A recent study of early peanut oral immunotherapy (OIT) in preschoolers demonstrated significant efficacy with higher rates of sustained unresponsiveness than has previously been seen in older cohorts. Sublingual immunotherapy (SLIT) for peanut has demonstrated moderate efficacy in school age cohorts, but has not been studied in this younger age group.
Children aged 12-48 months with peanut allergy or sensitization to peanut were enrolled in a multi-center phase II double blind placebo controlled study of peanut SLIT. We reviewed screening and entry challenge data of 40 subjects enrolled at a single site, between April 2015 and May 2017.
The majority of participants were male (55%) and Caucasian (80%). Average subject age was 29.5 months (12.4-47.4 months). Median peanut-specific IgE at enrollment was 14.3 kU/L (mean = 26.7, 0.35-100 kU/L) and peanut 1:20 skin prick test (SPT) size was 10.5 mm (mean = 11.1 mm, 4-24 mm). Multiple atopic co-morbidities were reported (75% atopic dermatitis, 40% allergic rhinitis, 23% asthma or recurrent wheezing). No subjects reported diagnosed eosinophilic GI disease. All subjects underwent a 1000 mg double blind placebo controlled food challenge (DBPCFC) at enrollment and tolerated a median dose of 30 mg (mean = 64.7 mg, 0-300 mg).
This cohort of preschool age children is representative of high-risk peanut allergy with SPT and IgE at the 95% predictive level and a low DBPCFC threshold providing an ideal opportunity to assess the effect of younger age on the overall efficacy of peanut SLIT.