Oral immunotherapy for children with a high-threshold peanut allergy

Yahia, Soad Haj; Machnes-Maayan, Diti; Frizinsky, Shirly; Maoz-Segal, Ramit; Offenganden, Irena; Kenett, Ron S.; Agmon‐Levin, Nancy; Hovav, Ran; Kidon, Mona

doi:10.1016/j.anai.2022.05.001

Cited by 8 publications

(5 citation statements)

References 33 publications

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“…There were seven mild/moderate allergic reactions (using the CoFAR Grading Scale for Systemic Allergic Reactions Version 3.0) 27 requiring medical intervention during 140 LPP‐MH POIT observed challenges (5%). All were treated in the clinic and patients returned to the previous safe formulation for an additional 4 weeks, before successful re‐challenge.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, another 19%, were diagnosed with PA, with a SHTD higher than 100 mg of PP. These patients were enrolled into a simplified OIT protocol, utilizing native peanut proteins, with very good safety and tolerability 27 . In this group of highly allergic young patients invited to participate in the LPP‐MH study, the calculated CTD of PP, 71.2 mg (95% CI 45.4–99.9), obtained from the open challenges was very similar to the one obtained in an equally young group of peanut‐allergic patients via a DBPCFC, 75.0 (5.0–175.0) mg of PP 3 …”

Section: Discussionmentioning

confidence: 99%

“…These patients were enrolled into a simplified OIT protocol, utilizing native peanut proteins, with very good safety and tolerability. 27 In this group of highly allergic However, all of these children had a challenge-proven IgE-mediated allergy with a very low threshold dose at the beginning of the trial.…”

Section: Skin Tests and Serum Tests Demonstrate Changes Commensuratementioning

confidence: 94%

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Peanut oral immunotherapy using an extensively heated and baked novel composition of peanuts

Kidon,

Shavit,

Levy

et al. 2024

Pediatric Allergy Immunology

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BackgroundOral immunotherapy (OIT) is an increasingly acceptable therapeutic option for peanut‐allergic (PA) children, despite significant side effects. Major peanut allergenic proteins are heat‐resistant and are not rendered hypoallergenic after baking or cooking. Lyophilized peanut protein—MH (LPP‐MH) is a novel composition from developing peanuts, enabling cooking‐induced reduction in allergenicity. We aimed to explore the safety and efficacy of OIT, with extensively heated and baked (EHEB) LPP‐MH in PA children.MethodsIn a single‐arm, single‐center, pilot study, PA children with a single highest tolerated dose of <100 mg peanut protein were placed on a 40‐week OIT protocol with 300 mg daily of heat‐treated LPP‐MH. A repeat open peanut food challenge was performed after 40 weeks of treatment and at a 6–12 months of follow‐up visit.ResultsThirty‐three children with PA were enrolled, with a mean cumulative tolerated dose (MCTD) of 71.2 mg PP (95% CI 45–100 mg). After 40 weeks, 32/33 patients were able to consume more than 300 mg of natural PP, with MCTD of 1709 mg (CI 365–3675 mg). There were no severe allergic reactions requiring epinephrine, during any of the observed LPP‐MH challenges or any treatment related doses at home. After 6–12 months on daily maintenance, the MCTD was 8821 mg (95% CI 1930–13,500 mg). This enabled most children age‐appropriate dietary inclusion of peanuts.ConclusionAn OIT protocol with heat‐treated LPP‐MH, a novel composition from developing peanuts, seems a potentially safe and efficacious OIT modality for PA children, enabling the introduction of dietary levels of peanut proteins in highly allergic PA children. Validation in randomized controlled studies is mandated.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Skin Tests and Serum Tests Demonstrate Changes Commensuratementioning

confidence: 94%

See 1 more Smart Citation

Peanut oral immunotherapy using an extensively heated and baked novel composition of peanuts

Kidon,

Shavit,

Levy

et al. 2024

Pediatric Allergy Immunology

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“…times a week; according to the authors, an individualized approach to OIT may be clinically more advantageous. 43 participants of the placebo group. The salivary sample is easier to obtain, so in the future, it could be used to look for predictive biomarkers of response to OIT.…”

Section: Ta B L E 2 (Continued)mentioning

confidence: 99%

“…Epinephrine use was reported by 3 (4%) participants 42 . An alternative protocol was recently proposed by Yahia et al., who stratified in tolerant (100–300 mg) and very tolerant (≥300 mg) children the population treated with OIT for 40 weeks until the dose of 2 g of peanuts 3 times a week; according to the authors, an individualized approach to OIT may be clinically more advantageous 43 . Smeekens et al.…”

Section: Oral Immunotherapymentioning

confidence: 99%

Current state and advances in desensitization for peanut allergy in pediatric age

Foti Randazzese,

Panasiti,

Caminiti

et al. 2024

Pediatric Allergy Immunology

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Peanut allergy affects about 1%–3% of the pediatric population in the world, with an important increase in the last decades. Nowadays, international guidelines recommend the early introduction of peanuts in the infant diet, with poor information about the quantity and the frequency of the intake. Allergen immunotherapy may represent the only therapeutic strategy able to modify the natural history of peanut allergy. In particular, oral immunotherapy showed the most promising results in terms of efficacy, but with significant rates of adverse reactions, mostly gastrointestinal. In 2020, the Food and Drug Administration and the European Medicines Agency approved Palforzia®, an oral drug for patients aged 4–17 years. Several studies are ongoing to improve the tolerability of oral immunotherapy and standardize the desensitization protocols. Sublingual immunotherapy permits to offer much lower doses than oral immunotherapy, but fewer adverse events are shown. Subcutaneous immunotherapy is associated with the greatest systemic adverse effects. Epicutaneous immunotherapy, for which Viaskin® patch was approved, has the highest safety profile. Innovative studies are evaluating the use of biological drugs, such as omalizumab or dupilumab, and probiotics, such as Lactobacillus rhamnosus, in monotherapy or associated with oral immunotherapy. Therapy for peanut allergy is constantly evolving, and new perspectives are ongoing to develop.image

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Peanut oral immunotherapy: Reconsidering a one-size-fits-all approach

Nair

Capucilli

2022

Annals of Allergy, Asthma & Immunology

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Oral immunotherapy for children with a high-threshold peanut allergy

Cited by 8 publications

References 33 publications

Peanut oral immunotherapy using an extensively heated and baked novel composition of peanuts

Peanut oral immunotherapy using an extensively heated and baked novel composition of peanuts

Current state and advances in desensitization for peanut allergy in pediatric age

Peanut oral immunotherapy: Reconsidering a one-size-fits-all approach

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