Immunotherapy approach induces peanut allergy remission

A research team led by the Murdoch Children’s Research Institute (MCRI) has discovered two peanut allergy treatments for children that are highly effective at inducing remission. The treatments — a combination of a probiotic together with oral immunotherapy (the gradual introduction of the allergenic food) and oral immunotherapy alone — were found to significantly induce remission and desensitisation, according to results published in The Lancet Child & Adolescent Health.

The team led by MCRI Professor Mimi Tang had previously shown that the combination treatment resulted in 74% of participants achieving remission after 18 months of treatment, and 70% of those initial responders remaining in remission and eating peanuts safely four years later. The next step was to test whether adding a probiotic provided a benefit over and above oral immunotherapy on its own and to compare long-term outcomes following treatment.

The randomised controlled trial conducted at The Royal Children’s Hospital in Melbourne, Perth Children’s Hospital, and the Women’s and Children’s Hospital in Adelaide involved 201 children aged from 1–10 years. The trial was staged over four years, with participants followed up to 12 months post-treatment. The oral immunotherapy approach applied a proprietary high-dose, rapid-escalation regimen that is being developed by Australian biotech company Prota Therapeutics as a lead candidate for the treatment of peanut allergy, named PRT120.

“The results show that high-dose peanut oral immunotherapy provides meaningful benefit to treated children,” said Prof Tang, who serves as CEO of Prota Therapeutics. “After 18 months of treatment, 74% of children who received the oral immunotherapy tolerated roughly a standard serve of peanut, equal to a snack pack of peanut M&Ms; 51% achieved clinical remission and were able to stop treatment altogether; while the remaining 24% were desensitised to this amount of peanut.

“Addition of a probiotic did not significantly improve effectiveness compared to oral immunotherapy; however, it appeared to enhance tolerability of the treatment, with fewer gastrointestinal symptoms especially in children between one and five years of age.”

The results also showed that treatment with oral immunotherapy, with or without a probiotic for childhood peanut allergy, provides a significant and substantial improvement in quality of life compared with current standard care, which is peanut avoidance.

MCRI’s Dr Paxton Loke said 99% of children who achieved remission and ceased treatment were eating peanuts as frequently as they liked in the 12 months after stopping treatment. Those in clinical remission had fewer reactions to peanut compared with those who were just desensitised, he said.

“Being desensitised still requires continued daily treatment and allergen avoidance, so remission appears to be a better outcome for children,” Dr Loke said. “Importantly, children in remission had a significantly improved quality of life compared with allergic children, suggesting that no longer having to avoid peanut provides greater benefit than continued allergen avoidance despite the risk of a possible reaction.”

Image credit: ©stock.adobe.com/au/Alexandr

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