This article is part of MPR‘s coverage of the American Academy of Allergy, Asthma & Immunology annual meeting, taking place in San Francisco, California. Our staff will report on medical research related to asthma, allergy, and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from AAAAI 2019.
SAN FRANCISCO — Boiled peanut oral immunotherapy safely and effectively induced sustained unresponsiveness in children with peanut allergy, according to findings presented at the American Academy of Allergy, Asthma & Immunology annual meeting held February 22-25 in San Francisco.
In this phase 2B/3 randomized controlled trial (Boiled Peanut Oral Immunotherapy for the Treatment of Peanut Allergy – BOIT; ClinicalTrials.gov Identifier: NCT02149719), researchers set out to determine the efficacy and safety of boiled peanut oral immunotherapy.
A total of 47 children (8-17 years) with confirmed peanut allergy using a double-blind placebo-controlled food challenge were randomized 2:1 to receive either oral immunotherapy with boiled peanut or standard treatment (avoidance). The oral immunotherapy was updosed with boiled peanuts for approximately 6 months and then followed by maintenance with roasted peanut. At 12 months, children underwent repeat food challenges to assess response, peanut oral immunotherapy was discontinued, and sustained unresponsiveness was evaluated after 4 weeks.
Prior to oral immunotherapy, the median cumulative eliciting dose was 143mg peanut protein in these children. Out of the 32 participants assigned to active treatment, 24 experienced the primary outcome of desensitization to 1.4g peanut protein (P<.0001) and of those, 14 tolerated >4.4g peanut protein. Sustained responsiveness after 4 weeks occurred in 13 participants.
Anaphylaxis occurred in 9 patients (17 episodes total), but overall boiled peanut oral immunotherapy had a favorable safety profile with gastrointestinal symptoms associated with <2% of doses.
The researchers have planned a head-to-head comparison of roasted vs boiled peanut oral immunotherapy in a larger cohort to get a better idea of effectiveness and safety of these 2 modalities.
Patel N, Vazquez-Ortiz M, Robb A, Shamji MH, Campbell DE, Turner PJ. Successful desensitization and sustained unresponsiveness using modified peanut: results from the BOPI study. Presented at: American Academy of Allergy, Asthma & Immunology annual meeting 2019; February 22-25, 2019; San Francisco, CA. Abstract 252.