Oral Low Doses Tolerance INduction Study for Peanuts

University Hospital, Montpellier2,000 enrolled

Overview

Several protocols have been proposed in scientifis literature, for oral tolerance induction (OIT) protocols for peanuts. A meta-analysis showed that the data in the literature are rather in favor of the exclusion of peanuts, and that OIT doesn't allow to expect significant levels of peanut protein consumed by the patient, and is associated with an increased risk of anaphylaxis and epinephrine use. Also, in most published protocols, patients with a history of anaphylactic shock, severe asthma, or multiple history of anaphylaxis are excluded. To date, no protocol has been validated for this type of treatment, and each center follows locally validated schemes. In our unit, the investigators use an OIT protocol that starts at low doses (first dose at 2.68 mg peanut protein) and doses increase is scheduled every 4 to 12 weeks (instead of every 2 weeks). The investigators do not exclude patients with asthma or those with a history of peanut anaphylaxis (grade 2 or 3). The investigators have noted that our protocol is associated with a good safety profile and good efficacy, probably due to the fact that the investigators start at low doses and increase the dose with a prolonged delay, compared to previously published protocols. For this reason, the investigators decided to evaluate the results the investigators obtained in our patients and to better analyze the efficacy and safety profile of our protocol.

Study Type

OBSERVATIONAL

Enrollment

2,000

Conditions

Peanut Allergy

Eligibility

Sex: ALLMin age: 5 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion criteria: * Patients evaluated at the Montpellier University Hospital, Allergy Unit ; * Patients aged 5 years or older; * Patients with a history of immediate reaction after consuming peanuts * AND a positive peanut prick test; * AND peanut positive specific serum IgE (ImmunoCAP®); * AND a positive oral peanut challenge test OR a clinical history of anaphylaxis AND peanut-specific IgE\> 100 kUA / L (ImmunoCAP®); * Patients who started peanut OIT between September 2018 and January 2021. Exclusion criteria: * Patients in exclusion period determined by a previous study; * Patients under legal protection, under guardianship or under curatorship; * Possible poor therapeutic compliance to the OIT protocol; * Active malignant neoplasia or autoimmune disease; * Active eosinophilic esophagitis or other gastrointestinal eosinophilic disorders; * Severe active eczema; * Pregnancy ; * Cardiovascular disease and use of beta blockers and / or ACE inhibitors; * Chronic urticaria; * Mastocytosis.

Outcomes

Primary Outcomes

Percentage of patients who reach a tolerated dose

Percentage of patients who reach a tolerated dose of 2000 mg of PP during the ITO and percentage of patients who reach a cumulative tolerated dose of 4400 mg of PP during the oral challenge, carried out at least 6 month after the end of the ITO.

Time frame: 24 months

Secondary Outcomes

Percentage of patients experiencing side effects during OIT

Percentage of patients experiencing side effects during OIT (classified on the basis of their severity); percentage of patients in whom the tolerated dose of PP could be doubled and tripled, compared to the eliciting dose, assessed during an oral food challenge before the beginning of the OIT; percentage of patients who achieve a tolerated dose of 300 mg of PP and 1000 mg of PP during OIT. By doing a subgroup analysis, we will evaluate the same results in patients with a clinical history of grade 2 or grade three anaphylaxis to peanuts.