Abstract | BACKGROUND: Although promising results have emerged regarding oral immunotherapy (OIT) and sublingual immunotherapy (SLIT) for the treatment of peanut allergy (PA), direct comparisons of these approaches are limited. OBJECTIVE: This study was conducted to compare the safety, efficacy, and mechanistic correlates of peanut OIT and SLIT. METHODS: In this double-blind study children with PA were randomized to receive active SLIT/placebo OIT or active OIT/placebo SLIT. Doses were escalated to 3.7 mg/d (SLIT) or 2000 mg/d (OIT), and subjects were rechallenged after 6 and 12 months of maintenance. After unblinding, therapy was modified per protocol to offer an additional 6 months of therapy. Subjects who passed challenges at 12 or 18 months were taken off treatment for 4 weeks and rechallenged. RESULTS: Twenty-one subjects aged 7 to 13 years were randomized. Five discontinued therapy during the blinded phase. Of the remaining 16, all had a greater than 10-fold increase in challenge threshold after 12 months. The increased threshold was significantly greater in the active OIT group (141- vs 22-fold, P = .01). Significant within-group changes in skin test results and peanut-specific IgE and IgG4 levels were found, with overall greater effects with OIT. Adverse reactions were generally mild but more common with OIT (P < .001), including moderate reactions and doses requiring medication. Four subjects had sustained unresponsiveness at study completion. CONCLUSION: OIT appeared far more effective than SLIT for the treatment of PA but was also associated with significantly more adverse reactions and early study withdrawal. Sustained unresponsiveness after 4 weeks of avoidance was seen in only a small minority of subjects.
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Authors | Satya D Narisety, Pamela A Frischmeyer-Guerrerio, Corinne A Keet, Mark Gorelik, John Schroeder, Robert G Hamilton, Robert A Wood |
Journal | The Journal of allergy and clinical immunology
(J Allergy Clin Immunol)
Vol. 135
Issue 5
Pg. 1275-82.e1-6
(May 2015)
ISSN: 1097-6825 [Electronic] United States |
PMID | 25528358
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2014 American Academy of Allergy, Asthma & Immunology. All rights reserved. |
Chemical References |
- Allergens
- Immunoglobulin G
- Immunoglobulin E
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Topics |
- Administration, Oral
- Administration, Sublingual
- Adolescent
- Allergens
(administration & dosage, immunology)
- Arachis
(adverse effects)
- Child
- Desensitization, Immunologic
(adverse effects, methods)
- Female
- Humans
- Immunoglobulin E
(blood, immunology)
- Immunoglobulin G
(blood, immunology)
- Male
- Peanut Hypersensitivity
(diagnosis, immunology, therapy)
- Pilot Projects
- Skin Tests
- Treatment Outcome
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