https://onlinelibrary.wiley.com/doi/10.1111/all.16493
ABSTRACT
Background
Peanut oral immunotherapy (OIT) has shown effectiveness in achieving desensitization of children; however, evidence in adults is lacking.
Methods
This phase II trial evaluated peanut OIT in peanut-allergic adults using real-world peanut products. A Simon’s minimax two-stage design, incorporating a stop:go for futility, was employed. A separate untreated control group was also recruited for comparison of mechanistic parameters. Participants underwent baseline double-blind placebo-control food challenges (DBPCFC) with peanut protein doses of 0.3 to 300 mg. Reacting participants were initiated on daily OIT with 2-weekly updosing until reaching a maintenance dose of 1000 mg (four large peanuts). The primary outcome was the proportion of OIT participants who tolerated a cumulative dose of 1.4 g peanut protein during exit DBPCFC (doses provided 0.3-3000 mg).
Results
Twenty-one adults (8 female; mean age 24.2 years [SD 4.9]) were enrolled in the OIT group, with 67% achieving the daily maintenance dose and meeting the primary endpoint. Three withdrew due to adverse reactions, and a further three did not complete the trial for reasons unrelated to OIT. The median tolerated dose increased from 30 mg (equivalent to approximately 1/8th of a peanut) to 3000 mg (12 peanuts) at the exit challenge, representing a 100-fold increase (p < 0.0001). OIT was associated with an improvement in QoL measures. Suppression of peanut skin prick test sizes and induction of peanut-specific IgG were observed in OIT but not in control participants.
Conclusions
Peanut OIT appears to be an efficacious treatment for adults with peanut allergy. Further studies are needed for confirmation and to characterize safety profiles in different adult subgroups.
Trial Registration
Grown Up Peanut Immunotherapy (GUPI) study; ClinicalTrials.gov identifier: NCT03648320
Graphical Abstract
In 21 adults initiated on peanut oral immunotherapy (OIT), 67% tolerated at least 1000 mg on exit DBPCFC. Decreases in SPT size and increases in peanut- and Ara h 2-specific IgG occurred in OIT participants but not in mechanistic controls (n = 9). Improvements were seen in FAQLQ-AF and food neophobia scores. Epinephrine was used infrequently; the majority (94.5%) of adverse reactions were mild (grade 1). AF, food allergy quality of life questionnaire—adult form; DBPCFC, double-blind, placebo-controlled food challenge; FAQLQ-OIT, oral immunotherapy; QoL, quality of life; SPT, skin prick test.
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I’ve heard of worse medical requirements to survive than having to eat REESE’S Peanut Butter Cups everyday.
If they would take Diamine Oxidase Enzyme, they most likely would have accelerated the desensitization process.
Thanks very much for posting this, RB. I have a relative who won’t even enter a place where there are peanuts. Maybe this can help.
“He Nearly Died From a Peanut Allergy – Now He Eats Them for Breakfast”
I thought he stopped believing Western Media.
So can we bring them back to airline flights?
https://www.poemtree.com/poems/TerenceThisIsStupidStuff.htm
There was a king reigned in the East:
There, when kings will sit to feast,
They get their fill before they think
With poisoned meat and poisoned drink.
He gathered all that sprang to birth
From the many-venomed earth;
First a little, thence to more,
He sampled all her killing store;
And easy, smiling, seasoned sound,
Sate the king when healths went round.
They put arsenic in his meat
And stared aghast to watch him eat;
They poured strychnine in his cup
And shook to see him drink it up:
They shook, they stared as white's their shirt:
Them it was their poison hurt.
—I tell the tale that I heard told.
Mithridates, he died old.
Everything that's old is new again.
I know someone who was in one of these trials and he is indeed able to tolerate peanuts now. They did the sublingual drop therapy to desensitize him.
I could not believe they could create a dose low or weak enough for him to be able to start it, his allergies were so bad, but they did and he is now desensitized.
He hates peanuts because of the food aversion issue, associating them with his horrific responses, but he is no longer in danger from anaphylaxis from accidental exposure.
Well good, maybe McDonald’s will bring back peanuts for the hot fudge Sunday and southwest airlines will bring back the honey roasted peanuts. It should be a crime to sell fudge or brownies without nuts.
After finding a study out of Turkey, I did the same thing. I have that Alpha-Gal Mammalian Meat allergy brought on by Lone Star tick bites. There’s a different tick in Australia and who knows what tick in Turkey. (almost like the world has been seeded with affected ticks that make people not able to eat beef)
In the study, they used pure beef extract(certain amount of water that had a certain amount of beef boiled in it) and introduced a tiny bit in ml and then kept doubling that amount until they swapped to actual chunks of beef and swapped to mg.
Both subjects had a reaction at one point so they stepped the plan back one day and proceeded again as per the doubling every day.
My allergy isn’t as extreme as some people get so I just get some Steak-Um which is 100% beef and eat a slice one day, two slices the next and so on.
It used to take months for the allergy to subside on it’s own and now I can knock it down in a week or two.
Now if I could just afford a good ribeye.
Don’t let the peanuts win.
When I was a kid, I never heard of a single person allergic to peanuts, ever.