Maximum Dose Food Challenges Reveal Transient Sustained Unresponsiveness in Peanut Oral Immunotherapy (POIMD Study)

Authors

Carla M Davis
Aikaterini Anagnostou
Sridevi Devaraj
Daisy T Vita
Fabian Rivera
Kathleen Pitts
Melissa Hearrell
Charles Minard
Danielle Guffey
Meera Gupta
Levi Watkin
Jordan S Orange
Sara Anvari

Publication Date

2-1-2022

Journal

The Journal of Allergy and Clinical Immunology: In Practice

DOI

10.1016/j.jaip.2021.10.074

PMID

34890827

PMCID

PMC10404846

PubMedCentral® Posted Date

8-7-2023

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Administration, Oral, Adolescent, Allergens, Arachis, Child, Child, Preschool, Desensitization, Immunologic, Humans, Peanut Hypersensitivity, Double-blind placebo-controlled food challenge, Peanut oral immunotherapy, Sustained unresponsiveness, Adverse events, Biomarker, Ara h 2, Outcomes, Tolerance, Peanut-specific IgE, Peanut-specific IgG4, Cytokine expression

Abstract

BACKGROUND: The maximum tolerated dose of peanut protein following peanut oral immunotherapy (POIT) is unknown because most research studies have not examined very high thresholds.

OBJECTIVE: To define the maximum dose tolerated by patients on POIT and severity of allergic reactions after a 1-month period of treatment discontinuation.

METHODS: In a phase 2 3-year POIT open-label study, we enrolled participants age 5 to 13 years with a 1-year build-up period followed by a 2-year daily maintenance dose of 3900 mg with assessment of the maximum tolerated dose using double-blind placebo-controlled food challenges (DBPCFCs) of 26,225 mg cumulative dose of peanut protein. The DBPCFC was performed at baseline, after 12-month build-up, at 2 year of maintenance, and after a 1-month period of treatment discontinuation. Biomarkers were assessed every 6 weeks for the first 6 months of therapy. A general linear mixed model was used for analysis.

RESULTS: The mean maximum cumulative tolerated dose after 12 months increased by 12,063 mg (P < .001) (n = 12), slightly decreased during maintenance (n = 11), and significantly decreased by 7593 mg after avoidance for 1 month (P = .03) (n = 6). Biomarker analysis revealed decreases in cytokine expression within the first 6 weeks of initiation of POIT and decreased peanut-IgG

CONCLUSIONS: The evaluation of POIT and sustained unresponsiveness by maximum tolerated dose by DBPCFCs in this small phase 2 trial showed that desensitization is diminished, with 100% loss of tolerated dose after 1 month of avoidance following 3 years of treatment.