Epicutaneous immunotherapy for the treatment of peanut allergy in children and young adults
Stacie M. Jones,Scott H. Sicherer,A. Wesley Burks,Donald Y.M. Leung,Robert Lindblad,Peter Dawson,Alice K. Henning,M. Cecilia Berin,David Y. Chiang,Brian P. Vickery,Robbie D. Pesek,Christine B. Cho,Wendy F. Davidson,Marshall Plaut,Hugh A. Sampson,Robert A. Wood +15 more
TLDR
Peanut EPIT administration was safe and associated with a modest treatment response after 52 weeks, with the highest responses among younger children, and when coupled with a high adherence and retention rate and significant changes in immune pathways, supports further investigation of this novel therapy.Abstract:
Background Peanut allergy is common, life-threatening, and without therapeutic options We evaluated peanut epicutaneous immunotherapy (EPIT) by using Viaskin Peanut for peanut allergy treatment Objective We sought to evaluate the clinical, safety, and immunologic effects of EPIT for the treatment of peanut allergy Methods In this multicenter, double-blind, randomized, placebo-controlled study, 74 participants with peanut allergy (ages 4-25 years) were treated with placebo (n = 25), Viaskin Peanut 100 μg (VP100; n = 24) or Viaskin Peanut 250 μg (VP250; n = 25; DBV Technologies, Montrouge, France) The primary outcome was treatment success after 52 weeks, which was defined as passing a 5044-mg protein oral food challenge or achieving a 10-fold or greater increase in successfully consumed dose from baseline to week 52 Adverse reactions and mechanistic changes were assessed Results At week 52, treatment success was achieved in 3 (12%) placebo-treated participants, 11 (46%) VP100 participants, and 12 (48%) VP250 participants ( P = 005 and P = 003, respectively, compared with placebo; VP100 vs VP250, P = 48) Median change in successfully consumed doses were 0, 43, and 130 mg of protein in the placebo, VP100, and VP250 groups, respectively (placebo vs VP100, P = 014; placebo vs VP250, P = 003) Treatment success was higher among younger children ( P = 03; age, 4-11 vs >11 years) Overall, 144% of placebo doses and 798% of VP100 and VP250 doses resulted in reactions, predominantly local patch-site and mild reactions ( P = 003) Increases in peanut-specific IgG 4 levels and IgG 4 /IgE ratios were observed in peanut EPIT-treated participants, along with trends toward reduced basophil activation and peanut-specific T H 2 cytokines Conclusions Peanut EPIT administration was safe and associated with a modest treatment response after 52 weeks, with the highest responses among younger children This, when coupled with a high adherence and retention rate and significant changes in immune pathways, supports further investigation of this novel therapyread more
Citations
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An update on allergic emergencies.
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TL;DR: The design and outcomes of recent clinical trials with traditional oral immunotherapy are discussed, and alternative protocols and formulations for safer and more effective oral treatment strategies for peanut allergy are considered.
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Stacie M. Jones,Laurent Pons,Joseph L. Roberts,Amy M. Scurlock,Tamara T. Perry,Mike Kulis,Wayne G. Shreffler,Pamela H. Steele,Karen A. Henry,Margaret Adair,James M. Francis,Stephen R. Durham,Brian P. Vickery,Xiao-Ping Zhong,A. Wesley Burks +14 more
TL;DR: Microarray data suggest a novel role for apoptosis in OIT, which induces clinical desensitization to peanut, with significant longer-term humoral and cellular changes.
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Oral immunotherapy for treatment of egg allergy in children.
A. Wesley Burks,Stacie M. Jones,Robert A. Wood,David Fleischer,Scott H. Sicherer,Robert Lindblad,Donald Stablein,Alice K. Henning,Brian P. Vickery,Andrew H. Liu,Amy M. Scurlock,Wayne G. Shreffler,Marshall Plaut,Hugh A. Sampson +13 more
TL;DR: These results show that oral immunotherapy can desensitize a high proportion of children with egg allergy and induce sustained unresponsiveness in a clinically significant subset.
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