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Desensitization and remission after peanut sublingual immunotherapy in 1- to 4-year-old peanut-allergic children:
Edwin H Kim1, J Andrew Bird2, Corinne A Keet1
1Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC.
Insights
Peanut sublingual immunotherapy (SLIT) safely desensitizes young children with peanut allergy. Starting treatment earlier in life, particularly between ages 1-2, leads to better outcomes and remission.
Area of Science:
- Allergy and Immunology
- Pediatric Gastroenterology
- Clinical Therapeutics
Background:
- Previous research indicated younger age may benefit peanut sublingual immunotherapy (SLIT).
- Peanut allergy affects a significant pediatric population, necessitating safe and effective treatments.
Purpose of the Study:
- To evaluate the safety and efficacy of peanut SLIT in children aged 1 to 4 years.
- To determine if earlier initiation of SLIT improves treatment outcomes.
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving 50 children aged 1-4 years with peanut allergy.
- Participants received either 4 mg peanut SLIT or placebo for 36 months, with desensitization assessed via double-blind, placebo-controlled food challenges (DBPCFC).
- Biomarker analysis and assessment of remission after therapy discontinuation were also conducted.
Main Results:
- Peanut SLIT significantly increased desensitization (60% vs 0%) and remission rates (48% vs 0%) compared to placebo.
- The highest rates of desensitization and remission were observed in the youngest age group (1-2 years).
- Adverse events were generally mild and similar between groups, with oropharyngeal itching being more common in the SLIT group.
Conclusions:
- Peanut SLIT is a safe and effective treatment for inducing desensitization and remission in young children (1-4 years) with peanut allergy.
- Initiating peanut SLIT at a younger age (1-2 years) is associated with superior treatment outcomes.
Background:
Prior studies of peanut sublingual immunotherapy (SLIT) have suggested a potential advantage with younger age at treatment initiation.
Objective:
We studied the safety and efficacy of SLIT for peanut allergy in 1- to 4-year-old children.
Methods:
Peanut-allergic 1- to 4-year-old children were randomized to receive 4 mg peanut SLIT versus placebo. Desensitization was assessed by double-blind, placebo-controlled food challenge (DBPCFC) after 36 months of treatment. Participants desensitized to at least 443 mg peanut protein discontinued therapy for 3 months and then underwent DBPCFC to assess for remission. Biomarkers were measured at baseline and longitudinally during treatment.
Results:
Fifty participants (25 peanut SLIT, 25 placebo) with a median age of 2.4 years were enrolled across 2 sites. The primary end point of desensitization was met with actively treated versus placebo participants having a significantly greater median cumulative tolerated dose (4443 mg vs 143 mg), higher likelihood of passing the month 36 DBPCFC (60% vs 0), and higher likelihood of demonstrating remission (48% vs 0). The highest rate of desensitization and remission was seen in 1- to 2-year-olds, followed by 2- to 3-year-olds and 3- to 4-year-olds. Longitudinal changes in peanut skin prick testing, peanut-specific IgG4, and peanut-specific IgG4/IgE ratio were seen in peanut SLIT but not placebo participants. Oropharyngeal itching was more commonly reported by peanut SLIT than placebo participants. Skin, gastrointestinal, upper respiratory, lower respiratory, and multisystem adverse events were similar between treatment groups.
Conclusion:
Peanut SLIT safely induces desensitization and remission in 1- to 4-year-old children, with improved outcomes seen with younger age at initiation.
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