Clinical efficacy and immune regulation with peanut oral immunotherapy.

Journal Article (Clinical Trial;Journal Article)

BACKGROUND: Oral immunotherapy (OIT) has been thought to induce clinical desensitization to allergenic foods, but trials coupling the clinical response and immunologic effects of peanut OIT have not been reported. OBJECTIVE: The study objective was to investigate the clinical efficacy and immunologic changes associated with OIT. METHODS: Children with peanut allergy underwent an OIT protocol including initial day escalation, buildup, and maintenance phases, and then oral food challenge. Clinical response and immunologic changes were evaluated. RESULTS: Of 29 subjects who completed the protocol, 27 ingested 3.9 g peanut protein during food challenge. Most symptoms noted during OIT resolved spontaneously or with antihistamines. By 6 months, titrated skin prick tests and activation of basophils significantly declined. Peanut-specific IgE decreased by 12 to 18 months, whereas IgG(4) increased significantly. Serum factors inhibited IgE-peanut complex formation in an IgE-facilitated allergen binding assay. Secretion of IL-10, IL-5, IFN-gamma, and TNF-alpha from PBMCs increased over a period of 6 to 12 months. Peanut-specific forkhead box protein 3 T cells increased until 12 months and decreased thereafter. In addition, T-cell microarrays showed downregulation of genes in apoptotic pathways. CONCLUSION: Oral immunotherapy induces clinical desensitization to peanut, with significant longer-term humoral and cellular changes. Microarray data suggest a novel role for apoptosis in OIT.

Full Text

Duke Authors

Cited Authors

  • Jones, SM; Pons, L; Roberts, JL; Scurlock, AM; Perry, TT; Kulis, M; Shreffler, WG; Steele, P; Henry, KA; Adair, M; Francis, JM; Durham, S; Vickery, BP; Zhong, X; Burks, AW

Published Date

  • August 2009

Published In

Volume / Issue

  • 124 / 2

Start / End Page

  • 292 - 300.97

PubMed ID

  • 19577283

Pubmed Central ID

  • PMC2725434

Electronic International Standard Serial Number (EISSN)

  • 1097-6825

Digital Object Identifier (DOI)

  • 10.1016/j.jaci.2009.05.022


  • eng

Conference Location

  • United States