Randomized Clinical Trial Finds Exposure Therapy Reverses Peanut Allergy in Infants, Toddlers

By John Henry Dreyfuss, MDalert.com staff.

Save to PDF Allergy and ImmunologyPediatricsPerformance-Based Medicine By
  • The peanut plant (Figure 1) contains a number of allergenic proteins.
  • Exposure therapy for infants and toddlers leaves 4 out of 5 desensitized, study finds.
  • Primary endpoint of sustained unresponsiveness to peanuts achieved in significantly more children in treatment groups.
  • Earlier implementation of peanut protein exposure therapy yields superior results.
  • At 2 treatment doses, exposure therapy was effective in rapidly suppressing allergic immune responses and achieving safe dietary reintroduction of peanuts.
  • Study adds to collection of studies showing that exposure is treatment of many childhood allergies.

 

Figure 1. The peanut plant.
(Sources: Wikipedia/By Franz Eugen Köhler, Köhler's Medizinal-Pflanzen/Public Domain.)

 

At 2 doses tested, early oral immunotherapy (E-OIT) was found to safely and effectively relieve peanut allergies in infants and young children (Figure 2). Earlier implementation of E-OIT was found to be more effective than later implementation, according to the results of a study published recently in the Journal of Allergy and Clinical Immunology. in  E-OIT “was highly successful in rapidly suppressing allergic immune responses and achieving safe dietary reintroduction,” the authors concluded.

The Ara h 2 and Ara h 6 proteins together account for the majority of allergic reactions to peanuts.

"If you are peanut-allergic, treatment early in life can have a longer benefit after stopping the treatment," said lead author A. Wesley Burks, MD, Curnen Distinguished Professor in the Department of Pediatrics, and a pediatric allergist at the University of North Carolina (UNC) School of Medicine at Chapel Hill. He is also the Executive Dean for the UNC School of Medicine, a past Chair and member of the National Institutes of Health (NIH) Hypersensitivity, Autoimmune, and Immune-mediated Diseases study section, and is Past President of the American Academy of Allergy, Asthma and Immunology.

"After the study we have continued to follow them and the group is still doing well," said Dr. Burks. “The follow-up period is now 2 years, and the benefits are longer-lasting than other studies have found,” he said.

Dr. Burks noted one very important caveat regarding E-OIT: Parents should never try exposure therapy on their own.

 

Figure 2. Staff Sgt. Kristin Parsons loads reagents into allergy testing machine in the diagnostic
 immunology lab at Wilford Hall Medical Center, Lackland Air Force Base, Texas. The lab recently
was named the Air Force's Center of Excellence for allergen testing.
(Sources: Wikipedia/By U.S. Air Force photo/Senior Airman Erin M. Peterson/
USAF Photographic Archives/Public Domain.)

 

Background

“Oral immunotherapy (OIT) is an effective experimental food allergy treatment that is limited by treatment withdrawal and the frequent reversibility of desensitization if interrupted. Newly diagnosed preschool children may have clinical and immunological characteristics more amenable to treatment,” explained the authors of the article in the Journal of Allergy and Clinical Immunology.

MDalert.com has covered this topic extensively. The evidence accumulates to support the hypothesis that exposure is the optimal treatment of a variety of childhood allergies. See our related articles here, here, and here.

 

Treated children were 19 times more likely
to become able to successfully consume dietary
peanut than were matched standard-care controls.


Objective, Methods, and Results

In the recent article in the Journal of Allergy and Clinical Immunology, the authors intended to test the safety, effectiveness, and feasibility of E-OIT in the treatment of peanut allergy (Figure 3).

The researchers enrolled 40 children aged 9 to 36 months with suspected or known peanut allergy. Included in the trial were children who reacted to peanut during an entry food challenge. The children were then randomly assigned to receive E-OIT at doses of 300mg/d or 3000mg/d in a double-blinded fashion.

 

Figure 3. A schematic of the allergy pathway.
(Sources: Wikipedia/By SariSabban - Sabban, Sari/Creative Commons.)

 

The primary end point was sustained unresponsiveness to peanut challenge at 4 weeks after stopping E-OIT (4-SU). The endpoint was assessed by double-blinded, placebo-controlled food challenge either upon achieving 4 pre-specified criteria, or after 3 maintenance years. “Peanut-specific immune responses were serially analyzed. Outcomes were compared with 154 matched standard-care controls,” the researchers explained.

Of 40 initial participants, 3 (7.5%) did not qualify. “Overall, 29 of 37 (78%) in the intent-to-treat analysis achieved 4-SU (300-mg arm, 17 of 20 [85%]; 3000 mg, 12 of 17 [71%], P=0.43) over a median of 29 months. Per-protocol, the overall proportion achieving 4-SU was 29 of 32 (91%). Peanut-specific IgE levels significantly declined in E-OIT-treated children, who were 19 times more likely to successfully consume dietary peanut than matched standard-care controls, in whom peanut-specific IgE levels significantly increased (relative risk, 19.42; 95% CI, 8.7-43.7; P<0.001). Allergic side effects during E-OIT were common but all were mild to moderate.


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