Oral Immunotherapy Induces Remission of Peanut Allergy
Giving peanut oral immunotherapy to highly peanut-allergic children ages 1 to 3 safely desensitized most of them to peanut.
Photo: Shutterstock/Hafiez Razali
An NIH clinical trial found that giving peanut oral immunotherapy to highly peanut-allergic children ages 1 to 3 years safely desensitized most of them to peanut and induced remission of peanut allergy in one-fifth.
The immunotherapy consisted of a daily oral dose of peanut flour for 2.5 years. Remission was defined as being able to eat 5 grams of peanut protein, equivalent to 1.5 tablespoons of peanut butter, without having an allergic reaction 6 months after immunotherapy. The youngest children and those who started the trial with lower levels of peanut-specific antibodies were most likely to achieve remission.
The results of this trial, called IMPACT and sponsored by NIAID, were published in The Lancet.
Peanut allergy affects about 2 percent of children in the U.S., or nearly 1.5 million individuals ages 17 years and younger. The risk of a life-threatening allergic reaction to accidentally eaten peanut is significant for these children, most of whom remain peanut-allergic for life.
Nearly 150 children ages 1 to 3 years participated in the IMPACT trial at 5 U.S. academic medical centers. The children were assigned at random to receive either flour containing peanut protein or a placebo flour.
During a 30-week period, children in the treatment group ate gradually escalating daily doses of up to 2 grams of peanut protein, equivalent to about 8 peanuts. The children then continued to consume their daily dose of peanut or placebo flour for an additional 2 years.
Next, the children received gradually increasing doses of peanut protein, then stopped treatment and avoided peanut for 6 months.
Finally, the children were given 5 grams of peanut protein. Those who did not have an allergic reaction were later fed 8 grams (2 tablespoons) of peanut butter, on a different day to confirm they could safely eat peanut.
At the end of the treatment period, 71 percent of children who received peanut flour were desensitized to peanut, compared to only 2 percent of those who received the placebo flour.