BOLETÍN BIBLIOGRÁFICO
DE INMUNOTERAPIA
Artículo destacado – Diciembre 2021
1
Pérdida de la tolerancia conseguida tras la ITO con cacahuete
Maximum Dose Food Challenges Reveal Transient Sustained Unresponsiveness in Peanut Oral Immunotherapy (POIMD study)
Davis CM, Anagnostou A, Devaraj S, Vita DT, Rivera F, Pitts K, et al.
Allergy Clin Immunol Pract. 2021 Dec 7:S2213-2198(21)01363-5. doi: 10.1016/j.jaip.2021.10.074. Epub ahead of print
BACKGROUND
The maximum tolerated dose (MTD) 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 three-year POIT open-label study, we enrolled participants age 5-13 years with a 1-year build-up period followed by a 2-year daily maintenance dose of 3,900 mg with assessment of the MTD utilizing double blind placebo-controlled food challenges (DBPCFCs) of 26,225 mg cumulative dose of peanut protein. DBPCFC was performed at baseline, after 12 month build-up, 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<0.001) (n=12), slightly decreased during maintenance (n=11) and significantly decreased by 7,593 mg after avoidance for 1-month (p=0.03)(n=6). Biomarker analysis revealed decreases in cytokine expression within the first 6 weeks of initiation of POIT and decreased peanut-IgG4 and increased cytokine expression after 1-month of discontinuation. The DBPCFC reaction severity, examined through a symptom score with one point for each defined symptom, decreased after 12 months, but did not significantly change after 1-month of POIT discontinuation.
CONCLUSION
The evaluation of POIT and sustained unresponsiveness by MTD by DBPCFCs in this small phase 2 trial showed desensitization is diminished, with 100% loss of tolerated dose after 1-month of avoidance following 3 years of treatment.