Severity of Reactions to Oral Peanut Challenges in Children and Adults
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
R. Sharon Chinthrajah, MD, Jaime S. Rosa, MD PhD, Dana Tupa, Bridget Smith, PhD, Ruchi S. Gupta, MD MPH, Stephen J. Galli, MD, Kari C. Nadeau, MD PhD FAAAAI

To understand differences in oral food challenges to peanut in children and adults.


Children and adults underwent double-blind, placebo-controlled food challenges (DBPCFCs) to peanut as part of screening for an oral immunotherapy clinical trial at Stanford University.   Challenges were performed up to 500mg of peanut allergen and graded for severity of reaction using the modified Bock’s grading system, and then rated as low for grade 1 and moderate to severe for grades 2-3.  History of asthma, allergic rhinitis, and/or atopic dermatitis, total IgE, peanut sIgE and peanut SPT were assessed. Fisher’s exact tests and Mann-Whitney tests were used to test differences between adults and children.



99 children and 14 adults underwent DBPCFCs to peanut.  More children experienced moderate to severe reactions than adults (50.5% vs 21.4%, p=0.049).  There were significant differences between children and adults in cumulative tolerated dose (median, 25mg vs 5mg, p=0.0221), history of atopic dermatitis (77% vs 36%, p=0.003), total IgE (median, 1481 ng/L vs 420 ng/L, p=0.0013), and peanut sIgE (median, 254 ng/L vs 15 ng/L, p<0.001). There were no significant differences in the history of asthma or allergic rhinitis, or peanut SPT size in these subjects.


Our site’s current preliminary data show that the children participating in OIT trials for peanut have higher total IgE, peanut sIgE, history of atopic dermatitis, and more moderate to severe reactions compared to adults.