Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization.
Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization.
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DOI：
10.1016/j.jaci.2010.12.1083
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发表时间：
2011-03
期刊：
影响因子：
--
通讯作者：
Burks AW
中科院分区：
文献类型：
--
作者：
Kim EH;Bird JA;Kulis M;Laubach S;Pons L;Shreffler W;Steele P;Kamilaris J;Vickery B;Burks AW
目前没有治疗花生过敏的方法。舌下免疫治疗是治疗花生过敏的一种新方法。探讨花生过敏患儿舌下含服免疫治疗的安全性、临床疗效及免疫学变化。在这项双盲、安慰剂对照研究中，受试者接受了6个月的剂量递增和6个月的维持给药，随后进行了双盲、安慰剂对照食物激发。18名1至11岁的儿童完成了12个月的给药和食物激发。给药副作用主要是口咽和不常见的需要治疗。在双盲、安慰剂对照的食物挑战期间，治疗组安全摄入的花生蛋白质是安慰剂组的20倍（中位数1710 mg vs. 85 mg，p=0.011）。机制研究表明，用10 - 2 mcg/ml（p = 0.009）和10 - 3 mcg/ml（p=0.009）花生刺激后，点刺皮肤试验风团大小减小（p= 0.020），嗜碱性粒细胞反应性降低。花生特异性IgE在最初的4个月内增加（p=0.002），然后在剩余的8个月内稳步下降（p=0.003），而花生特异性IgG 4在12个月内增加（p=0.014）。最后，IL-5水平在12个月后下降（p=0.015）。在IL-13水平、调节性T细胞百分比或IL-10和IFN-γ产生方面没有发现统计学显著变化。花生舌下免疫疗法能够安全地诱导花生过敏儿童的临床脱敏，免疫学变化的证据表明过敏反应发生了显着变化。需要进一步的研究来确定持续的花生舌下免疫治疗是否能够诱导长期的免疫耐受。
There are no treatments currently available for peanut allergy. Sublingual immunotherapy is a novel approach to the treatment of peanut allergy. To investigate the safety, clinical effectiveness and immunologic changes with sublingual immunotherapy in peanut-allergic children. In this double-blind, placebo-controlled study, subjects underwent 6 months of dose escalation and 6 months of maintenance dosing followed by a double-blind, placebo-controlled food challenge. Eighteen children ages 1 to 11 years completed 12 months of dosing and the food challenge. Dosing side effects were primarily oropharyngeal and uncommonly required treatment. During the double-blind, placebo-controlled food challenge, the treatment group safely ingested 20 times more peanut protein than the placebo group (median 1710 mg vs. 85 mg, p=0.011). Mechanistic studies demonstrated a decrease in prick skin test wheal size (p=0.020) and decreased basophil responsiveness after stimulation with 10−2 mcg/ml (p=0.009) and 10−3 mcg/ml (p=0.009) of peanut. Peanut-specific IgE increased over the initial 4 months (p=0.002) then steadily decreased over the remaining 8 months (p=0.003) while peanut-specific IgG4 increased during the 12 months (p=0.014). Lastly, IL-5 levels decreased after 12 months (p=0.015). No statistically significant changes were found in IL-13 levels, the percent of T regulatory cells, or IL-10 and IFN-gamma production. Peanut sublingual immunotherapy is able to safely induce clinical desensitization in peanut allergic children with evidence of immunologic changes suggesting a significant change in the allergic response. Further study is required to determine if continued peanut sublingual immunotherapy is able to induce long-term immune tolerance.
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