Oral Immunotherapy (OIT) for Peanut Allergy

Peanut allergy is known to cause severe anaphylactic reactions. Compared with other food
allergies it tends to be more persistent and also its prevalence seems to be rising.
Currently there is no proven treatment other than strict avoidance. We are attempting to
decrease the risk of anaphylaxis on accidental ingestion by desensitizing subjects to peanut
using peanut oral immunotherapy (OIT). We are also studying the effect of peanut OIT on the
peanut specific immune response to determine if tolerance to peanut protein will develop.
Children ages one to six years of age with peanut allergy will be randomized to peanut OIT or
placebo (active subjects). Thirty subjects will also be recruited as controls. These subjects
will not receive any peanut or placebo but only have skin prick testing and lab work in
addition to a history and physical exam. Active subjects will undergo a modified rush
immunotherapy on the first day and then increase the doses at least every two weeks up to a
maintenance dose of 4 grams (equivalent to about 13 peanuts). Doses will be taken daily at
home except for dose increases which will be done on the research unit. Outcome variables of
interest include response to double-blind placebo controlled food challenge, skin prick
testing, peanut specific IgE, and adverse events. These results will be compared between the
start and end of peanut OIT using appropriate statistical analysis.

Inclusion Criteria:

- Age 1- 6 years all of either sex, any race, any ethnicity at the time of the initial
visit

- The presence of IgE specific to peanuts (a positive skin prick test to peanuts
(diameter of wheal >3.0 mm) and a positive in vitro IgE [CAP-FEIA] > 7 kUA/L

- A history of significant clinical symptoms occurring within 60 minutes after ingesting
peanuts

- Provide signed informed consent

Exclusion Criteria:

- History of severe anaphylaxis to peanut as defined by hypoxia, hypotension, or
neurological compromise (Cyanosis or oxygen saturation < 92% at any stage,
hypotension, confusion, collapse, loss of consciousness; or incontinence)

- Currently participating in a study using an investigational new drug

- Participation in any interventional study for the treatment of food allergy in the
past 12 months

- Subjects with a known wheat food allergy will be excluded because of cross
contamination of oat with wheat

- Poor control or persistent activation of atopic dermatitis

- Moderate to severe persistent asthma

- Currently being treated with greater than medium daily doses of inhaled
corticosteroids, as defined by the National Heart Lung and Blood Institute (NHLBI)
guidelines

- Inability to discontinue antihistamines for skin testing and oral food challenges
(OFCs)