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Feasibility of desensitizing children highly allergic to peanut by high‐dose oral immunotherapy
Author(s) -
ReierNilsen Tonje,
Michelsen Merethe Melbye,
Lødrup Carlsen Karin C.,
Carlsen KaiHåkon,
Mowinckel Petter,
Nygaard Unni C.,
Namork Ellen,
Borres Magnus P.,
Håland Geir
Publication year - 2019
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.13604
Subject(s) - oral immunotherapy , medicine , dosing , anaphylaxis , peanut allergy , maintenance dose , oral food challenge , adverse effect , allergy , immunoglobulin e , randomized controlled trial , pediatrics , food allergy , immunology , antibody
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 ( AE s) 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, AE s, 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 AE s (26.7%) and social reasons (6.7%). Increased peanut s‐IgG 4 /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 AE s, including high risk of anaphylaxis, limited the feasibility of reaching MMD .