title: Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization.
abstract: BACKGROUND
  There are no treatments currently available for peanut allergy. Sublingual immunotherapy (SLIT) is a novel approach to the treatment of peanut allergy.
  
  
  OBJECTIVE
  We sought to investigate the safety, clinical effectiveness, and immunologic changes with SLIT in children with peanut allergy.
  
  
  METHODS
  In this double-blind, placebo-controlled study subjects underwent 6 months of dose escalation and 6 months of maintenance dosing followed by a double-blind, placebo-controlled food challenge.
  
  
  RESULTS
  Eighteen children aged 1 to 11 years completed 12 months of dosing and the food challenge. Dosing side effects were primarily oropharyngeal and uncommonly required treatment. During the double-blind, placebo-controlled food challenge, the treatment group safely ingested 20 times more peanut protein than the placebo group (median, 1,710 vs 85 mg; P = .011). Mechanistic studies demonstrated a decrease in skin prick test wheal size (P = .020) and decreased basophil responsiveness after stimulation with 10(-2) μg/mL (P = .009) and 10(-3) μg/mL (P = .009) of peanut. Peanut-specific IgE levels increased over the initial 4 months (P = .002) and then steadily decreased over the remaining 8 months (P = .003), whereas peanut-specific IgG4 levels increased during the 12 months (P = .014). Lastly, IL-5 levels decreased after 12 months (P = .015). No statistically significant changes were found in IL-13 levels, the percentage of regulatory T cells, or IL-10 and IFN-γ production.
  
  
  CONCLUSIONS
  Peanut SLIT is able to safely induce clinical desensitization in children with peanut allergy, with evidence of immunologic changes suggesting a significant change in the allergic response. Further study is required to determine whether continued peanut SLIT is able to induce long-term immune tolerance.
authors.affiliation: Department of Pediatrics, Division of Allergy and Immunology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Edwin H
authors.initials: EH
authors.lastname: Kim
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Bird
authors.forename: Michael
authors.initials: M
authors.lastname: Kulis
authors.forename: Susan
authors.initials: S
authors.lastname: Laubach
authors.forename: Laurent
authors.initials: L
authors.lastname: Pons
authors.forename: Wayne
authors.initials: W
authors.lastname: Shreffler
authors.forename: Pamela
authors.initials: P
authors.lastname: Steele
authors.forename: Janet
authors.initials: J
authors.lastname: Kamilaris
authors.forename: Brian
authors.initials: B
authors.lastname: Vickery
authors.forename: A Wesley
authors.initials: AW
authors.lastname: Burks
mesh_terms: D000286:Administration, Sublingual; D002648:Child; D002675:Child, Preschool; D003888:Desensitization, Immunologic / Q000379:methods* / Q000639:trends; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D021183:Peanut Hypersensitivity / Q000628:therapy*