title: Oral peanut immunotherapy in children with peanut anaphylaxis.
abstract: BACKGROUND
  The only treatment option for peanut allergy is strict avoidance.
  
  
  OBJECTIVE
  To investigate efficacy and safety of oral immunotherapy (OIT) in peanut allergy.
  
  
  METHODS
  Twenty-three children (age, 3.2-14.3 years) with IgE-mediated peanut allergy confirmed by positive double-blind, placebo-controlled food challenge (DBPCFC) received OIT following a rush protocol with roasted peanut for 7 days. If a protective dose of at least 0.5 g peanut was not achieved, patients continued with a long-term buildup protocol using biweekly dose increases up to at least 0.5 g peanut. A maintenance phase for 8 weeks was followed by 2 weeks of peanut avoidance and a final DBPCFC. Immunologic parameters were determined.
  
  
  RESULTS
  After OIT using the rush protocol, patients tolerated a median dose of only 0.15 g peanut. Twenty-two of 23 patients continued with the long-term protocol. After a median of 7 months, 14 patients reached the protective dose. At the final DBPCFC, patients tolerated a median of 1 g (range, 0.25-4 g) in comparison with 0.19 g peanut at the DBPCFC before OIT (range, 0.02-1 g). In 2.6% of 6137 total daily doses, mild to moderate side effects were observed; in 1.3%, symptoms of pulmonary obstruction were detected. OIT was discontinued in 4 of 22 patients because of adverse events. There was a significant increase in peanut-specific serum IgG(4) and a decrease in peanut-specific IL-5, IL-4, and IL-2 production by PBMCs after OIT.
  
  
  CONCLUSIONS
  Long-term OIT appears to be safe and of some benefit in many patients with peanut allergy. With an increase in threshold levels and a reduction of peanut-specific T(H)2 cytokine production, the induction of tolerance may be feasible in some patients.
authors.affiliation: Department of Pediatric Pneumology and Immunology, University Hospital Charité, Berlin, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Blumchen
authors.forename: Helen
authors.initials: H
authors.lastname: Ulbricht
authors.forename: Ute
authors.initials: U
authors.lastname: Staden
authors.forename: Kerstin
authors.initials: K
authors.lastname: Dobberstein
authors.forename: John
authors.initials: J
authors.lastname: Beschorner
authors.forename: Lucila Camargo Lopes
authors.initials: LC
authors.lastname: de Oliveira
authors.forename: Wayne G
authors.initials: WG
authors.lastname: Shreffler
authors.forename: Hugh A
authors.initials: HA
authors.lastname: Sampson
authors.forename: Bodo
authors.initials: B
authors.lastname: Niggemann
authors.forename: Ulrich
authors.initials: U
authors.lastname: Wahn
authors.forename: Kirsten
authors.initials: K
authors.lastname: Beyer
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015847:Interleukin-4 / Q000096:biosynthesis; D015848:Interleukin-5 / Q000096:biosynthesis; D008297:Male; D021183:Peanut Hypersensitivity / Q000276:immunology / Q000628:therapy*
chemical_list: D015848:Interleukin-5; D015847:Interleukin-4