Desensitization And Remission After Peanut Sublingual Immunotherapy in 1- To 4-Year-Old Peanut-Allergic Children: A Randomized, Placebo-Controlled Trial
Year: 2024
Type: conference-abstract
Abstract: Assess the safety and efficacy of peanut sublingual immunotherapy (SLIT) in children of ages 1 to 4 years.Fifty patients aged 1 to 4 years with peanut allergy. Inclusion criteria required positive reaction in a double-blind placebo-controlled food challenge (DBPCFC) to peanut, plus either peanut-specific IgE (pn-IgE) ≥ 0.35 kUA/L and positive peanut skin prick test (SPT) in the setting of convincing clinical history of peanut allergy, or pn-IgE ≥ 5 kUA/L and positive peanut SPT in otherwise peanut naïve patients. Patients with history of severe anaphylaxis to peanut, eosinophilic, or other inflammatory gastrointestinal disease, and severe asthma were excluded from the study.This was a randomized, double-blind, placebo-controlled study conducted at 2 large academic sites. Patients were randomly assigned to receive peanut versus placebo SLIT. Initial dose under observation at clinical sites started at 1:100 dilution of peanut (2.5 µg peanut protein). Dose was held under the tongue for 2 minutes, then swallowed. If tolerated, patients continued that dose at home daily, with escalations at home and in-office according to protocol, until achieving maintenance dose of 4 mg. DBPCFC was performed at entry, at 36 months to assess desensitization, and 3 months after discontinuation of therapy to assess remission.There was a significantly greater median cumulative tolerated dose (44,443 mg versus 143 mg) in patients who were actively treated versus patients who received placebo, with an associated higher likelihood of passing the month 36 DBPCFC (60% versus 0) and demonstrating remission at month 39 DBPCFC (48% versus 0). Desensitization and remission rates were highest in the group of 1- to 2-year-olds. Changes in peanut-specific SPT, IgG4, and IgG4/IgE ratio were noted in patients who received peanut SLIT but not placebo. Patients in the peanut SLIT group reported oropharyngeal itching more commonly, but other adverse events, including the skin, gastrointestinal, and respiratory systems, were comparable between treatment groups.Peanut SLIT can induce desensitization and subsequent remission safely in peanut allergic children ages 1 to 4 years old. Improved outcomes were seen when initiated at a younger age.Allergy to peanut often develops early in life and is rarely outgrown. Sublingual immunotherapy provides a unique approach to desensitize patients to peanuts by taking advantage of the immunologic environment of the oral mucosa. Although this was a small study population, and it is likely that the young children in the study were not fully able to cooperate with instructions of holding the study drug under their tongue, thereby providing a form of low-dose oral immunotherapy, this study provides evidence that this could be a well-tolerated therapeutic option for young peanut-allergic pediatric patients.
Source: PEDIATRICS
Authors: Natalie Trotto, Vivian Hernandez-Trujillo
Language: English
Subfield: Immunology and Allergy
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4404924707