  • Lucila Camargo Lopes de Oliveira, MD

      Affiliations

    • Department of Pediatric Pneumology and Immunology, University Hospital Charité, Berlin, Germany
    • ,
  • Wayne G. Shreffler, MD, PhD

      Affiliations

    • Department of Pediatrics, Mount Sinai Medical Center, New York, NY
    • ,
  • Hugh A. Sampson, MD

      Affiliations

    • Department of Pediatrics, Mount Sinai Medical Center, New York, NY
    • ,
  • Bodo Niggemann, MD

      Affiliations

    • Department of Pediatric Pneumology and Immunology, University Hospital Charité, Berlin, Germany
    • ,
  • Ulrich Wahn, MD

      Affiliations

    • Department of Pediatric Pneumology and Immunology, University Hospital Charité, Berlin, Germany
    • ,
  • Kirsten Beyer, MD

      Affiliations

    • Department of Pediatric Pneumology and Immunology, University Hospital Charité, Berlin, Germany
    • Corresponding Author InformationReprint requests: Kirsten Beyer, MD, Department of Pediatric Pneumology and Immunology, University Hospital Charité, Augustenburger Platz 1, 13353 Berlin, Germany.

Received 2 December 2009; received in revised form 26 April 2010; accepted 27 April 2010. published online 14 June 2010.

Background

The only treatment option for peanut allergy is strict avoidance.

Objective

To investigate efficacy and safety of oral immunotherapy (OIT) in peanut allergy.

Methods

Twenty-three children (age, 3.2-14.3 years) with IgE-mediated peanut allergy confirmed by positive double-blind, placebo-controlled food challenge (DBPCFC) received OIT following a rush protocol with roasted peanut for 7 days. If a protective dose of at least 0.5 g peanut was not achieved, patients continued with a long-term buildup protocol using biweekly dose increases up to at least 0.5 g peanut. A maintenance phase for 8 weeks was followed by 2 weeks of peanut avoidance and a final DBPCFC. Immunologic parameters were determined.

Results

After OIT using the rush protocol, patients tolerated a median dose of only 0.15 g peanut. Twenty-two of 23 patients continued with the long-term protocol. After a median of 7 months, 14 patients reached the protective dose. At the final DBPCFC, patients tolerated a median of 1 g (range, 0.25-4 g) in comparison with 0.19 g peanut at the DBPCFC before OIT (range, 0.02-1 g). In 2.6% of 6137 total daily doses, mild to moderate side effects were observed; in 1.3%, symptoms of pulmonary obstruction were detected. OIT was discontinued in 4 of 22 patients because of adverse events. There was a significant increase in peanut-specific serum IgG4 and a decrease in peanut-specific IL-5, IL-4, and IL-2 production by PBMCs after OIT.

Conclusion

Long-term OIT appears to be safe and of some benefit in many patients with peanut allergy. With an increase in threshold levels and a reduction of peanut-specific TH2 cytokine production, the induction of tolerance may be feasible in some patients.

Key words: Allergy, anaphylaxis, children, food, oral immunotherapy, peanut, specific oral tolerance induction, tolerance

Abbreviations used: DBPCFC, Double-blind, placebo-controlled food challenge, OIT, Oral immunotherapy, SPT, Skin prick test

 

 Supported by the Food Allergy and Anaphylaxis Network, USA.

 Disclosure of potential conflict of interest: H. A. Sampson receives research support from the Food Allergy Initiative and the NIAID, NIH; is a consultant/scientific advisor for the Food Allergy Initiative; and is 45% owner of Herbal Springs, LLC. U. Wahn receives research support from the German Research Foundation and Danone. K. Beyer receives honoraria from Dr Beckmann, Stallergenes, HAL, Nutricia, Phadia, CSL Behring, and GlaxoSmithKline and receives research support from the German Research Foundation, the European Union, the Food Allergy and Anaphylaxis Network, Phadia, and the Paul Ehrlich Institute. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(10)00726-8

doi:10.1016/j.jaci.2010.04.030

The Journal of Allergy and Clinical Immunology
Volume 126, Issue 1 , Pages 83-91.e1, July 2010

Article Tools

* Image Usage & Resolution