Chagarlamudi Hema, Smith Hunter G, Kim Edwin H
From the Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina and.
Department of Pediatrics, McGaw Medical Center of Northwestern University and Lurie Children's Hospital, Chicago, Illinois.
J Food Allergy. 2024 Aug 1;7(1):14-20. doi: 10.2500/jfa.2025.7.250007. eCollection 2024 Aug.
Peanut allergy remains a common problem that persists into adulthood for most patients, with risks of accidental ingestion and poor quality of life. Oral immunotherapy (OIT) and anti-immunoglobulin E (IgE) therapy are effective options for peanut allergy; however, each therapy has limitations, which makes them not ideal for all patients.
The objective was to summarize recent studies that support sublingual immunotherapy (SLIT) for peanut allergy as an alternative option to OIT and anti-IgE therapy, and to discuss practical considerations for its use in clinical practice.
Published reports of SLIT for the treatment of peanut allergy from the past 15 years were identified. Efficacy as measured by food challenges was compared across studies as well as dosing reactions during SLIT therapy.
Published studies of peanut SLIT demonstrate significant increases in reaction threshold after therapy. When considering desensitization, higher thresholds were reported with younger age at initiating therapy. Furthermore, the potential for a 3-month remission was seen for toddlers after treatment. Adverse effects with SLIT were similar across the ages, with transient oropharyngeal pruritus being most commonly reported. Severe symptoms that require treatment with epinephrine have generally not been reported. Despite the reassuring safety, withdrawal from therapy was common in older participants. Key questions remain with regard to the minimum duration of sublingual administration, optimal maintenance dose, and best measures of treatment efficacy.
Peanut SLIT has been extensively studied, which demonstrated desensitization at levels that approach OIT while also having a simple administration and reassuring safety that may make it a good option for peanut allergy alongside OIT and anti-IgE therapy.
花生过敏仍然是一个常见问题，大多数患者会持续到成年期，存在意外摄入风险且生活质量较差。口服免疫疗法（OIT）和抗免疫球蛋白E（IgE）疗法是治疗花生过敏的有效选择；然而，每种疗法都有局限性，这使得它们并非对所有患者都理想。
目的是总结近期支持舌下免疫疗法（SLIT）治疗花生过敏作为OIT和抗IgE疗法替代选择的研究，并讨论其在临床实践中应用的实际考虑因素。
检索过去15年发表的关于SLIT治疗花生过敏的报告。比较各研究中通过食物激发试验衡量的疗效以及SLIT治疗期间的剂量反应。
已发表的花生SLIT研究表明治疗后反应阈值显著提高。在考虑脱敏时，开始治疗时年龄越小，报告的阈值越高。此外，治疗后幼儿有3个月缓解的可能性。SLIT的不良反应在各年龄段相似，最常报告的是短暂的口咽瘙痒。一般未报告需要用肾上腺素治疗的严重症状。尽管安全性令人放心，但老年参与者中退出治疗的情况很常见。关于舌下给药的最短持续时间、最佳维持剂量和治疗效果的最佳衡量指标仍存在关键问题。
花生SLIT已得到广泛研究，其脱敏程度接近OIT，同时给药简单且安全性令人放心，这可能使其成为与OIT和抗IgE疗法并列的治疗花生过敏的良好选择。
