Long-term sublingual immunotherapy for peanut allergy in children: Clinical and immunologic evidence of desensitization

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:144

Article

Kim, Edwin H.¹  Yang, Luanna²  Ye, Ping²  Guo, Rishu²  Li, Quefeng³  Kulis, Michael D.²  Burks, A. Wesley² 

[1] Univ N Carolina, Sch Med, Dept Med, Div Rheumatol Allergy & Immunol, Chapel Hill, NC 27515 USA

[2] Univ N Carolina, Sch Med, Dept Pediat, Div Allergy Immunol & Rheumatol, Chapel Hill, NC 27515 USA

[3] Univ N Carolina, Dept Biostat, Gillings Sch Global Publ Hlth, Chapel Hill, NC 27515 USA

关键词: Peanut allergy;    sublingual immunotherapy;    food immunotherapy;    food desensitization;    sustained unresponsiveness;    food allergy treatments;   

DOI  :  10.1016/j.jaci.2019.07.030

来源: Elsevier

【 摘 要 】

Background: Peanut sublingual immunotherapy (SLIT) for 1 year has been shown to induce modest clinical desensitization in allergic children. Studies of oral immunotherapy, epicutaneous immunotherapy, and SLIT have suggested additional benefit with extended treatment. Objective: We sought to investigate the safety, clinical effectiveness, and immunologic changes with long-term SLIT in children with peanut allergy. Methods: Children with peanut allergy aged 1 to 11 years underwent extended maintenance SLIT with 2 mg/d peanut protein for up to 5 years. Subjects with peanut skin test wheals of less than 5 mm and peanut-specific IgE levels of less than 15 kU/L were allowed to discontinue therapy early. Desensitization was assessed through a double-blind, placebo-controlled food challenge (DBPCFC) with up to 5000 mg of peanut protein after completion of SLIT dosing. Sustained unresponsiveness was further assessed by using identical DBPCFCs after 2 to 4 weeks without peanut exposure. Results: Thirty-seven of 48 subjects completed 3 to 5 years of peanut SLIT, with 67% (32/48) successfully consuming 750 mg or more during DBPCFCs. Furthermore, 25% (12/48) passed the 5000-mg DBPCFC without clinical symptoms, with 10 of these 12 demonstrating sustained unresponsiveness after 2 to 4 weeks. Side effects were reported with 4.8% of doses, with transient oropharyngeal itching reported most commonly. Side effects requiring antihistamine treatment were uncommon (0.21%), and no epinephrine was administered. Peanut skin test wheals, peanut-specific IgE levels, and basophil activation decreased significantly, and peanut-specific IgG 4 levels increased significantly after peanut SLIT. Conclusion: Extended-therapy peanut SLIT provided clinically meaningful desensitization in the majority of children with peanut allergy that was balanced with ease of administration and a favorable safety profile.

【 授权许可】

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