Sustained unresponsiveness to peanut in subjects who have completed peanut oral immunotherapy

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:133

Article

Vickery, Brian P.¹  Scurlock, Amy M.^2,3  Kulis, Michael¹  Steele, Pamela H.¹  Kamilaris, Janet¹  Berglund, Jelena P.⁴  Burk, Caitlin¹  Hiegel, Anne^2,3  Carlisle, Suzanna^2,3  Christie, Lynn^2,3  Perry, Tamara T.^2,3  Pesek, Robbie D.^2,3  Sheikh, Saira¹  Virkud, Yamini⁵  Smith, P. Brian⁵  Shamji, Mohamed H.⁶  Durham, Stephen R.⁶  Jones, Stacie M.^2,3  Burks, A. Wesley¹ 

[1] Univ N Carolina, Sch Med, Dept Pediat, Chapel Hill, NC USA

[2] Univ Arkansas Med Sci, Dept Pediat, Little Rock, AR 72205 USA

[3] Arkansas Childrens Hosp, Little Rock, AR 72202 USA

[4] Duke Translat Med Inst, Durham, NC USA

[5] Duke Univ, Dept Pediat, Sch Med, Durham, NC 27706 USA

[6] Imperial Coll, Natl Heart & Lung Inst, Sect Allergy & Clin Immunol, London, England

关键词: Peanut allergy;    oral immunotherapy;    desensitization;    tolerance;    sustained unresponsiveness;   

DOI  :  10.1016/j.jaci.2013.11.007

来源: Elsevier

【 摘 要 】

Background: Although peanut oral immunotherapy (OIT) has been conclusively shown to cause desensitization, it is currently unknown whether clinical protection persists after stopping therapy. Objective: Our primary objective was to determine whether peanut OIT can induce sustained unresponsiveness after withdrawal of OIT. Methods: We conducted a pilot clinical trial of peanut OIT at 2 US centers. Subjects age 1 to 16 years were recruited and treated for up to 5 years with peanut OIT. The protocol was modified over time to permit dose increases to a maximum of 4000 mg/d peanut protein. Blood was collected at multiple time points. Clinical end points were measured with 5000-mg double-blinded, placebo-controlled food challenges once specific criteria were met. Results: Of the 39 subjects originally enrolled, 24 completed the protocol and had evaluable outcomes. Twelve (50%) of 24 successfully passed a challenge 1 month after stopping OIT and achieved sustained unresponsiveness. Peanut was added to the diet. At baseline and the time of challenge, such subjects had smaller skin test results, as well as lower IgE levels specific for peanut, Ara h 1, and Ara h 2 and lower ratios of peanut-specific IgE/total IgE compared with subjects not passing. There were no differences in peanut IgG(4) levels or functional activity at the end of the study. Conclusions: This is the first demonstration of sustained unresponsiveness after peanut OIT, occurring in half of subjects treated for up to 5 years. OIT favorably modified the peanut-specific immune response in all subjects completing the protocol. Smaller skin test results and lower allergen-specific IgE levels were predictive of successful outcome.

【 授权许可】

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