Oral immunotherapy for children with a high-threshold peanut allergy

摘要

Background: Between 25 and 30 of children with peanut allergy (PA) have a relatively high-threshold peanut allergy (HTPA), with a single maximal tolerated dose (SMTD) higher than 100 mg of peanut protein (PP). How-ever, this threshold may decrease with time, age, exercise, illness, sleep deprivation, and other covariates.Objective: To explore the feasibility of a simplified oral immunotherapy (OIT) protocol in a group of children with HTPA. Methods: Children with PA with an SMTD higher than 100 mg were placed on a 40-week OIT protocol of either 300 mg/d of PP or 100 mg/d for 20 weeks followed by 300 mg/d for 20 weeks. A repeat open peanut food chal-lenge was performed after 40 weeks of treatment and at a 6-month follow-up visit. After the 40-week challenge, all children received a maintenance dosage of 2 gPP 3 times a week.Results: A total of 28 children with HTPA were enrolled, with 56 boys, 89 younger than 6 years old, and a mean SMTD of 304 mg (95 confidence interval 229-378). All were placed on the described OIT protocol. Overall, 2 children were not compliant and 3 had allergic reactions at home on the dose previously tolerated in clinic, 23 completed the 40-week protocol, and all were able to consume 2 g of PP. The mean tolerated dosage at the 6 -month follow-up was 8 g. This enabled most children age-appropriate dietary inclusion of peanut-containing products.Conclusion: In children with HTPA, a simple, fixed-dose OIT can be both safe and efficacious.(c) 2022 American College of Allergy, Asthma Immunology. Published by Elsevier Inc. All rights reserved.