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Desensitization for Peanut Allergies in Children

  • Pediatric Allergy (F Baroody, Section Editor)
  • Published:
Current Treatment Options in Allergy Aims and scope Submit manuscript

Opinion Statement

Immunotherapy for peanut allergy has been an exploding topic of study within the last few years. Sublingual, epicutaneous, and oral immunotherapy are being investigated and show promise in the treatment of peanut allergy. Oral immunotherapy has shown the most clinical benefit; however, sublingual and epicutaneous immunotherapy appear to have the most favorable safety profiles. Most studies to date suggest that only a minority of subjects achieve sustained unresponsiveness to peanut after discontinuation of immunotherapy. Recent efforts have been focused on identifying adjunct therapies, such as omalizumab, that may assist patients in achieving peanut desensitization more quickly and with greater success. Several underlying immunologic mechanisms, including a switch from IgE to IgG4 production and induction of T regulatory cells, have been studied although more research is needed to identify reliable biomarkers. This article will describe the immunotherapy approaches that are being investigated to induce peanut desensitization, and highlight the benefits and risks of these therapies that need to be considered before they are ready for routine clinical practice.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Bock SA, Munoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001–2006. J Allergy Clin Immunol. 2007;119(4):1016–8.

    Article  PubMed  Google Scholar 

  2. Sicherer SH et al. U.S. prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol. 2010;125(6):1322–6.

    Article  CAS  PubMed  Google Scholar 

  3. Skolnick HS, Conover-Walker MK, Koerner CB, Sampson HA, et al. The natural history of peanut allergy. J Allergy Clin Immunol. 2001;107:367–74.

    Article  CAS  PubMed  Google Scholar 

  4. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6):S1–58.

  5. Du Toit G et al. Randomized trial of peanut consumption in infants at risk of peanut allergy. N Engl J Med. 2015;372:803–13.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, et al. Guidelines for the diagnosis and Management of Food Allergy in the United States: summary of the NIAID-sponsored expert panel report. J Allergy Clin Immunol. 2010;126(6):1105–18.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nelson HS, Lahr J, Rule R, Bock SA, Leung DY. Treatment of anaphylactic sensitivity to peanuts by immunotherapy with injections of aqueous peanut extract. J Allergy Clin Immunol. 1997;99:744–51.

    Article  CAS  PubMed  Google Scholar 

  8. Oppenheimer JJ, Nelson HS, Bock SA, et al. Treatment of peanut allergy with rush immunotherapy. J Allergy Clin Immunol. 1992;90:256.

    Article  CAS  PubMed  Google Scholar 

  9. Kim EH, Bird A, Kulis M, et al. Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization. J Allergy Clin Immunol. 2011;127(3):640–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Fleisher D, Burks A, Vickery B, Scurlock A, Wood R, Jones S, et al. Sublingual immunotherapy for peanut allergy: a randomized, double-blind, placebo-controlled multicenter trial. J Allergy Clin Immunol. 2014;135:1–10. The first multicenter randomized placebo-controlled trial of peanut SLIT. Demonstrated that 70% of subjects treated with active SLIT were able to tolerate approximately 0.5 g of peanut after 44 weeks of treatment.

    Google Scholar 

  11. Burks AW, Wood RA, Jones SM, et al. Sublingual immunotherapy for peanut allergy: follow-up of a randomized multicenter trial. J Allergy Clin Immunol. 2014;135(5):1240–8. Long-term follow-up of Fleisher et al study demonstrating favorable safety profile of peanut SLIT; however, sustained unresponsiveness was observed in only a small minority of patients even after 2-3 years of active treatment.

    Article  Google Scholar 

  12. Dioszeghy V, Mondoulet L, Dhelft V, Ligouis M, Puteaux E, Benhamou PH, et al. Epicutaneous immunotherapy results in rapid allergen uptake by dendritic cells through intact skin and downregulates the allergen-specific response in sensitized mice. J Immunol. 2011;186(10):5629–37.

