Patients Taking Lower Maintenance Doses of Peanut Oral Immunotherapy May Still Achieve Desensitization

Oral immunotherapy (OIT) is a treatment that could potentially help peanut allergic patients achieve desensitization, but some patients are unable to tolerate maintenance doses that are large enough to facilitate unlimited peanut consumption.

When patients are able to tolerate the target maintenance dose of 3,000 mg (equivalent of 10 peanuts), they are considered to be able to consume any amount of peanuts without severe reactions. Israeli researchers presenting their findings at the 2018 American Academy of Allergy, Asthma & Immunology (AAAAI) and World Allergy Organization (WAO) Joint Congress have discovered that patients who can only tolerate lower maintenance doses also have the potential to become fully desensitized.

145 Patients in the study underwent peanut OIT. Their initial tolerated dose was established in a hospital setting and patients were instructed to consume the dose every day at home.

“The doses were gradually increased on a monthly basis as patients were able to tolerate more peanut protein,” said author Arnon Elizur, MD. “Eleven patients, ranging from 6 to 19 years-old, were unable to reach the target maintenance dose and were placed on lower maintenance doses of peanut protein, as tolerated.”

Patients were treated for three to thirteen months before their maintenance dose of 600-1,500 mg of peanut protein, was determined. In that span, five of the 11 patients experienced reactions during the home treatments including one reaction that required the use of an epinephrine auto-injector.

Following a period of 6 to 68 months of low maintenance dose consumption, patients were given an oral food challenge of 3,000 mg of peanut protein. All but one patient successfully passed the challenge. The only patient not to pass the challenge was on the lowest maintenance dose of the group at 600 mg and reacted to 2,100 mg of peanut protein.

Eight out of the 11 patients reported full compliance to the daily dose consumption, while three patients occasionally stopped treatment for greater than a week.

“A small portion of patients will not be able to reach the 3,000 mg target maintenance dose,” said Elizur. “However, this study shows that even lower doses, are not only protective against severe reactions in the case of accidental exposure to peanut, but also can enable free peanut consumption long-term.” 

This article has been republished from materials provided by American Academy of Allergy, Asthma & Immunology . Note: material may have been edited for length and content. For further information, please contact the cited source.

Reference
Long Term outcome of Peanut Oral Immunotherapy (OIT) in Patients Unable to Reach Maintenance Goal. Liat Nachshon, Michael R. Goldberg, Michael B. Levy, Na’ama Epstein-Rigbi, Arnon Elizur. Presentation from the 2018 American Academy of Allergy, Asthma & Immunology (AAAAI) and World Allergy Organization (WAO) Joint Congress 04 March 2018.