MD NewslinePeanut Immunotherapy with Slow Up-Dosing Effective in Young Children

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A recent study published in the Journal of Allergy and Clinical Immunology: In Practice demonstrates the effectiveness of a slow up-dosing strategy for peanut oral immunotherapy (OIT) in young children. The randomized controlled trial, conducted at Sachs’ Children and Youth Hospital in Stockholm, involved 75 children aged 1 to 3 years and showed promising results in both safety and efficacy. This research provides valuable insights for clinicians considering early intervention in peanut allergy management.

Key Points:

• The study focused on peanut OIT using a slow up-dosing strategy in children aged 1 to 3 years.
• 72% of children in the OIT group tolerated a cumulative dose of 750 mg peanut protein after 1 year.
• Only 4% of children in the avoidance group tolerated the same dose.
• Adverse events occurred in just 1.4% of administered doses, with most being mild.
• Three doses of epinephrine were required for two individuals due to more severe reactions.
• The maintenance dose in the OIT protocol was 285 mg of peanut protein daily.
• Peanut allergy affects approximately 2% of children.
• The study suggests that early intervention may yield better outcomes for peanut allergy management.
• The slow up-dosing approach could potentially be integrated into treatment protocols to minimize adverse reactions while maximizing tolerance development.
• The primary outcome was sustained unresponsiveness to a cumulative dose of 750 mg peanut protein after 3 years of OIT and 4 weeks of avoidance.
• The trial randomly assigned children to either receive peanut OIT or avoid peanuts.
• The OIT group started with very small amounts of peanut protein, gradually increasing the dose every 4 to 6 weeks.
• The study’s findings emphasize the potential for early intervention to modify the immune response more effectively than in older children.

HCN Medical Memo
The slow up-dosing strategy for peanut oral immunotherapy in young children shows promise as a safe and effective approach to managing peanut allergies. Early intervention may lead to better outcomes, potentially changing the landscape of peanut allergy treatment in pediatric patients.

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