A randomized controlled study of peanut oral immunotherapy: Clinical desensitization and modulation of the allergic response

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:127

Article

Varshney, Pooja¹  Jones, Stacie M.³  Scurlock, Amy M.³  Perry, Tamara T.³  Kemper, Alex²  Steele, Pamela¹  Hiegel, Anne³  Kamilaris, Janet¹  Carlisle, Suzanne³  Yue, Xiaohong¹  Kulis, Mike¹  Pons, Laurent¹  Vickery, Brian¹  Burks, A. Wesley¹ 

[1] Duke Univ, Med Ctr, Dept Pediat, Div Allergy & Immunol, Durham, NC 27710 USA

[2] Duke Univ, Med Ctr, Div Quantitat Sci, Durham, NC 27710 USA

[3] Univ Arkansas Med Sci, Dept Pediat, Sect Allergy & Immunol, Little Rock, AR 72205 USA

关键词: Peanut allergy;    oral immunotherapy;    desensitization;    food allergy;   

DOI  :  10.1016/j.jaci.2010.12.1111

来源: Elsevier

【 摘 要 】

Background: Open-label oral immunotherapy (OIT) protocols have been used to treat small numbers of patients with peanut allergy. Peanut OIT has not been evaluated in double-blind, placebo-controlled trials. Objective: To investigate the safety and effectiveness of OIT for peanut allergy in a double-blind, placebo-controlled study. Methods: In this multicenter study, children ages 1 to 16 years with peanut allergy received OIT with peanut flour or placebo. Initial escalation, build-up, and maintenance phases were followed by an oral food challenge (OFC) at approximately 1 year. Titrated skin prick tests (SPTs) and laboratory studies were performed at regular intervals. Results: Twenty-eight subjects were enrolled in the study. Three peanut OIT subjects withdrew early in the study because of allergic side effects. During the double-blind, placebo-controlled food challenge, all remaining peanut OIT subjects (n = 16) ingested the maximum cumulative dose of 5000 mg (approximately 20 peanuts), whereas placebo subjects (n = 9) ingested a median cumulative dose of 280 mg (range, 0-1900 mg; P < .001). In contrast with the placebo group, the peanut OIT group showed reductions in SPT size (P < .001), IL-5 (P = .01), and IL-13 (P = .02) and increases in peanut-specific IgG(4) (P < .001). Peanut OIT subjects had initial increases in peanut-specific IgE (P < .01) but did not show significant change from baseline by the time of OFC. The ratio of forkhead box protein 3 (FoxP3)(hi) : FoxP3(intermediate) CD4+ CD25+ T cells increased at the time of OFC (P = .04) in peanut OIT subjects. Conclusion: These results conclusively demonstrate that peanut OIT induces desensitization and concurrent immune modulation. The current study continues and is evaluating the hypothesis that peanut OIT causes long-term immune tolerance. (J Allergy Clin Immunol 2011;127:654-60.)

【 授权许可】

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