Feasibility of desensitizing children highly allergic to peanut by high-dose oral immunotherapy
Autor: | Karin C. Lødrup Carlsen, Magnus P. Borres, Geir Håland, Merethe Melbye Michelsen, Tonje Reier-Nilsen, Ellen Namork, Unni Cecilie Nygaard, Petter Mowinckel, Kai-Håkon Carlsen |
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Rok vydání: | 2018 |
Předmět: |
Male
0301 basic medicine medicine.medical_specialty Adolescent Arachis Oral immunotherapy medicine.medical_treatment Immunology Peanut allergy Administration Oral Comorbidity Immunoglobulin E 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Humans Immunology and Allergy Medicine Peanut Hypersensitivity Child Adverse effect Skin Tests Desensitization (medicine) biology business.industry Maintenance dose food and beverages Immunotherapy Allergens medicine.disease Respiratory Function Tests Treatment Outcome 030104 developmental biology 030228 respiratory system Desensitization Immunologic Child Preschool biology.protein Female business Anaphylaxis |
Zdroj: | Allergy. European Journal of Allergy and Clinical Immunology |
ISSN: | 0105-4538 |
Popis: | Background There are limited data on the feasibility, efficacy and safety of high-dose oral immunotherapy (OIT) in children highly allergic to peanuts. Objective In children highly allergic to peanut, we primarily aimed to determine the feasibility of reaching the maximum maintenance dose (MMD) of 5000 mg peanut protein or, alternatively, a lower individual maintenance dose (IMD), by OIT up-dosing. Secondarily, we aimed to identify adverse events (AEs) and determine factors associated with reaching a maintenance dose. Methods The TAKE-AWAY peanut OIT trial enrolled 77 children 5-15 years old, with a positive oral peanut challenge. Fifty-seven were randomized to OIT with biweekly dose step-up until reaching MMD or IMD and 20 to observation only. Demographic and biological characteristics, AEs, medication and protocol deviations were explored for associations with reaching maintenance dose. Results All children had anaphylaxis defined by objective symptoms in minimum two organ systems during baseline challenge. The MMD was reached by 21.1%, while 54.4% reached an IMD of median (minimum, maximum) 2700 (250, 4000) mg peanut protein, whereas 24.5% discontinued OIT. During up-dosing, 19.4% experienced anaphylaxis. Not reaching the MMD was caused by distaste for peanuts (66.7%), unacceptable AEs (26.7%) and social reasons (6.7%). Increased peanut s-IgG4 /s-IgE ratio (OR [95% CI]: 1.02 [1.00, 1.04]) was associated with reaching MMD. Conclusion Although 75.5% of children with peanut anaphylaxis reached a maintenance dose of 0.25-5 g, only 21.1% reached the MMD. Distaste for peanuts and AEs, including high risk of anaphylaxis, limited the feasibility of reaching MMD. |
Databáze: | OpenAIRE |
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