Epicutaneous immunotherapy for the treatment of peanut allergy in children and young adults

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:139

Article

Jones, Stacie M.^1,2  Sicherer, Scott H.³  Burks, A. Wesley⁴  Leung, Donald Y. M.⁵  Lindblad, Robert W.⁶  Dawson, Peter⁶  Henning, Alice K.⁶  Berin, M. Cecilia³  Chiang, David³  Vickery, Brian P.⁴  Pesek, Robbie D.^1,2  Cho, Christine B.⁶  Davidson, Wendy F.⁷  Plaut, Marshall⁷  Sampson, Hugh A.³  Wood, Robert A.⁸ 

[1] Univ Arkansas Med Sci, Dept Pediat, 13 Childrens Way,Slot 512-13, Little Rock, AR 72205 USA

[2] Arkansas Childrens Hosp, 800 Marshall St, Little Rock, AR 72202 USA

[3] Icahn Sch Med Mt Sinai, Dept Pediat, New York, NY 10029 USA

[4] Univ N Carolina, Dept Pediat, Chapel Hill, NC USA

[5] Natl Jewish Hlth, Dept Pediat, Denver, CO USA

[6] EMMES Corp, Rockville, MD USA

[7] NIAID, NIH, 9000 Rockville Pike, Bethesda, MD 20892 USA

[8] Johns Hopkins Univ, Sch Med, Dept Pediat, Baltimore, MD 21205 USA

关键词: Peanut hypersensitivity;    food allergy;    immunotherapy;    IgE;    desensitization;    epicutaneous;   

DOI  :  10.1016/j.jaci.2016.08.017

来源: Elsevier

【 摘 要 】

Background: Peanut allergy is common, life-threatening, and without therapeutic options. We evaluated peanut epicutaneous immunotherapy (EPIT) by using Viaskin Peanut for peanut allergy treatment. Objective: We sought to evaluate the clinical, safety, and immunologic effects of EPIT for the treatment of peanut allergy. Methods: In this multicenter, double-blind, randomized, placebo-controlled study, 74 participants with peanut allergy (ages 4-25 years) were treated with placebo (n = 25), Viaskin Peanut 100 mu g (VP100; n = 24) or Viaskin Peanut 250 mu g (VP250; n = 25; DBV Technologies, Montrouge, France). The primary outcome was treatment success after 52 weeks, which was defined as passing a 5044-mg protein oral food challenge or achieving a 10-fold or greater increase in successfully consumed dose from baseline to week 52. Adverse reactions and mechanistic changes were assessed. Results: At week 52, treatment success was achieved in 3 (12%) placebo-treated participants, 11 (46%) VP100 participants, and 12 (48%) VP250 participants (P = .005 and P = .003, respectively, compared with placebo; VP100 vs VP250, P = .48). Median change in successfully consumed doses were 0, 43, and 130 mg of protein in the placebo, VP100, and VP250 groups, respectively (placebo vs VP100, P = .014; placebo vs VP250, P = .003). Treatment success was higher among younger children (P = .03; age, 4-11 vs >11 years). Overall, 14.4% of placebo doses and 79.8% of VP100 and VP250 doses resulted in reactions, predominantly local patch-site and mild reactions (P = .003). Increases in peanut-specific IgG(4) levels and IgG(4)/IgE ratios were observed in peanut EPIT-treated participants, along with trends toward reduced basophil activation and peanut-specific T(H)2 cytokines. Conclusions: Peanut EPIT administration was safe and associated with a modest treatment response after 52 weeks, with the highest responses among younger children. This, when coupled with a high adherence and retention rate and

【 授权许可】

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