Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Safra Children's Hospital, Sheba Medical Centre, Tel Hashomer, Israel.
Ann Allergy Asthma Immunol. 2022 Sep;129(3):347-353. doi: 10.1016/j.anai.2022.05.001. Epub 2022 May 10.
Between 25% and 30% of children with peanut allergy (PA) have a relatively high-threshold peanut allergy (HTPA), with a single maximal tolerated dose (SMTD) higher than 100 mg of peanut protein (PP). However, this threshold may decrease with time, age, exercise, illness, sleep deprivation, and other covariates.
To explore the feasibility of a simplified oral immunotherapy (OIT) protocol in a group of children with HTPA.
Children with PA with an SMTD higher than 100 mg were placed on a 40-week OIT protocol of either 300 mg/d of PP or 100 mg/d for 20 weeks followed by 300 mg/d for 20 weeks. A repeat open peanut food challenge was performed after 40 weeks of treatment and at a 6-month follow-up visit. After the 40-week challenge, all children received a maintenance dosage of 2 gPP 3 times a week.
A total of 28 children with HTPA were enrolled, with 56% boys, 89% younger than 6 years old, and a mean SMTD of 304 mg (95% confidence interval 229-378). All were placed on the described OIT protocol. Overall, 2 children were not compliant and 3 had allergic reactions at home on the dose previously tolerated in clinic, 23 completed the 40-week protocol, and all were able to consume 2 g of PP. The mean tolerated dosage at the 6-month follow-up was 8 g. This enabled most children age-appropriate dietary inclusion of peanut-containing products.
In children with HTPA, a simple, fixed-dose OIT can be both safe and efficacious.
25%至 30%的花生过敏（PA）儿童存在相对较高阈值的花生过敏（HTPA），单次最大耐受剂量（SMTD）高于 100mg 的花生蛋白（PP）。然而，随着时间、年龄、运动、疾病、睡眠剥夺和其他协变量的变化，这个阈值可能会降低。
探索简化口服免疫疗法（OIT）方案在一组 HTPA 儿童中的可行性。
将 SMTD 高于 100mg 的 PA 患儿纳入研究，并接受 40 周的 OIT 方案，其中 300mg/d 的 PP 或 100mg/d 的剂量持续 20 周，随后剂量增加至 300mg/d 再持续 20 周。治疗 40 周后和 6 个月随访时进行重复开放花生食物挑战。40 周挑战后，所有儿童接受每周 3 次、2gPP 的维持剂量。
共纳入 28 例 HTPA 患儿，其中 56%为男性，89%年龄小于 6 岁，SMTD 平均为 304mg（95%置信区间 229-378）。所有患儿均接受上述 OIT 方案治疗。总体而言，有 2 例患儿不依从，3 例患儿在之前耐受的剂量下在家中发生过敏反应，23 例患儿完成了 40 周的方案，所有患儿均能耐受 2gPP。6 个月随访时的平均耐受剂量为 8g。这使大多数儿童能够在年龄适宜时摄入含花生的产品。
在 HTPA 儿童中，简单、固定剂量的 OIT 既安全又有效。
