BMJ 2014;348:g1265 doi: 10.1136/bmj.g1265 (Published 30 January 2014)

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NEWS Oral immunotherapy for peanut allergy shows promise but questions remain Zosia Kmietowicz BMJ

A study that found that oral immunotherapy can help children with peanut allergy increase their tolerance to peanuts has been hailed as an important step in treating food allergies, but more studies are needed to answer a range of questions about the treatment before it is more widely used, commentators have said.

Peanut allergy affects about 0.5% to 1.4% of children in high income countries and despite trying to avoid foods with traces of peanuts in them accidental reactions occur in 14% to 55% of children every year, according to the background in the paper.

Aged between seven to 16 years the children were randomly assigned to receive either 26 weeks of oral immunotherapy using gradually escalating doses of peanut protein up to 800 mg/day, or peanut avoidance, the present standard of care. All the children then participated in a double blind placebo controlled oral food challenge during which they gradually consumed increasing amounts of peanut protein under medical supervision to determine at what level they experienced allergic symptoms.

Writing in a linked commentary Matthew J Greenhawt, from the University of Michigan Food Allergy Center in the United States, said that although the results were exceptionally promising, oral immunotherapy remained an experimental treatment that is still years away from routine clinical use.2

In the phase II STOP II trial, 99 children with varying severities of peanut allergy were treated over five years in the National Institute for Healthcare Research Wellcome Trust Clinical Research Facility at Addenbrooke’s, part of Cambridge University Hospitals.

The researchers then staged a second part of the experiment, in which the control group was offered 26 weeks of oral immunotherapy followed by a final food challenge.

The results, reported in the Lancet, showed that after six months of therapy 24 of 39 children (62%) (95% confidence interval 45% to 78%) who received oral immunotherapy in the first phase passed the primary outcome of desensitisation and tolerated a daily dose of 1400 mg of peanut protein, roughly equivalent to 10 peanuts (an amount unlikely to be encountered by chance), compared with none of those in the control group. 1 After the second phase, 54% (35% to 72%) of the control group tolerated the 1400 mg challenge. At the lower dose of 800 mg of peanut protein a day 84% (70% to 93%) of the first group and 91% (79% to 98%) of the second group tolerated the challenge for 26 weeks. Food allergy specific quality of life scores also improved after immunotherapy (median change −1·61; P

Oral immunotherapy for peanut allergy shows promise but questions remain.

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