Desensitization and remission after peanut sublingual immunotherapy in 1- to 4-year-old peanut-allergic children: A randomized, placebo-controlled trial

Edwin H. Kim, J. Andrew Bird, Corinne A. Keet, Yamini V. Virkud, Lauren Herlihy, Ping Ye, Johanna M. Smeekens, Rishu Guo, Xiaohong Yue, Anusha Penumarti, Bahjat Qaqish, Quefeng Li, Michael D. Kulis, A. Wesley Burks

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Background: Prior studies of peanut sublingual immunotherapy (SLIT) have suggested a potential advantage with younger age at treatment initiation. Objective: We studied the safety and efficacy of SLIT for peanut allergy in 1- to 4-year-old children. Methods: Peanut-allergic 1- to 4-year-old children were randomized to receive 4 mg peanut SLIT versus placebo. Desensitization was assessed by double-blind, placebo-controlled food challenge (DBPCFC) after 36 months of treatment. Participants desensitized to at least 443 mg peanut protein discontinued therapy for 3 months and then underwent DBPCFC to assess for remission. Biomarkers were measured at baseline and longitudinally during treatment. Results: Fifty participants (25 peanut SLIT, 25 placebo) with a median age of 2.4 years were enrolled across 2 sites. The primary end point of desensitization was met with actively treated versus placebo participants having a significantly greater median cumulative tolerated dose (4443 mg vs 143 mg), higher likelihood of passing the month 36 DBPCFC (60% vs 0), and higher likelihood of demonstrating remission (48% vs 0). The highest rate of desensitization and remission was seen in 1- to 2-year-olds, followed by 2- to 3-year-olds and 3- to 4-year-olds. Longitudinal changes in peanut skin prick testing, peanut-specific IgG4, and peanut-specific IgG4/IgE ratio were seen in peanut SLIT but not placebo participants. Oropharyngeal itching was more commonly reported by peanut SLIT than placebo participants. Skin, gastrointestinal, upper respiratory, lower respiratory, and multisystem adverse events were similar between treatment groups. Conclusion: Peanut SLIT safely induces desensitization and remission in 1- to 4-year-old children, with improved outcomes seen with younger age at initiation.

Original languageEnglish (US)
Pages (from-to)173-181.e10
JournalJournal of Allergy and Clinical Immunology
Volume153
Issue number1
DOIs
StatePublished - Jan 2024

Keywords

  • Peanut allergy
  • SLIT
  • desensitization
  • food allergy
  • food immunotherapy
  • remission
  • sublingual immunotherapy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Fingerprint

Dive into the research topics of 'Desensitization and remission after peanut sublingual immunotherapy in 1- to 4-year-old peanut-allergic children: A randomized, placebo-controlled trial'. Together they form a unique fingerprint.

Cite this