Details

Autor(en) / Beteiligte

• Garvey, Aisling A., MB
• O'Sullivan, Donnchadh, MB
• Hourihane, Jonathan O'B., DM

Titel

Home-based induction of sustained unresponsiveness in children with mild reactions to high doses of peanut

Ist Teil von

• The journal of allergy and clinical immunology in practice (Cambridge, MA), 2017-11, Vol.5 (6), p.1757-1759

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2017

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Few children with peanut allergy develop oral tolerance to peanut1,2 but 50% of children with peanut allergy do not react during formal oral food challenge (OFC) until they receive a cumulative eliciting dose of more than 100 mg peanut.3 These “low-dose–tolerant” patients have received no specific medical attention to date, which is focused on the “low-dose–sensitive” subjects.4-6 “Low-dose–tolerant” peanut-allergic children receive the standard advice about peanut avoidance (total avoidance) and epinephrine (constant availability), despite their demonstrated tolerance of low to moderate doses. The clinical team felt that this decision was appropriate and safe and was also ethical under the circumstances that these families literally could not wait for a formalized research protocol to be developed that included “low-dose–tolerant, high-dose–mild” children like theirs. [...]it was considered within the reasonable scope of an off-label practice to offer this clinical service to these patients. OIT for food allergy shows promising results; however, it is costly and resource intensive. [...]at present OIT is aimed mainly/exclusively at patients who demonstrate reactivity to low doses of peanut. Patient details Withdrew∗ (n = 6) Desensitized (n = 2) Sustained unresponsiveness (n = 8) Demographic characteristics Males 4 0 5 Current age (y) 11 (8.5-12.75) 8.5 (7-8.5) 12.5 (9.25-14) Comorbidities, n (%) Eczema 6 (100) 2 (100) 6 (75) Asthma 5 (83) 1 (50) 5 (62) Hayfever 4 (66) 0 (0) 3 (37) History of other food allergies 3 (50) 1 (50) 6 (75) Family history of atopy 4 (66) 1 (50) 7 (87) Allergy workup Age at first reaction (y) 5 (1.93-8.53) 1.2 (1.2-1.2) 4.3 (1.63-6.63) Peanut specific IgE (KUA/L) 6.8 2.9 2.39 rAra h2 specific IgE (KUA/L) 4.65 3.5 1.2 Maximum skin prick test (mm) (before age at program entry) 9 8.5 8 Table I Demographic characteristics, comorbidities, and diagnostic investigations according to group Group Patient no.