Searching for a Safe, Cheap and Simple Protocol to Desensitize Children with Peanut Allergy. Patient Data of Four Children with Peanut Allergy Undergoing Oral Immunotherapy (OIT)

Abstract

Objectives: To find a safe, effective and easy-to-perform method to desensitize children with peanut allergy. Design:Patients with anaphylactic reactions to peanut protein (Sampson Grade 1-3) were investigated for peanut IgE, AraH2 positivity and underwent lung function test with exercise challenge before entering an open food challenge (OFC) test. Oral immunotherapy (OIT) with incremental doses was started under a protective medication of levocetirizine with an amount of peanut protein lower than the reaction threshold in the OFC. Maintenance was reached with a dosage of 250 mg peanut protein (2 kernels) and OIT was continued with this amount on a daily basis. Levocetirizine was discontinued after two months symptom free period on maintenance dosage.Settings: Blood samples, lung function tests OFC and initial dose of OIT were carried out in an outpatient setting able to deal with anaphylactic reactions.Patients: Four patients, three males and one female, aged 6-12 years with systemic reactions to peanut in an open challenge test under went OIT. Patients revealed co-morbidities such as asthma, atopic eczema, other food allergies, pollen allergy and coeliac disease in addition to peanut allergy.Interventions: During OIT, patients had repeatedly phone contacts with a physician. If extensive side effects occurred, the dosage was stepped down to the dosage formerly tolerated.Results: All four patients reached the maintenance dose of 250 mg peanut protein (2 kernels). The interval between starting OIT and reaching maintenance was 7-35 weeks. Adverse reactions during OIT were considerably mild and consisted of GER, mild to moderate stomach pain and an itchy throat and treated with antihistamine. No one needed adrenalin for the symptoms during OIT. Conclusions:OIT was effective in patients with mild to moderate anaphylaxis due to peanut allergy using an uncomplicated, individually tailored protocol.