PREDICTIVE DECLINE IN PEANUT SKIN TEST AND RAST AMONG PEANUT-ALLERGIC CHILDREN UNDERGOING HIGH-DOSE ORAL IMMUNOTHERAPY

• Published in: Annals of allergy, asthma, & immunology Vol. 121; no. 5; pp. S2 - S3
• Main Authors: Randhawa, I., Morphew, T., Marsteller, N.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.11.2018
• ISSN: 1081-1206; 1534-4436
• DOI: 10.1016/j.anai.2018.09.007

Peanut immunotherapy remains a limited form of treatment for peanut allergic children. Limitations primarily stem from small study sizes, significant adverse events, unclear long-term immunological outcomes and the inability to reach tolerance. In our cohort of peanut anaphylaxis patients undergoing tolerance induction oral immunotherapy, we sought to determine the rate of decline in peanut skin prick testing (SPT) and RAST results following one year of high-dose, weekly peanut immunotherapy. Extensive RAST and SPT to peanut was performed in addition to other diagnostic markers. Fifty-one patients underwent sequential food challenges to non-allergic nuts followed by desensitization of sensitized or anaphylactic tree nuts culminating with peanut desensitization. All patients passed a 10g peanut protein challenge. Patients transitioned over 4 months to pass a 30g peanut protein challenge. Patients sustained a weekly 30g peanut protein dose for one year. During any given week, patients were free to eat products with < 1g of peanut protein. After one year patient biomarker analysis was repeated. All patients demonstrated positive peanut allergy diagnostics in SPT, component testing and RAST before treatment; post-treatment a reduction was observed in this cohort. The rate of reduction was greatest for patients whose post-SPT value was in the lowest quartile (reduced to 22.2% of pre-SPT value which corresponded to an average drop from 7.5-2.0mm). Peanut-specific RAST and SPT are reproducible, temporal markers when following patient response to immunotherapy. Peanut immunotherapy is effective in reducing SPT and RAST specific peanut values corroborated with intermittent, high-dose peanut protein exposure.