A newly released study indicated that childhood peanut allergies could be desensitized with oral immunotherapy treatments, and some children could achieve remission.
The clinical trial was co-led by Arkansas Children’s Research Institute (ACRI) and UAMS researcher Stacie Jones, M.D. The results were published Jan. 21 in the medical journal The Lancet.
The youngest trial participants and those who started with lower levels of peanut-specific antibodies were the most likely to be successful.
“In children with a peanut allergy, initiation of peanut oral immunotherapy before age 4 years was associated with an increase in both desensitization and remission,” according to The Lancet’s summary. “Development of remission correlated with immunological biomarkers. The outcomes suggest a window of opportunity at a young age for intervention to induce remission of peanut allergy.”
ACRI, a research institute owned by Arkansas Children’s Hospital, was one of five participating U.S. academic medical centers in the clinical trial. The study was funded by the National Institutes of Health.
The trial involved 146 children who received peanut oral immunotherapy treatments or placebos between Aug. 13, 2013, and Oct. 1, 2015.
Participants were a median age of 39.3 months who had an allergic reaction after eating half a gram of peanuts or less, the equivalent of 1.5 peanuts. Ninety-six of the children received the immunotherapy, which consisted of a daily oral dose of 2,000 mg of peanut protein flour for 134 weeks, followed by 26 weeks of avoidance. Fifty children were part of the control group.
By the 134th week, 68 of the 96 who received the immunotherapy had achieved desensitization as defined by the study, while one member of the placebo group had done so. According to The Lancet summary, the median cumulative tolerated dose that week was 5,005 mg vs. 5 mg in the placebo group. After the 26 weeks of avoidance, 20 of the 96 participants met the criteria for remission compared to one in the placebo group – the same child as in the earlier group.
Remission was defined as being able to eat 5 grams of peanut protein, or the equivalent of about 16 peanuts, without having a reaction six months after finishing the immunotherapy, according to a press release from Arkansas Children’s Hospital and UAMS.
The study noted that a significant percentage of those who had achieved 5,000 mg of tolerance at week 134 could not longer tolerate that much at week 160.
“In addition to the desensitization we saw in a majority of peanut-allergic children, we also saw a promising number of children whose peanut tolerability did not reach our threshold for remission but still increased significantly after treatment,” Jones said in the press release. “We are tremendously excited that some of this work happened at Arkansas Children’s Research Institute, underscoring our commitment to discoveries that have life-changing potential for families.”
According to the press release, 2% of children in Western countries have peanut allergies, most of which last a lifetime. Children with peanut allergies are advised to avoid eating them but are at risk of suffering peanut-induced anaphylaxis caused by accidental exposures.
The Immune Tolerance Network conducted the trial under the leadership of Jones and A. Wesley Burks, M.D., CEO of UNC Health Care and dean of the University of North Carolina School of Medicine. The other participants were Stanford University, Johns Hopkins Hospital and Icahn School of Medicine at Mount Sinai.
The Lancet summary found that 98% of participants receiving the oral immunotherapy had at least one dosing reaction during the study, while 80% receiving the placebo did. Most reactions were mild to moderate and occurred more frequently in those receiving the oral immunotherapy. Thirty-five incidents of those with moderate symptoms, involving 21 participants, were treated with epinephrine.