Long-term sublingual immunotherapy ups peanut desensitization in allergic kids

Extended sublingual immunotherapy (SLIT) with peanut allergen clinically improves desensitization in children allergic to the food, a recent study has found.

Researchers enrolled 48 children (median age, 6.5 years; 67 percent male) with peanut allergies and who were subjected to extended maintenance SLIT with 2 mg/d of peanut protein for up to 5 years. Desensitization was evaluated using a double-blind, placebo-controlled food challenge trial. SLIT discontinuation was allowed only in those with skin test wheals <5 mm and peanut-specific immunoglobulin E (IgE) levels <15 kU/L.

A total of 75,366 total doses were delivered over the entire study period, of which only 4.78 percent (n=3,599) led to symptoms of side effects, affecting 45 of the 48 included children. Almost all of the symptoms resolved on their own, such that only 0.21 percent (n=158) required antihistamines. None of the children required epinephrine.

Thirty-seven participants were able to complete the study protocol and qualified for the food challenge trial. Majority (n=32; 67 percent) were able to consume at least 750 mg of peanut protein, while almost half (n=23; 48 percent) could tolerate at least 1,750 mg. A quarter (n=12; 25 percent) passed the food challenge, successfully intaking 5,000 mg of peanut protein without showing clinical symptoms.

This improvement in desensitization was accompanied by a significant decrease in median wheal size from baseline to study end (11.8 to 7.8 mm; p=0.049). The same was true for levels of peanut-specific IgEs (83.9 to 20.0 kU/L; p<0.0001).