Sustained unresponsiveness to peanut in subjects who have completed peanut oral immunotherapy. 2014

J Allergy Clin Immunol. Author manuscript; available in PMC 2015 Feb 1.
Published in final edited form as:
PMCID: PMC3960331

Sustained unresponsiveness to peanut in subjects who have completed peanut oral immunotherapy

LINK TO: Sustained unresponsiveness to peanut in subjects who have completed peanut oral immunotherapy. J Allergy Clin Immunol. 2014 Feb;133(2):468-75.

“Layperson explanation”

This study measured “Sustained Unresponsiveness” after OIT. “Sustained unresponsiveness” is a term which means “no reaction” (unresponsive) to the allergen in a food challenge after a patient stops taking their daily maintenance dose. The effect of “not responding” is sustained even after the patient stops regular eating of the allergen.
In this study, they started recruiting patients in March 2007, with a final 39 patients, 29 of whom completed the initial study. Overall, 27 of 29 (93%) reached the total peanut dose of 3.9 g with no more than mild symptoms, suggesting successful desensitization to peanut protein. Two subjects did not ingest the maximal dose and stopped after 2.1 g. One stopped because of parental anxiety, and the other because of mild urticaria and 1 vomiting episode. See the original study, published in 2009: 
With this final part of the study they were down to 24 patients from the original 39: 6 who withdrew due to symptoms and 9 who withdrew for personal and other reasons.
After they passed a successful food challenge, all of them stopped daily dosing for 4 weeks. Then they did a food challenge. 50% of the 24 patients  passed the challenge and were called “Treatment Successes” and had reached  “sustained unresponsiveness”. If they passed, they were advised to incorporate peanut into the diet “at their pleasure”  at least several days per week instead of dosing daily.

Notably, the other half who did not  sustained unresponsiveness were called “Treatment Failures,” BUT were they really? They were still able to consume a much larger amount of peanut, with less severe reactions, than they could at the study’s outset. Note that the half that “failed” being able to eat unlimited peanuts after being off therapy for a month were still able to eat 10-12 peanuts with the majority being able to eat 12!!! Not one subject in the study ate less than 10 peanuts after totally discontinuing peanut ingestion for a month. The half that were treatment “failures” resumed OIT. So half the kids started losing desensitization after being off OIT for a month but 10-12 peanuts is certainly way more than bite-proof /CC protection.

You can read an easy summary of these major study here:

“Our findings suggest for the first time that in peanut-allergic patients, long-term treatment with oral immunotherapy may produce sustained benefits allowing introduction of peanut back into the diet,” said study author Dr. Brian Vickery, Assistant Professor Of Pediatrics at the University of North Carolina.”

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