Little boy eating peanuts

Oral immunotherapy can have significant benefits in young children with severe peanut allergy, show results from a National Institutes of Health (NIH) study that found 71% of the children in the study were desensitized to peanuts after treatment.

Around 21% of the children in the Immune Tolerance Network IMPACT trial went into remission, defined as being able to eat 5g of peanut protein without having an allergic reaction six months after completing immunotherapy. This amount is the equivalent of at least two slices of toast with peanut butter, if not more.

Notably, the youngest children—under the age of four years, and those with lower levels of peanut specific antibodies at the start of the trial were most likely to achieve remission.

“The landmark results of the IMPACT trial suggest a window of opportunity in early childhood to induce remission of peanut allergy through oral immunotherapy,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH, which sponsored and funded the trial.

“It is our hope that these study findings will inform the development of treatment modalities that reduce the burden of peanut allergy in children.”

The IMPACT trial took place over two years between 2013 and 2015 and included 146 children aged under 12 years (median age 39 months) with severe peanut allergy. The level of allergy was defined as reacting to 500 mg or less of peanut protein.

The children were randomly allocated to receive immunotherapy (96 children) equivalent to 2000mg peanut protein a day, or placebo (50 children), for 134 weeks, followed by 26 weeks of avoidance of any peanut intake.

The primary outcome, desensitization at 134 weeks, was met by 71% of the children in the immunotherapy group, and the secondary outcome, remission at 160 weeks was met by 21%.  In contrast, one of placebo group (5mg per day of peanut protein) was desensitized and went into remission.

Younger children and those with lower peanut-specific IgE antibodies had a better chance of going into remission according to the researchers.

“Interestingly, we also observed that those children who did achieve remission were more likely to be at the younger end of the age group, with the best outcomes in children aged one year old, suggesting that very early interventions may provide the best opportunity to achieve remission,” commented first author of The Lancet paper describing the work, Stacie Jones, a professor at University of Arkansas for Medical Sciences.

“However, there were only small numbers of children aged one year old enrolled in our study, so more studies are needed to investigate this finding,” she cautions.

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