Journal
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
Volume 127, Issue 3, Pages 640-U153Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2010.12.1083
Keywords
Peanut allergy; sublingual immunotherapy; desensitization; food allergy
Categories
Funding
- National Institutes of Health [NCCAM R01-AT004435-03, 5T32-AI007062-32]
- American Academy of Allergy, Asthma & Immunology/Food Allergy Initiative
- Wallace Research Foundation [WRF2010.01]
- National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) [UL1RR024128]
- NIH Roadmap for Medical Research
- NIAID
- NIH/NIAID
- Thrasher Research Fund
- American Lung Association
- Cephalon
- Anaphylaxis Network (FAAN)
- Wallace Research Foundation
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Background: There are no treatments currently available for peanut allergy. Sublingual immunotherapy (SLIT) is a novel approach to the treatment of peanut allergy. Objective: We sought to investigate the safety, clinical effectiveness, and immunologic changes with SLIT in children with peanut allergy. Methods: In this double-blind, placebo-controlled study subjects underwent 6 months of dose escalation and 6 months of maintenance dosing followed by a double-blind, placebo-controlled food challenge. Results: Eighteen children aged 1 to 11 years completed 12 months of dosing and the food challenge. Dosing side effects were primarily oropharyngeal and uncommonly required treatment. During the double-blind, placebo-controlled food challenge, the treatment group safely ingested 20 times more peanut protein than the placebo group (median, 1,710 vs 85 mg; P = .011). Mechanistic studies demonstrated a decrease in skin prick test wheal size (P = .020) and decreased basophil responsiveness after stimulation with 10(-2) mu g/mL (P = .009) and 10(-3) mu g/mL (P = .009) of peanut. Peanut-specific IgE levels increased over the initial 4 months (P = .002) and then steadily decreased over the remaining 8 months (P = .003), whereas peanut-specific IgG4 levels increased during the 12 months (P = .014). Lastly, IL-5 levels decreased after 12 months (P = .015). No statistically significant changes were found in IL-13 levels, the percentage of regulatory T cells, or IL-10 and IFN-gamma production. Conclusion: Peanut SLIT is able to safely induce clinical desensitization in children with peanut allergy, with evidence of immunologic changes suggesting a significant change in the allergic response. Further study is required to determine whether continued peanut SLIT is able to induce long-term immune tolerance. (J Allergy Clin Immunol 2011;127:640-6.)
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