Sublingual Immunotherapy Offers Hope for Children With Peanut Allergy: Presented at AAAAI

SAN FRANCISCO -- March 24, 2011 -- Sublingual immunotherapy has demonstrated that it can desensitise children who are allergic to peanut protein, according to results from one of the first trials of its kind, presented at the 2011 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting.

There are currently no treatments available for peanut allergy, noted principal investigator Wesley Burks, MD, Duke Medical Center, Durham, North Carolina.

“There was a wide range of peanuts that these children tolerated following sublingual immunotherapy treatment, or ‘SLIT,’” Dr. Burks stated during an oral presentation on March 23. “We saw individual kids on active treatment who could tolerate 2,500 mg of peanuts at the end of the study compared to 85 mg and less in the placebo arm.”

Dr. Burks and colleagues conducted a 6-month, double-blind, placebo-controlled dose-escalation trial to a total of 2,000 mcg of peanut protein daily. The dose escalation was followed by 6 months of maintenance dosing before a double blind, placebo-controlled food challenge. A total of 18 children, aged 1 to 11 years of age at the beginning of the trial, completed the 1-year study and the food challenge. Eleven children were in the treatment arm and 7 were in the placebo arm.

The study was halted early because the treatment arm showed such strong evidence of efficacy, Dr. Burks noted.

During the final food challenge, children in the active arm were able to consume 20 times more peanuts -- a median of 1,710 mg (6 or 7 peanuts) – than children in the placebo arm, who could tolerate a median of 85 mg -- about 20% of a single peanut (P =.011).

Children in the treatment group showed an increase in peanut-specific immunoglobulin E over the first 4 months of the trial (P =.002) compared with the placebo group, then a steady decrease over the next 8 months (P =.003).

At the same time, peanut-specific immunoglobulin G4 increased over the 12 months of the trial (P =.014). Treatment also produced significantly smaller skin-prick-testing wheals (P =.020) and a decrease in the secretion of interleukin 5 after 12 months (P =.015).

There were no statistically significant differences in the percentage of T regulatory cells or interleukin 10 and interferon-gamma secretion between the groups, Dr. Burks noted.

The study is continuing, with all of the children in the placebo group moving to active treatment. Tolerance of peanut protein in the original placebo group has increased from a median of 85 mg to more than 500 mg in the latest food challenge, the researchers stated. The goal is to follow these children for a longer term to determine whether peanut tolerance continues to increase and whether the clinical effects of SLIT are long lasting.

[Presentation title: Evidence of Desensitization by Sublingual Immunotherapy in Peanut-Allergic. Abstract 269]  http://beta.docguide.com/sublingual-immunotherapy-offers-hope-children-peanut-allergy??tsid=25