Under-the-tongue immunotherapy a treatment for childhood peanut allergy
Researchers have developed an alternative way of desensitizing very young peanut-allergic children to the food. Under-the-tongue immunotherapy was found to be safer and easier to administer than the current treatment and may provide another method of curbing this potentially deadly allergy.
Peanut allergy typically develops early in life and is rarely outgrown. Peanuts are the most likely food to cause anaphylaxis and death, leading a child and their parents to experience the anxiety and social isolation that can commonly accompany a life-threatening allergy.
Oral immunotherapy (OIT) is well-studied as a way of inducing desensitization to peanuts in children and adolescents but can cause adverse reactions. So, researchers at University of North Carolina (UNC) Health developed an immunotherapy that is delivered sublingually (under the tongue) and is safe to use in very young peanut-allergic children.
“From our prior studies in older children, we were optimistic that peanut SLIT [sublingual immunotherapy] could have a similar treatment effect in toddlers,” said Edwin Kim, lead and corresponding author of the study. “However, what we found was even better. The desensitization levels we saw were higher than expected and on par with levels we normally would only expect with oral immunotherapy.”
Whereas with OIT peanut flour is mixed with another food and eaten, with SLIT, a small amount of peanut protein in a fluid is administered under the tongue. The researchers recruited 50 peanut-allergic children aged one to four, with half receiving 4 mg peanut SLIT and the other half a placebo. The primary endpoint of the study was desensitization, assessed by a food challenge after three years of treatment.
The researchers found that almost 80% of the children treated with SLIT tolerated 15 peanuts – the food challenge – without allergic symptoms after completing the treatment. The researchers say these results translate into strong protection against peanut exposure, given that typical peanut allergy reactions are caused by one peanut or less.
They also found that 63% of children maintained their peanut allergy protection three months after stopping the treatment, indicating remission. Remission was highest in the one-to-two-year-olds (58%), followed by two-to-three-year-olds (33%) and three-to-four-year-olds (43%), suggesting that early intervention may be important.
Reports of throat itch were reported in peanut SLIT participants, similar to studies on environmental allergen SLIT, but the symptoms were self-limiting and resolved spontaneously without leading to more significant reactions. Other reactions – skin, gastrointestinal, respiratory – were similar between the treatment and placebo groups.
The researchers say their findings demonstrate that, compared to peanut OIT, SLIT is safer and simpler to administer.
“Peanut OIT is currently available and being offered by increasing numbers of allergists, however, we are quickly learning that in addition to its known risk of allergic reactions, the actual doing of OIT can be very difficult for many families,” Kim said. “Peanut SLIT could be a good option to consider as it may be able to provide comparable levels of protection while being safe and easier to administer.”
The study was published in The Journal of Allergy and Clinical Immunology.
Source: UNC Health