Sublingual immunotherapy for peanut allergy: Clinical and immunologic evidence of desensitization

• Published in: Journal of allergy and clinical immunology Vol. 127; no. 3; pp. 640 - 646.e1
• Main Authors: Kim, Edwin H., Bird, J. Andrew, Kulis, Michael, Laubach, Susan, Pons, Laurent, Shreffler, Wayne, Steele, Pamela, Kamilaris, Janet, Vickery, Brian, Burks, A. Wesley
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2011; Elsevier Limited
• Subjects: Administration, Sublingual; adverse effects; Allergies; Allergy and Immunology; Arachis hypogaea; Asthma; Child; Child, Preschool; children; desensitization; Desensitization, Immunologic - methods; Desensitization, Immunologic - trends; Dilution; Dose-Response Relationship, Drug; Female; Food; Food allergies; food allergy; Humans; hypersensitivity; immunoglobulin E; immunoglobulin G; immunosuppression; Immunotherapy; interferon-gamma; interleukin-10; interleukin-13; interleukin-5; Laboratories; Male; Peanut allergy; Peanut Hypersensitivity - therapy; peanut protein; peanuts; Phenols; placebos; Proteins; sublingual immunotherapy; T-lymphocytes; United States > US; SLIT; Peanut allergy; SPT; Treg; sublingual immunotherapy; OIT; FoxP3; food allergy; SCIT; desensitization; DBPCFC; Double-blind, placebo-controlled food challenge; Subcutaneous immunotherapy; Skin prick test; Oral immunotherapy; Forkhead box protein 3; Regulatory T
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2010.12.1083

There are no treatments currently available for peanut allergy. Sublingual immunotherapy (SLIT) is a novel approach to the treatment of peanut allergy. We sought to investigate the safety, clinical effectiveness, and immunologic changes with SLIT in children with peanut allergy. In this double-blind, placebo-controlled study subjects underwent 6 months of dose escalation and 6 months of maintenance dosing followed by a double-blind, placebo-controlled food challenge. Eighteen children aged 1 to 11 years completed 12 months of dosing and the food challenge. Dosing side effects were primarily oropharyngeal and uncommonly required treatment. During the double-blind, placebo-controlled food challenge, the treatment group safely ingested 20 times more peanut protein than the placebo group (median, 1,710 vs 85 mg; P = .011). Mechanistic studies demonstrated a decrease in skin prick test wheal size (P = .020) and decreased basophil responsiveness after stimulation with 10−2 μg/mL (P = .009) and 10−3 μg/mL (P = .009) of peanut. Peanut-specific IgE levels increased over the initial 4 months (P = .002) and then steadily decreased over the remaining 8 months (P = .003), whereas peanut-specific IgG4 levels increased during the 12 months (P = .014). Lastly, IL-5 levels decreased after 12 months (P = .015). No statistically significant changes were found in IL-13 levels, the percentage of regulatory T cells, or IL-10 and IFN-γ production. Peanut SLIT is able to safely induce clinical desensitization in children with peanut allergy, with evidence of immunologic changes suggesting a significant change in the allergic response. Further study is required to determine whether continued peanut SLIT is able to induce long-term immune tolerance.