title: Double-blind placebo-controlled challenge showed that peanut oral immunotherapy was effective for severe allergy without negative effects on airway inflammation.
abstract: OBJECTIVE
  This study examined the efficacy and the safety of peanut oral immunotherapy (OIT).
  
  
  METHODS
  We recruited 60 patients aged six years to 18 years who had a moderate-to-severe reaction to a double-blind placebo-controlled peanut challenge: 39 received OIT during an eight-month build-up phase and maintenance phase and 21 controls avoided peanuts. We measured specific immunoglobulin E and G4 (IgE and IgG4) to peanuts and to Ara h 1, 2, 3, 8 and 9 and monitored adverse events, bronchial hyper-responsiveness (BHR) to methacholine and fractional concentrations of exhaled nitric oxide (FeNO). The median follow-up period was 30 months.
  
  
  RESULTS
  Most (85%) of the OIT patients passed the build-up phase and 67% tolerated 5 g of peanuts during the post-treatment challenge. No controls were desensitised, with a risk ratio of 29 and 95% confidence interval of 1.9-455. During OIT, IgE to peanut, Ara h 1, 2 and 3 decreased and IgG4 increased. Consuming peanuts had no harmful effects on BHR or FeNO. The annual incidence rate of emergency visits during the follow-up period was 11% or 3.0 per 10 000 patient-days.
  
  
  CONCLUSIONS
  Peanut OIT was efficacious in severe allergies without negative effects on airway inflammation, but unpredictable long-term reactions might occur.
authors.affiliation: The Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Anna Kaarina
authors.initials: AK
authors.lastname: Kukkonen
authors.affiliation: The Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Riikka
authors.initials: R
authors.lastname: Uotila
authors.affiliation: The Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Leo Pekka
authors.initials: LP
authors.lastname: Malmberg
authors.affiliation: The Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Anna Susanna
authors.initials: AS
authors.lastname: Pelkonen
authors.affiliation: The Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Mika Juhani
authors.initials: MJ
authors.lastname: Mäkelä
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D001985:Bronchial Provocation Tests; D002648:Child; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007249:Inflammation / Q000276:immunology; D008297:Male; D016210:Methacholine Chloride; D021183:Peanut Hypersensitivity / Q000628:therapy*; D055815:Young Adult
chemical_list: D016210:Methacholine Chloride
keywords: Airway inflammation; Ara h 2; Bronchial hyper-responsiveness; Oral immunotherapy; Peanut allergy