Specific Immunotherapy in Young Children Induces Peanut Allergy Remission - European Medical Journal

Specific Immunotherapy in Young Children Induces Peanut Allergy Remission

2 Mins
Allergy & Immunology

PEANUT ALLERGY in children is a common and dangerous chronic condition, affecting almost 1.5 million of the United States’ population aged 17 and younger. New research from the National Institute of Allergy and Infectious Diseases (NIAID)-funded IMPACT trial has emerged, indicating that exposure to peanut oral immunotherapy in 1- to 3-year-olds with severe peanut allergies can desensitise this reaction safely.

Led by Anthony S. Fauci, Director of NIAID, this clinical trial used daily oral doses of peanut flour over a period of 2 and a half years. Researchers hypothesised that continued exposure to this specific immunotherapy while the immune system is maturing could alter a child’s reaction to peanuts. The randomised, double–blind IMPACT trial saw 150 participants made up of highly peanut–allergic children aged 1 to 3. The children randomly received either peanut protein flour, or a placebo.

The dose of peanut protein was gradually increased each day over a 30-week period up to 2 grams, equivalent to six peanuts, and participants continued to consume this daily dose for 2 years. Treatment continued in the form of an ‘oral food challenge’, in which children received increasing doses of peanut protein up to a total of 5 grams. Following this, peanut exposure was halted for 6 months. The final stage of the trial saw participants repeat this oral food challenge, with subsequent exposure to 8 grams of peanut protein a few days later to confirm the absence of a reaction.

A desensitised reaction to peanuts was defined as having no allergic reaction to the oral food challenge, in which participants consumed 5 grams of protein. Seventy-one percent of children in the IMPACT trial who were exposed to peanut protein were desensitised to peanuts, compared with 2% of those given the placebo. Following the six-month period of peanut negation, 21% of exposed participants completed the second oral food challenge with no allergic reaction.

Following post-trial analyses, Fauci and researchers concluded that the age of a child and their levels of peanut-specific immunoglobulin-E could predict remission. Seventy-one percent of 1-year-olds achieved remission, whereas only 19% of 3-year-olds successfully experienced remission, presenting an inverse relationship. Although one adverse reaction was observed in each child throughout the trial, only 21 children required epinephrine administration. Fauci explained: “The landmark results of the IMPACT trial suggest a window of opportunity in early childhood to induce remission of peanut allergy through oral immunotherapy.”

Join our mailing list

To receive the EMJ updates straight to your inbox free of charge, please click the button below.
Join Now