Long-term sublingual immunotherapy for peanut allergy in children: Clinical and immunologic evidence of desensitization
| Autor: | Edwin H. Kim, Luanna Yang, Rishu Guo, Michael D. Kulis, Quefeng Li, A. Wesley Burks, Ping Ye |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty Time Factors Arachis medicine.medical_treatment Immunology Peanut allergy Immunoglobulin E Article 03 medical and health sciences 0302 clinical medicine medicine Immune Tolerance Immunology and Allergy Humans Peanut Hypersensitivity Child Desensitization (medicine) Sublingual Immunotherapy Intention-to-treat analysis biology business.industry food and beverages Infant Allergens medicine.disease Slit Dermatology Basophil activation 030104 developmental biology Treatment Outcome 030228 respiratory system Child Preschool biology.protein Itching Antihistamine Female Immunization medicine.symptom business |
| Zdroj: | J Allergy Clin Immunol |
| ISSN: | 1097-6825 |
| Popis: | 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 IgG4 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. |
| Databáze: | OpenAIRE |
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