Efficacy and Safety of Oral Immunotherapy in Children Aged 1-3 Years with Peanut Allergy (Immune Tolerance Network IMPACT Trial): A Randomized Placebo-Controlled Study
For young children with peanut allergies, food avoidance is the current standard of care. We sought to assess whether oral peanut immunotherapy can induce desensitization (an increased allergic reaction threshold during treatment) or remission (a state of unresponsiveness after stopping immunotherapy) in this population.
Between August 13, 2013 and October 1, 2015, 146 children, with a median age of 39 3 months (IQR 30 8–44 7), were randomized to receive oral peanut immunotherapy (96 participants) or a placebo (50 participants). At week 134, 68 (71%, 95% CI 61-80) of 96 participants who received oral peanut immunotherapy versus one (2%, 0 05-11) of 50 who received placebo have reached the primary endpoint of desensitization (risk difference [RD] 69%, 95% CI 59–79; pvs. 80% with placebo) had at least one reaction to oral immunotherapy dosage, mostly mild to moderate and occurring more frequently in participants receiving oral peanut immunotherapy. 35 oral immunotherapy dosing events with moderate symptoms were treated with epinephrine in 21 participants receiving oral peanut immunotherapy.
In children with peanut allergy, initiation of oral peanut immunotherapy before the age of 4 years has been associated with an increase in both desensitization and remission. Development of remission correlated with immunological biomarkers. The results suggest a window of opportunity at an early age for an intervention to induce peanut allergy remission.
National Institute of Allergy and Infectious Diseases, Immune Tolerance Network.