Desensitization has been shown with sublingual immunotherapy (SLIT) in children with peanut allergy with a median reaction threshold of 1710 mg of peanut protein after 12 months of therapy using a 2 mg maintenance dose. We aimed to study if higher doses and longer duration of treatment could provide a more robust response.
Fifty-five subjects ages 1-11 years with peanut allergy were enrolled in an open-label study of peanut SLIT. After an entry oral food challenge (OFC), subjects were built up to a maintenance dose of 4 mg of peanut protein and continued on therapy for a total of 48 months. An exit OFC was then performed to a cumulative dose of 5000 mg of peanut protein to assess for desensitization.
We report interim results for the first 14 subjects to undergo the OFC after 48 months of peanut SLIT therapy. The median cumulative dose of peanut protein tolerated was 0 mg (0-425 mg) prior to treatment while it was 2900 mg (800-5000 mg) after 48 months of peanut SLIT.
Peanut SLIT demonstrated desensitization to a significantly higher level than would be expected of an accidental ingestion of peanut (~100 mg). The longer duration of treatment and higher daily maintenance dose resulted in more effective desensitization to peanut than previously published. Further investigation is needed to to evaluate the effectiveness of this dose on the induction of sustained unresponsiveness.