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TOPLINE:

In a phase 2 trial of peanut oral immunotherapy (OIT) involving 21 adults, 67% achieved maintenance dose tolerance, with the median tolerated dose increasing 100-fold from 30 mg to 3000 mg. Treatment showed improved quality-of-life measures and significant immunological changes, including suppressed skin prick test reactivity and increased peanut-specific immunoglobulin G (IgG).

METHODOLOGY:

• A phase 2 trial evaluated peanut OIT in adults with peanut allergy using real-world peanut products, employing a Simon’s minimax two-stage design with stop:go futility analysis.
• Participants underwent baseline double-blind placebo-controlled food challenges with peanut protein doses ranging from 0.3 to 300 mg.
• Daily OIT was initiated with 2-weekly updosing until reaching a maintenance dose of 1000 mg (equivalent to four large peanuts).
• Primary outcome measured the proportion of OIT participants tolerating a cumulative dose of 1.4 g peanut protein during the exit food challenge (dose, 0.3-3000 mg).

TAKEAWAY:

• Among 21 adults (mean age, 24.2 years), 67% achieved the daily maintenance dose and met the primary endpoint.
• The median tolerated dose increased significantly from 30 mg (approximately 1/8 peanut) to 3000 mg (12 peanuts) at exit challenge, representing a 100-fold increase (P < .0001).
• Treatment was associated with improved quality-of-life measures and demonstrated suppression of peanut skin prick test sizes.
• Researchers observed induction of peanut-specific IgG in OIT participants but not in control subjects.

IN PRACTICE:

“Peanut OIT can be an efficacious treatment for desensitization of adult peanut-allergic patients. Larger studies will be required to further characterize the safety profile and identify the group of adult patients most likely to benefit with the minimum risk of systemic adverse reactions and also if OIT has the potential to lead to long-term tolerance in this age group,” wrote the authors of the study.

SOURCE:

The study was led by Hannah Hunter and Kok Loong Ue, Guy’s and St Thomas’ NHS Foundation Trust in London, England. It was published online in Allergy.

LIMITATIONS:

The study design did not include a placebo group, though this was justified by the rare occurrence of spontaneous resolution of peanut allergy in adults. While the primary endpoint was measured under double-blind conditions using validated reagents, the study population showed a predominant White demographic, limiting generalizability across diverse populations. The researchers noted that the study did not address longer-term effects of OIT, particularly whether desensitization could be maintained without daily peanut consumption after several years of continuous treatment.

DISCLOSURES:

The National Institute for Health Research (NIHR) Research for Patient Benefit program provided funding support through Award ID: PB-PG-1215-20006. The views expressed in the study do not necessarily reflect those of the NIHR or the Department of Health and Social Care. The study funders had no involvement in study design, data collection, analysis, interpretation, or report writing. The corresponding author maintained full data access and final publication decision authority.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.