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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Reminds me of a guy who does videos on YouTube called “Venom Guy”. Microdosed himself with many different snake venoms in increasing amounts to the point that he gan take bites from a king cobra and black mamba at th3 same time and suffer no real effects.
I’m certain there will be Pfizer vax for pnut allergies.
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.
Terrence This Is Stupid Stuff. - A.E. Houseman