Oral immunotherapy using boiled peanuts for treating peanut allergy: An open‐label, single‐arm trial

Abstract

Background Peanut allergy affects 1%–3% of children in Western countries. Boiling peanuts has been demonstrated to result in a hypoallergenic product that may provide a safer way of inducing desensitization in peanut‐allergic patients by first inducing tolerance to boiled peanut. We aimed to assess the efficacy and safety of oral immunotherapy (OIT) using sequential doses of boiled peanuts followed by roasted peanuts for treating peanut allergy in children. Methods In this open‐label, phase 2, single‐arm clinical trial, children aged 6–18 years with a positive history of peanut allergy and positive peanut skin prick test ≥ 8 mm and/or peanut‐specific IgE ≥ 15 kU/L at screening underwent OIT involving sequential up‐dosing with 12‐hour boiled peanut for 12 weeks, 2‐hour boiled peanut for 20 weeks and roasted peanut for 20 weeks, to a target maintenance dose of 12 roasted peanuts daily. Primary outcome: proportion of children passing open‐label oral food challenge involving cumulative administration of 12 roasted peanuts (12 g peanuts; approximately 3000 mg peanut protein) 6–8 weeks after reaching the target maintenance dose. Secondary outcomes included treatment‐related adverse events and use of medications for treating allergy symptoms. Results Between 1 July 2017 and 22 June 2018, 70 participants were enrolled and commenced OIT. Desensitization was successfully induced in 56 of 70 (80%) participants. Withdrawal due to treatment‐related adverse events was infrequent (n = 3). Treatment‐related adverse events were reported in 43 (61%) participants, corresponding to a rate of 6.58 per 1000 OIT doses. Medication use associated with treatment‐related adverse events was infrequent, with rescue epinephrine use reported by three (4%) participants (0.05 per 1000 doses). Conclusion Oral immunotherapy using boiled followed by roasted peanuts represents a pragmatic approach that appears effective in inducing desensitization and is associated with a favourable safety profile.

Optimising the management of peanut allergy by targeting immune plasticity

“…Different routes of therapy are being examined. Boiled peanut, 62 epicutaneous peanut patch 63,64 and sublingual treatment 65 may show improved safety and effectiveness of immunotherapy. A small trial of peanut sublingual immunotherapy with a top maintenance dose of 4 mg among pre‐school children reported 15/25 (60%) without symptoms on double‐blind challenge after 3 years of treatment 66 .…”

Current trends in peanut allergy immunotherapy: a review

“…Only 3 participants reported the need to use epinephrine. However, it is important to note that the lack of a control cohort is a limitation of this study [31].…”

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

“…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…”

“…Adverse events were reported in 43 (61%) participants. 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 .…”