Desensitization of Peanut Allergy in Children with the Equivalent of Five Peanuts Daily

David J. Amrol, MD

Most children tolerated oral immunotherapy, but peanut protein must be consumed daily and the effect on long-term tolerance is unknown.

Peanut allergy affects roughly 1% of children in developed countries and is the leading cause of food-allergy related deaths. Currently, avoidance is the only acceptable treatment and only 20% of patients outgrow their allergy. In a randomized, double-blind, crossover trial, researchers in the U.K. compared the efficacy of 26 weeks of escalating doses of peanut flour or usual care (peanut avoidance) in 99 children (age range, 7–16 years) with peanut allergy. Peanut protein doses were increased every 2 weeks in the clinic until patients tolerated 800 mg daily (roughly 5 peanuts).

After the first phase of the trial, 84% of patients in the active-treatment group tolerated the target dose and 62% tolerated a 1400 mg peanut challenge (desensitization, the primary outcome). In contrast, none of the patients in the control group tolerated the peanut challenge. In the second phase, after 6 months of crossover therapy, 91% of immunotherapy recipients tolerated the target dose and 54% passed the peanut challenge. Quality-of-life scores were clinically improved with immunotherapy. Only one patient had reactions requiring epinephrine.

Citation(s):

Anagnostou K et al. Assessing the efficacy of oral immunotherapy for the desensitisation of peanut allergy in children (STOP II): A phase 2 randomised controlled trial. Lancet 2014 Jan 30; [e-pub ahead of print].