Clinical efficacy and immune regulation with peanut oral immunotherapy.

Full Abstract

BACKGROUND: Oral immunotherapy (OIT) has been thought to induce clinical desensitization to allergenic foods, but trials coupling the clinical response and immunologic effects of peanut OIT have not been reported. OBJECTIVE: The study objective was to investigate the clinical efficacy and immunologic changes associated with OIT. METHODS: Children with peanut allergy underwent an OIT protocol including initial day escalation, buildup, and maintenance phases, and then oral food challenge. Clinical response and immunologic changes were evaluated. RESULTS: Of 29 subjects who completed the protocol, 27 ingested 3.9 g peanut protein during food challenge. Most symptoms noted during OIT resolved spontaneously or with antihistamines. By 6 months, titrated skin prick tests and activation of basophils significantly declined. Peanut-specific IgE decreased by 12 to 18 months, whereas IgG(4) increased significantly. Serum factors inhibited IgE-peanut complex formation in an IgE-facilitated allergen binding assay. Secretion of IL-10, IL-5, IFN-gamma, and TNF-alpha from PBMCs increased over a period of 6 to 12 months. Peanut-specific forkhead box protein 3 T cells increased until 12 months and decreased thereafter. In addition, T-cell microarrays showed downregulation of genes in apoptotic pathways. CONCLUSION: Oral immunotherapy induces clinical desensitization to peanut, with significant longer-term humoral and cellular changes. Microarray data suggest a novel role for apoptosis in OIT.

Author information

Author/s: Jones, Stacie M (SM); Pons, Laurent (L); Roberts, Joseph L (JL); Scurlock, Amy M (AM); Perry, Tamara T (TT); Kulis, Mike (M); Shreffler, Wayne G (WG); Steele, Pamela (P); Henry, Karen A (KA); Adair, Margaret (M); Francis, James M (JM); Durham, Stephen (S); Vickery, Brian P (BP); Zhong, Xiaoping (X); Burks, A Wesley (AW);

Affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark, USA.

Grants: 1R01-AI068074-01A1 (Agency:NIAID NIH HHS) ; 5M01-R000030-45 (Agency:PHS HHS)

Journal and publication information

Publication Type: Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't

Journal: The Journal of allergy and clinical immunology (J Allergy Clin Immunol), published in United States. (Language: eng)

Reference: 2009-Aug; vol 124 (issue 2) : pp 292-300, 300.e1-97

Dates: Created 2009/08/03; Completed 2009/09/08;

PMID: 19577283, status: MEDLINE (last retrieval date: 9/8/2009, IMS Date: )

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