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AAAAI: Gradual Exposure Reduces Kids' Peanut Allergy 3-17-08
PHILADELPHIA, March 17 -- Children with clinical peanut allergies became at
least modestly tolerant after a program of oral immunotherapy, a researcher said
here.
Of 20 children, 18 were eventually able to eat the equivalent of 13 peanuts with
few or no allergy symptoms, reported Scott Nash, M.D., of Duke University, at
the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
The children, ages one to 16, did not have histories of severe anaphylactic
reactions, but they had previously had moderate allergic symptoms after eating
peanut protein, with positive skin prick tests and peanut-specific IgE levels of
at least 15,000 units/L, consistent with significant peanut allergy.
At baseline, they all had allergic reactions after eating the equivalent of less
than a single peanut.
Standard treatment for such patients is avoidance of foods containing peanut
products and keeping an epinephrine injector close by to deal with severe
reactions, Dr. Nash said.
The study protocol began with multiple doses the first day, starting with 0.1 mg
of peanut protein in the form of flour and working up to 50 mg by day's end. All
children had symptoms at this level on the first day.
The children then took peanut protein every day at home, starting at 50 mg/day
and increasing by 25 mg every two weeks. The escalation stopped at 300 mg/day --
the equivalent of one peanut -- which was chosen as the maintenance dose.
After four to 11 months on this dose, the children were challenged with larger
amounts of peanut.
Among 20 children completing the planned protocol, 19 were able to eat 3.9 g of
peanut protein, 10 with no reaction at all.
One of the 19 developed hives and stridor about 90 minutes after ingesting the
full amount, necessitating an emergency dose of epinephrine.
The remaining eight had mild, transient symptoms -- developing early in the
challenge in two cases, later on in the other six.
The twentieth child developed hives and sneezing after eating 2.1 g of peanut,
at which point a concerned parent stopped the test, Dr. Nash said.
Patients were maintained on therapy for up to 42 months, with the treatment
still ongoing.
Mean levels of IgE and other immunologic markers of peanut allergy increased
initially and then gradually declined over time. Dr. Nash said this was
consistent with results with other allergy immunotherapies.
Mean wheal sizes in skin prick tests decreased from about 8.5 mm at baseline to
approximately 5 mm after six months. With continuation of therapy, wheal sizes
declined to as little as 3.5 mm.
Dr. Nash noted that IgG4 levels increased during the trial. He said the role of
this immunoglobulin species is not clear. It may be a blocking antibody, but
that would not fully explain the effects on symptom resolution, he indicated.
He said follow-up clinical studies are aimed at increasing the immunotherapy
doses further in an effort to induce greater tolerance.
"We are showing that some of those patients' IgEs are declining, and declining
to a level where their food allergy may be actually going away. Some people have
been able to come off of oral immunotherapy and still tolerate a peanut
challenge," Dr. Nash said.
Also underway is a double-blind, placebo-controlled study using a similar
protocol.
Comment:
Again More Proof Western Medicine is coming around to the principles of homeopathy!