    Article  CAS  PubMed  Google Scholar 

  13. Dioszeghy V, Mondoulet L, Dhelft V, Ligouis M, Puteaux E, Dupont C, et al. The regulatory T cell induction by epicutaneous immunotherapy is sustained and mediates long-term protection from eosinophilic disorders in peanut-sensitized mice. Clin Exp Allergy J Br Soc Allergy Clin Immunol. 2014;44(6):867–81.

    Article  CAS  Google Scholar 

  14. Sampson HA et al. Epicutaneous immunotherapy (EPIT) is effective and safe to treat peanut allergy: a multi-national double-blind placebo-controlled randomized phase IIb trial. J Allergy Clin Immunol. 2015;135(2):AB390.

    Article  Google Scholar 

  15. Sampson HA, Agbotounou W, Thebault C, et al. Enhanced efficacy and confirmed safety of two-year epicutaneous immunotherapy (EPIT) treatment of peanut allergy with Viaskin peanut: the continuation of the VIPES phase IIb randomized controlled trial (RCT). J Allergy Clin Immunol. 2016;137(2):AB408.

    Article  Google Scholar 

  16. Jones SM, Pons L, Roberts JL, et al. Clinical efficacy and immune regulation with peanut oral immunotherapy. J Allergy Clin Immunol. 2009;124(2):292–300.

  17. Blumchen K, Ulbricht H, Staden U, et al. Oral peanut immunotherapy in children with peanut anaphylaxis. J Allergy Clin Immunol. 2010;126(1):83–91.

    Article  CAS  PubMed  Google Scholar 

  18. Varshney P, Jones SM, Scurlock AM, et al. A randomized controlled study of peanut oral immunotherapy: clinical desensitization and modulation of the allergic response. J Allergy Clin Immunol. 2011;127(3):654–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Anagnostou K, Islam S, King Y, Foley L, et al. Assessing the efficacy of oral immunotherapy for the desensitization of peanut allergy in children (STOP II): a phase 2 randomized controlled trial. Lancet. 2014;383:1297–303. One of the largest randomized placebo-controlled crossover trials to evaluate the efficacy of peanut OIT. Demonstrated that most children with peanut allergy can be successfully desensitized with OIT.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Bird JA, Feldman M, Arneson A, et al. Modified peanut oral immunotherapy protocol safely and effectively induces desensitization. J Allergy Clin Immunol Pract. 2015;3(3):433–5. Demonstrated that clinical desensitization can be achieved with peanut OIT using lower daily maintenance dosing of 2 g peanut/day and without a traditional dose escalation day.

    Article  PubMed  Google Scholar 

  21. Vickery BP, Scurlock AM, Kulis M, et al. Sustained unresponsiveness to peanut in subjects who have completed peanut oral immunotherapy. J Allergy Clin Immunol. 2014;133(2):468–75. One of the first peanut oral immunotherapy trials to evaluate sustained unresponsiveness upon discontinuance of peanut OIT.

    Article  CAS  PubMed  Google Scholar 

  22. Chin SJ, Vickery BP, Kulis MD, et al. Sublingual versus oral immunotherapy for peanut-allergic children: a retrospective comparison. J Allergy Clin Immunol. 2013;132(2):476–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Narisety SD, Frischmeyer-Guerrerio PA, Keet CA, et al. A randomized, double-blind placebo-controlled pilot study of sublingual versus oral immunotherapy for the treatment of peanut allergy. J Allergy Clin Immunol. 2014;135(5):1275–82. A randomized double-blind placebo-controlled pilot study that directly compared peanut SLIT and OIT. Revealed that OIT is generally more effective than SLIT at desensitizing patients but is also associated with more side effects.

  24. Vickery BP, Lin J, Kulis M, et al. Peanut oral immunotherapy modifies IgE and IgG4 responses to major peanut allergens. J Allergy Clin Immunol. 2013;131(1):128–34.

