Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf-Harofeh Medical Center, Zerifin, Israel.
Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatr Allergy Immunol. 2018 Aug;29(5):519-526. doi: 10.1111/pai.12914. Epub 2018 Jun 5.
Oral immunotherapy (OIT) is currently recommended as a treatment option for peanut-allergic patients. Data regarding its long-term compliance and efficacy in real life are required.
Peanut-allergic patients aged ≥4 years were enrolled in a single-center clinical OIT program. Buildup to 3000 mg peanut protein was performed. Patients reaching this dose before or after 12/2014 were instructed to consume 3000 or 1200 mg daily, respectively. Patients were followed ≥6 months after reaching maintenance and rechallenged to 3000 mg.
Of the 145 patients studied, 113 (77.9%) were fully desensitized to 3000 mg and 133 (91.7%) were desensitized to ≥300 mg. 21/145 patients (14.5%) required adrenaline for home-dose reactions during buildup. Non-anaphylactic gastrointestinal symptoms, experienced by 9 patients (6.2%), reversed with dose reduction. Of the 111 patients available for analysis 6 months after reaching 3000 mg, 97 (87.4%) continued regular peanut consumption. Only 2/111 patients (1.8%) required adrenaline over the long-term (median, range; 18, 6-75 months) follow-up. Adherence to treatment was significantly higher in patients consuming 1200 mg (73/76, 96.1%) vs those consuming 3000 mg (24/35, 72.2%), (P = .001). A higher maintenance dosage and home adrenaline requirement during buildup predicted adherence cessation (OR 12.5, P = .001; and OR 7.8, P = .02, respectively). 63/64 patients (98.4%) consuming 1200 mg maintenance dose were successfully rechallenged to 3000 mg.
This real-life experience demonstrates the efficacy of peanut OIT long-term. A lower maintenance dose minimized treatment cessation while maintaining desensitization. OIT should be performed in qualified centers given the prevalence of adverse reactions, particularly during buildup.
目前推荐口服免疫疗法（OIT）作为花生过敏患者的治疗选择。需要有关其在现实生活中的长期依从性和疗效的数据。
纳入了年龄≥4 岁的花生过敏患者参加单中心临床 OIT 项目。进行 3000mg 花生蛋白递增量。在 2014 年 12 月之前或之后达到此剂量的患者分别接受 3000mg 或 1200mg 的每日剂量。在达到维持剂量后至少随访 6 个月，并重新挑战 3000mg。
在研究的 145 名患者中，113 名（77.9%）对 3000mg 完全脱敏，133 名（91.7%）对≥300mg 脱敏。在增量期间，21/145 名患者（14.5%）因家庭剂量反应需要肾上腺素。9 名患者（6.2%）经历了非过敏性胃肠道症状，通过减少剂量逆转。在达到 3000mg 后 6 个月可分析的 111 名患者中，97 名（87.4%）继续定期食用花生。在长期（中位数，范围；18、6-75 个月）随访中，仅 2/111 名患者（1.8%）需要肾上腺素。服用 1200mg 的患者治疗依从性明显更高（76/76，96.1%），而服用 3000mg 的患者（35/35，72.2%），（P=.001）。增量期间维持剂量较高和家庭使用肾上腺素需要预测停药（OR 12.5，P=.001；和 OR 7.8，P=.02）。63/64 名（98.4%）服用 1200mg 维持剂量的患者成功重新挑战 3000mg。
这项真实生活经验证明了花生 OIT 的长期疗效。较低的维持剂量在保持脱敏的同时最大限度地减少了治疗的中断。鉴于不良反应的普遍性，特别是在增量期间，OIT 应在合格的中心进行。
