Feasibility of desensitizing children highly allergic to peanut by high‐dose oral immunotherapy

Reier‐Nilsen, Tonje; Michelsen, Merethe Melbye; Carlsen, Karin C. Lødrup; Carlsen, Kai‐Håkon; Mowinckel, Petter; Nygaard, Unni Cecilie; Namork, Ellen; Borres, Magnus P.; Håland, Geir

doi:10.1111/all.13604

Cited by 39 publications

(44 citation statements)

References 44 publications

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“…In a high maintenance dose peanut OIT study, 130 the IgG4/IgE ratio was the only significant predictor to reach the 5000 mg maintenance dose. 130 In two long-term follow-up studies on children who received milk OIT, a lower milk sIgE was predictive of safety and long-term outcome. 131,132 In Egypt, the IgE after 2 years of OIT was analyzed to find the marker of successful OIT as compared to the DBPCFC.…”

Section: Clinic Al Mark Er S and Pro Cedur Al Fac Tor S Of Tre Atmementioning

confidence: 91%

“…In a high‐dose peanut OIT in children (TAKE‐AWAY), only 21% of 77 could reach 5000 mg, but 75% could reach an individualized maintenance dose . Factors such as parental education level or history of severe anaphylaxis did not predict reaching 5000 mg . Target doses of both 300 mg and 3000 mg appeared similarly efficacious for peanut SU in preschoolers .…”

Section: Clinical Markers and Procedural Factors Of Treatment Failurementioning

confidence: 96%

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Recent developments and highlights in food allergy

Eiwegger

Hung

Diego

et al. 2019

Allergy

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The achievement of long-lasting, safe treatments for food allergy is dependent on the understanding of the immunological basis of food allergy. Accurate diagnosis is essential for management. In recent years, data from oral food challenges have revealed that routine allergy testing is poor at predicting clinical allergy for tree nuts, almonds in particular. More advanced antigen-based tests including component-resolved diagnostics and epitope reactivity may lead to more accurate diagnosis and selection of therapeutic intervention. Additional diagnostic accuracy may come from cellular tests such as the basophil activation test or mast cell approaches. In the context of clinical trials, cellular tests have revealed specific T-cell and B-cell populations that are more abundant in food-allergic individuals with distinct mechanistic features.Awareness of clinical markers, such as the ability to eat baked forms of milk and egg, continues to inform the understanding of natural tolerance development.Mouse models have allowed for investigation into multiple mechanisms of food allergy including modification of epithelial metabolism, and the induction of regulatory cell subsets and the microbiome. Increasing numbers of children who underwent food immunotherapy enlarged the body of evidence on mechanisms and predictors of treatment success. Experimental immunological markers in conjunction with clinical determinants such as lower age and lower initial specific IgE appear to be of benefit.More research on the optimal dose, preparation, and route of application integrating a high-level safety and efficacy is demanded. Alternatively, biologics blocking TSLP, IL-33, IL-4 and IL-13, or IgE may help to achieve that. K E Y W O R D Sallergy treatment, biologics, food allergy, immune tolerance, immunotherapy | 2357 EIWEGGER Et al.

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Section: Clinic Al Mark Er S and Pro Cedur Al Fac Tor S Of Tre Atmementioning

confidence: 91%

Section: Clinical Markers and Procedural Factors Of Treatment Failurementioning

confidence: 96%

Recent developments and highlights in food allergy

Eiwegger

Hung

Diego

et al. 2019

Allergy

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show abstract

“…Baseline characteristics are given in Table 1 and were similar among OIT children (n = 57), controls (n = 20), and ineligible children, except that significantly more of the OIT children needed adrenaline during DBPCFC (P = 0.03). 5 Of the 57 OIT children, 43 completed Y 1 and 39 Y 2 , while all 20 controls attended investigations at both Y 1 and Y 2.…”

Section: Study Populationmentioning

confidence: 99%

“…However, a recent editorial 17 raised concerns regarding OITs in children highly sensitized to peanuts, based upon recent results from our ongoing 4-year peanut OIT; "Take-Away food allergy: Inducing tolerance in children allergic to peanut" trial (the TAKE-AWAY trial). 5 This open-labeled randomized controlled trial has an overall objective to assess whether 4 years of OIT induces SU 1 year after cessation of treatment in children with primary peanut allergy. In the present study, we explored the effect of OIT on desensitization and PROs reported by the children and their guardians.…”

Section: Introductionmentioning

confidence: 99%

Parent and child perception of quality of life in a randomized controlled peanut oral immunotherapy trial

Reier‐Nilsen

Carlsen

Michelsen

et al. 2019

Pediatric Allergy Immunology

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Background Improved quality of life (QoL) after oral immunotherapy (OIT) in peanut allergic children is often reported by their parents, while the child's perspective is less clear. Objective We aimed to explore whether 2 years of OIT improved QoL in children with peanut allergy and to identify factors influencing change in QoL. Methods In the open‐labeled TAKE‐AWAY peanut OIT trial including children with anaphylaxis to peanuts, 57 were randomized to OIT and 20 to observation. The Pediatric Quality of Life Inventory Version 4.0 was completed by parents and children at enrollment (Y0), after 1 year (end of updosing; Y1) and after 2 years (Y2) of OIT. Minimally clinically important difference (MCID) is ≥5.3. Perceived treatment burden was recorded by visual analogue scales, including adverse events (AEs). An open food challenge (OFC) was performed at Y2. Results At Y2, 18 children had discontinued OIT and 2 of 39 OIT children refused OFC, while 35 of 37 were desensitized to 7500 mg peanut protein. From Y0 to Y2, the mean change (95% confidence intervals) in QoL was 4.4 (0.5, 8.3) among child self‐reports and twice as large among parental proxy reports (9.3 [4.3, 14.3]; both P < 0.0001), without significant improvement among the controls. The change in QoL was significantly different from the controls for the parental proxy reports only (P = 0.002). Neither treatment burden nor AEs significantly predicted changes in QoL. Conclusion Two years of OIT improved child‐QoL as reported by parents, but not by the children, suggesting that parents may overestimate improvement in child‐QoL by OIT.

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“…In this issue of Allergy , Reier‐Nilsen et al present the results of the build‐up phase of the TAKE‐AWAY trial, an open‐label controlled, randomized, high‐dose peanut OIT trial in 5‐ to 15‐year‐old children aiming for sustained unresponsiveness to peanut after 4 years of treatment (Take‐Away Food Allergy; Inducing Tolerance in Children Allergic to Peanut, NCT02457416). Seventy‐seven children were randomized to either receive peanut OIT (n = 57) or avoidance (n = 20).…”

mentioning

confidence: 99%