TY - JOUR
T1 - Sublingual immunotherapy for peanut allergy
T2 - Clinical and immunologic evidence of desensitization
AU - Kim, Edwin H.
AU - Bird, J. Andrew
AU - Kulis, Michael
AU - Laubach, Susan
AU - Pons, Laurent
AU - Shreffler, Wayne
AU - Steele, Pamela
AU - Kamilaris, Janet
AU - Vickery, Brian
AU - Burks, A. Wesley
N1 - Funding Information:
Disclosure of potential conflict of interest: J. A. Bird has received research support from the American Academy of Allergy, Asthma & Immunology and the Food Allergy Initiative . M. Kulis has received research support from the National Institutes of Health (NIH)/National Institute of Allergy and Infectious Diseases (NIAID). W. Shreffler has received research support from the NIAID . B. Vickery has received research support from the NIH/NIAID, Thrasher Research Fund, American Lung Association, and Cephalon . A. W. Burks has consulted for ActoGeniX NV, Intelliject, McNeil Nutritionals, Novartis, and Schering-Plough; is a minority stockholder in Allertein and MastCell, Inc; is on an advisory board for Dannon Co Probiotics; is on an expert panel for Nutricia; has received research support from the NIH, Food Allergy and Anaphylaxis Network (FAAN), and Wallace Research Foundation ; and is on the medical board of directors of FAAN. The rest of the authors have declared that they have no conflict of interest.
Funding Information:
Supported by the National Institutes of Health : NCCAM R01–AT004435–03 , 5T32–AI007062–32 ; the American Academy of Allergy, Asthma & Immunology/Food Allergy Initiative Howard Gittis Memorial 3rd Year/4th Year Fellowship/Instructor Award (J. A. B.); and the Wallace Research Foundation ( WRF2010.01 ). Additional support for the project was provided by grant UL1RR024128 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and the NIH Roadmap for Medical Research, and its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.
PY - 2011/3
Y1 - 2011/3
N2 - Background: There are no treatments currently available for peanut allergy. Sublingual immunotherapy (SLIT) is a novel approach to the treatment of peanut allergy. Objective: We sought to investigate the safety, clinical effectiveness, and immunologic changes with SLIT in children with peanut allergy. Methods: In this double-blind, placebo-controlled study subjects underwent 6 months of dose escalation and 6 months of maintenance dosing followed by a double-blind, placebo-controlled food challenge. Results: Eighteen children aged 1 to 11 years completed 12 months of dosing and the food challenge. Dosing side effects were primarily oropharyngeal and uncommonly required treatment. During the double-blind, placebo-controlled food challenge, the treatment group safely ingested 20 times more peanut protein than the placebo group (median, 1,710 vs 85 mg; P = .011). Mechanistic studies demonstrated a decrease in skin prick test wheal size (P = .020) and decreased basophil responsiveness after stimulation with 10-2 μg/mL (P = .009) and 10-3 μg/mL (P = .009) of peanut. Peanut-specific IgE levels increased over the initial 4 months (P = .002) and then steadily decreased over the remaining 8 months (P = .003), whereas peanut-specific IgG4 levels increased during the 12 months (P = .014). Lastly, IL-5 levels decreased after 12 months (P = .015). No statistically significant changes were found in IL-13 levels, the percentage of regulatory T cells, or IL-10 and IFN-γ production. Conclusion: Peanut SLIT is able to safely induce clinical desensitization in children with peanut allergy, with evidence of immunologic changes suggesting a significant change in the allergic response. Further study is required to determine whether continued peanut SLIT is able to induce long-term immune tolerance.
AB - Background: There are no treatments currently available for peanut allergy. Sublingual immunotherapy (SLIT) is a novel approach to the treatment of peanut allergy. Objective: We sought to investigate the safety, clinical effectiveness, and immunologic changes with SLIT in children with peanut allergy. Methods: In this double-blind, placebo-controlled study subjects underwent 6 months of dose escalation and 6 months of maintenance dosing followed by a double-blind, placebo-controlled food challenge. Results: Eighteen children aged 1 to 11 years completed 12 months of dosing and the food challenge. Dosing side effects were primarily oropharyngeal and uncommonly required treatment. During the double-blind, placebo-controlled food challenge, the treatment group safely ingested 20 times more peanut protein than the placebo group (median, 1,710 vs 85 mg; P = .011). Mechanistic studies demonstrated a decrease in skin prick test wheal size (P = .020) and decreased basophil responsiveness after stimulation with 10-2 μg/mL (P = .009) and 10-3 μg/mL (P = .009) of peanut. Peanut-specific IgE levels increased over the initial 4 months (P = .002) and then steadily decreased over the remaining 8 months (P = .003), whereas peanut-specific IgG4 levels increased during the 12 months (P = .014). Lastly, IL-5 levels decreased after 12 months (P = .015). No statistically significant changes were found in IL-13 levels, the percentage of regulatory T cells, or IL-10 and IFN-γ production. Conclusion: Peanut SLIT is able to safely induce clinical desensitization in children with peanut allergy, with evidence of immunologic changes suggesting a significant change in the allergic response. Further study is required to determine whether continued peanut SLIT is able to induce long-term immune tolerance.
KW - Peanut allergy
KW - desensitization
KW - food allergy
KW - sublingual immunotherapy
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U2 - 10.1016/j.jaci.2010.12.1083
DO - 10.1016/j.jaci.2010.12.1083
M3 - Article
C2 - 21281959
AN - SCOPUS:79952305190
SN - 0091-6749
VL - 127
SP - 640-646.e1
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 3
ER -