Efficacy of Combined Therapy of Probiotic and Peanut Oral Immunotherapy in Treating Children With Peanut Allergy

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Probiotic Plus Peanut Oral Immunotherapy to Treat Peanut Allergy in Children

The prevalence of food allergy is on the rise, with an estimated rate of 8% in children and 2% in adults. The need for preventative strategies is high in case of peanut allergy as it is usually a lifelong condition and is associated with anaphylaxis-related deaths. Curative strategies consist of oral immunotherapy (OIT) to induce tolerance and promote unresponsiveness and a probiotic adjuvant with tolerance-promoting effects. This study published in the Journal of Allergy and Clinical Immunology evaluated the efficacy of a combined treatment involving probiotic and peanut oral immunotherapy.

In this double-blind, placebo-controlled trail, 62 children aged 1–10 years were randomised to receive Lactobacillus rhamnosus and peanut OIT (i.e., probiotic and peanut OIT [PPOIT]; n=31) or placebo (n=31) once-daily for 18 months. These children were stratified based on age (≤5 and >5 years) and peanut skin test wheal size (≤10 and >10 mm). Attainment of possible sustained unresponsiveness (unresponsiveness 2–5 weeks post-treatment discontinuation) was the primary outcome. Secondary outcomes included desensitisation, peanut skin prick test (SPT) and peanut specific immunoglobulin (Ig) E and IgG4 levels.

A total of 56 children completed the study. About 82.1% children in the PPOIT group achieved possible sustained unresponsiveness compared to 3.6% in the placebo group. More number of children in the PPOIT group were desensitised compared to the placebo group (89.7% versus 7.1%). Reduced SPT responses and IgE levels along with increased IgG4 levels were also observed in the PPOIT group.

In conclusion, PPOIT was able to effectively induce possible sustained unresponsiveness and cause modulation of peanut-specific immune response as demonstrated by the immune changes in children with peanut allergy.

News Source: Tang ML, Ponsonby AL, Orsini F, et al. Administration of a probiotic with peanut oral immunotherapy: A randomized trial. J Allergy Clin Immunol. 2015;135(3):737–744.