  25. Burton OT, Logsdon SL, Zhou JS, et al. Oral immunotherapy induces IgG antibodies that act through FcγRIIb to suppress IgE-mediated hypersensitivity. J Allergy Clin Immunol. 2014;134:1310–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Gorelik M, Narisety SD, Guerrerio A, et al. Suppression of the immunologic response to peanut during immunotherapy is often transient. J Allergy Clin Immunol. 2015;135(5):1283–92. This study showed that suppression of basophil effector functions, dendritic cell activation, and Th2 cytokine responses can be transient in some patients during peanut OIT and SLIT.

    Article  CAS  PubMed  Google Scholar 

  27. Thyagarajan A, Jones SM, Calatroni A, Pons L, Kulis M, Woo CS, Kamalakannan M, Vickery BP, Scurlock AM, Wesley Burks A, et al. Evidence of pathway specific basophil anergy induced by peanut oral immunotherapy in peanut-allergic children. Clin Exp Allergy. 2012;42:1197–205.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Wisniewski JA, Commins SP, Agrawal R, et al. Analysis of cytokine production by peanut-reactive T cells identifies residual Th2 effectors in highly allergic children who received peanut oral immunotherapy. Clin Exp Allergy. 2015;45:1201–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Syed A, Garcia MA, Shu-Chen L, et al. Peanut oral immunotherapy results in increased antigen-induced Treg function and hypomethylation of FOXP3. J Allergy Clin Immunol. 2014;133(2):500–10. Revealed that peanut OIT may be associated with induction of suppressive T regulatory cells.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Burk CM, Kulis M, Leung N, Kim A, Burks W, Vickery BP. Utility of component analyses in subjects undergoing sublingual immunotherapy for peanut allergy. Clin Exp Allergy. 2015;46:347–53.

    Article  Google Scholar 

  31. Tang M, Ponsonby A, Orsini F. Administration of a probiotic with peanut oral immunotherapy: a randomized trial. J Allergy Clin Immunol. 2014;135(3):737–44. A randomized trial examining the efficacy of combining a probiotic with peanut OIT in inducing desensitization.

    Article  Google Scholar 

  32. Schneider LC, Rachid R, LeBovidge J, et al. A pilot study of omalizumab to facilitate rapid oral desensitization in high-risk peanut allergic patients. J Allergy Clin Immunol. 2013;132(6):1368–74. Pilot study demonstrating that pre-treatment with omalizumab prior to OIT may lead to more rapid desensitization with fewer side effects.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Lucendo AJ, Arias A, Tenias JM. Relation between eosinophilic esophagitis and oral immunotherapy for food allergy: a systematic review with meta-analysis. Ann Allergy Asthma Immunol. 2014;113:624–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. National Institutes of Health, 10 Clinical Center Drive, Bethesda, MD, 20892, USA

    Rekha D. Jhamnani M.D.

  2. National Institutes of Health, 4 Memorial Drive, Building 4, Room 228, Bethesda, MD, 20892, USA

    Pamela Frischmeyer-Guerrerio M.D. Ph.D.

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  1. Rekha D. Jhamnani M.D.
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  2. Pamela Frischmeyer-Guerrerio M.D. Ph.D.
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Correspondence to Pamela Frischmeyer-Guerrerio M.D. Ph.D..

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Conflict of Interest

Dr. Rekha D. Jhamnani declares that she has no conflict of interest.

Dr. Pamela Frischmeyer-Guerrerio declares that she has no conflict of interest.

Dr. Pamela Frischmeyer-Guerrerio is supported by the Intramural Research Program of the NIH, NIAID.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Pediatric Allergy

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Jhamnani, R.D., Frischmeyer-Guerrerio, P. Desensitization for Peanut Allergies in Children. Curr Treat Options Allergy 3, 282–291 (2016). https://doi.org/10.1007/s40521-016-0091-3

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  • DOI: https://doi.org/10.1007/s40521-016-0091-3

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