Sublingual immunotherapy for peanut allergy: Long-term follow-up of a randomized multicenter trial

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:135

Article

Burks, A. Wesley¹  Wood, Robert A.²  Jones, Stacie M.^3,4  Sicherer, Scott H.⁵  Fleischer, David M.^6,7  Scurlock, Amy M.^3,4  Vickery, Brian P.¹  Liu, Andrew H.⁸  Henning, Alice K.⁹  Lindblad, Robert⁹  Dawson, Peter⁹  Plaut, Marshall¹⁰  Sampson, Hugh A.⁵ 

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

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

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

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

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

[6] Univ Colorado, Denver Sch Med, Dept Pediat, Denver, CO 80202 USA

[7] Childrens Hosp Colorado, Denver, CO USA

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

[9] EMMES Corp, Rockville, MD USA

[10] NIAID, NIH, Bethesda, MD 20892 USA

关键词: Peanut allergy;    sublingual immunotherapy;    desensitization;    food allergy;    follow-up;   

DOI  :  10.1016/j.jaci.2014.12.1917

来源: Elsevier

【 摘 要 】

Background: We previously reported the initial results of the first multicenter, randomized, double-blind, placebo-controlled clinical trial of peanut sublingual immunotherapy (SLIT), observing a favorable safety profile associated with modest clinical and immunologic effects in the first year. Objective: We sought to provide long-term (3-year) clinical and immunologic outcomes for our peanut SLIT trial. Key end points were (1) percentage of responders at 2 years (ie, could consume 5 g of peanut powder or a 10-fold increase from baseline), (2) percentage reaching desensitization at 3 years, (3) percentage attaining sustained unresponsiveness after 3 years, (4) immunologic end points, and (5) assessment of safety parameters. Methods: Response to treatment was evaluated in 40 subjects aged 12 to 40 years by performing a 10-g peanut powder oral food challenge after 2 and 3 years of daily peanut SLIT therapy. At 3 years, SLIT was discontinued for 8 weeks, followed by another 10-g oral food challenge and an open feeding of peanut butter to assess sustained unresponsiveness. Results: Approximately 98% of the 18,165 doses were tolerated without adverse reactions beyond the oropharynx, with no severe symptoms or uses of epinephrine. A high rate (> 50%) discontinued therapy. By study's end, 4 (10.8%) of 37 SLITtreated participants were fully desensitized to 10 g of peanut powder, and all 4 achieved sustained unresponsiveness. Responders at 2 years showed a significant decrease in peanutspecific basophil activation and skin prick test titration compared with nonresponders. Conclusions: Peanut SLIT induced a modest level of desensitization, decreased immunologic activity over 3 years in responders, and had an excellent long-term safety profile. However, most patients discontinued therapy by the end of year 3, and only 10.8% of subjects achieved sustained unresponsiveness.

【 授权许可】

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