High-dose oral immunotherapy in children with anaphylaxis to peanut
Appears in the following Collection
AbstractPeanut allergy is common, and the main cause of life-threatening allergic reactions among children in the Western world. Concern for accidental exposure may reduce quality of life (QoL). In allergen specific immunotherapy, initial exposure of a very low allergen dose is followed by incremental amounts of the culprit allergen until a maintenance dose is reached. Trials of oral immunotherapy (OIT) report successful desensitization (increased reactivity threshold to the allergen during treatment) with acceptable safety profiles. Paradoxically, children with severe peanut allergy, thought to benefit the most from a successful treatment, are often excluded from trials due to the risk of anaphylaxis. The main objective of the present thesis was to determine the feasibility and effect of two years’ OIT in children with anaphylaxis to peanut. In the prospective, open labelled 4-year high-dose peanut OIT TAKE-AWAY trial, 57 children were randomized to OIT and 20 to observation only. Immunological tests, QoL-questionnaires and food challenge were performed at inclusion and after two years of treatment. In children with anaphylaxis to peanut, 24.6 % were deemed ineligible to OIT due to very low reactivity thresholds. Up-dosing was completed by 75.5 % with maintenance doses ranging from 250 to 5000 mg peanut protein (ppt), while 21.1 % only reached the pre-defined maximum maintenance dose (MMD) of 5000 mg ppt. The main reason for not reaching MMD was distaste for peanuts, followed by adverse events. Every fifth child experienced an anaphylactic adverse event, questioning the feasibility and safety of high-dose OIT in these patients. After two years of OIT, desensitization to 7500 mg ppt was confirmed in 94.6 % of the children. The QoL in children improved as reported by the parents, but not by the children. Hence, parents’ apparent over estimation of their child’s improvement in QoL by OIT, should be considered if such treatment is to be offered for peanut allergy.
List of papers
|Paper 1: Reier-Nilsen T, Michelsen MM, Lodrup Carlsen KC, Carlsen KH, Mowinckel P, Nygaard UC, Namork E, Borres MP, Haland G. Predicting reactivity threshold in children with anaphylaxis to peanut. Clin Exp Allergy. 2018 Apr; 48(4):415-423. doi: 10.1111/cea.13078. The article is included in the thesis. Also available at https://doi.org/10.1111/cea.13078|
|Paper 2: Reier-Nilsen T, Michelsen MM, Lodrup Carlsen KC, Carlsen KH, Mowinckel P, Nygaard UC, Namork E, Borres MP, Haland G. Feasibility of desensitizing children highly allergic to peanut by high-dose oral immunotherapy. Allergy 2018 Oct doi: 10.1111/all.13604. The article is included in the thesis. Also available at https://doi.org/10.1111/all.13604|
|Paper 3: Reier-Nilsen T, Lodrup Carlsen KC, Michelsen MM, Drottning S, Carlsen KH, Chi Zhang, Borres MP, Haland G. The child’s perspective of quality of life in a randomized controlled peanut oral immunotherapy trial. Submitted to PAI Dec 3, and accepted for publication. The paper is not available in DUO. Accepted article available at: https://doi.org/10.1111/pai.13066|