Sublingual Immunotherapy for Peanut Allergy

描述（由申请人提供）：对食物的口服耐受性通常在生命的最初几年形成。在美国，6%的儿童和3.5%的成年人发生口服耐受性异常，即食物过敏。花生过敏是最常见的食物过敏之一，发生在1%的幼儿中。有趣的是，大约只有20%的花生过敏儿童在5岁时会对花生产生口服耐受性。我们建议利用一种治疗形式，舌下免疫疗法（SLIT）来研究并可能加速对花生的口服耐受性的发展。这项应用是基于我们的工作和其他人的数据，过敏原特异性SLIT将脱敏，并可能耐受花生过敏的受试者。以前没有设计良好的SLIT食物过敏研究，科学严谨。我们的假设是，在食物过敏发生后早期实施花生过敏原SLIT将通过改变嗜碱性粒细胞/肥大细胞的反应性使患者临床脱敏，并将由于过敏原特异性T调节细胞的活性而导致临床耐受性的发生。这项建议是基于我们的初步研究，研究了SLIT在花生过敏的大龄儿童中的作用，以及口服免疫疗法在花生和鸡蛋过敏儿童中的作用。我们的方法将是招募两组具有花生敏感性（花生特异性IgE > 7 KU/L和显著的初始症状）的受试者;一组在他们发展后不久（1至5岁），第二组尚未超过他们的花生过敏（6至11岁），并在前瞻性随机、盲法SLIT方案中用花生SLIT治疗他们。我们将研究这些受试者的嗜碱性粒细胞/肥大细胞反应性，抗原特异性T细胞反应以及粘膜和全身体液免疫反应。 我们正在结合来自过敏，免疫学和病理学领域的科学研究人员的专业知识以及NIH资助的GCRC的资源进行研究。我们的具体目标是：（1）确定过敏原特异性SLIT是否会导致花生过敏幼儿的临床脱敏和耐受性的发展，（2）确定对花生脱敏状态的发展是否与肥大细胞和嗜碱性粒细胞的下调有关，（3）确定对花生的临床耐受性的发展是否与抗原活化的外周CD 4 + T调节表型的增加相关。（4）确定SLIT中花生特异性粘膜和全身体液免疫应答对脱敏和口服耐受的影响。这些研究的完成将提供有关口服耐受性和过敏原特异性SLIT作用的细胞和分子机制的新信息，并为开发食物过敏的新治疗方法提供基础。 公共卫生相关性-项目叙述：该项目旨在开发食物过敏的治疗方法。食物过敏影响6% - 8%的幼儿和4%的成年人，目前没有可用的预防治疗。治疗方法的开发和了解其工作机制对于未来治疗食物过敏患者非常重要。

DESCRIPTION (provided by applicant): Oral tolerance to foods normally develops during the first few years of life. An aberration of oral tolerance, food allergy, occurs in 6% of children and 3.5% of adults in the United States. Peanut allergy is one of the most common of the food allergies occurring in 1% of young children. Interestingly, approximately only 20% of young children with peanut allergy will develop oral tolerance to peanuts by age five. We propose to utilize a form of treatment, sublingual immunotherapy (SLIT) to investigate and possibly hasten the development of oral tolerance to peanuts. This application is based on data from our work and others that allergen-specific SLIT will desensitize and possibly tolerize peanut-allergic subjects. There have not been well-designed previous studies of SLIT for food allergy that have been scientifically rigorous. Our hypothesis is that instituting peanut allergen SLIT early after development of food allergy will clinically desensitize patients by altering basophil/mast cell reactivity and will cause clinical tolerance to develop because of the activity of allergen- specific T regulatory cells. This proposal is based on our preliminary studies that have examined the effects of SLIT in older children with peanut allergy and of oral immunotherapy in peanut- and egg-allergic children. Our approach will be to enroll two cohorts of subjects who have peanut sensitivity (peanut specific IgE > 7 KU/L and significant initial symptoms); one group soon after their development (ages 1 to 5 years) and the second group who have not outgrown their peanut allergy (ages 6 to 11 years) and treat them with peanut SLIT in a prospective randomized, blinded SLIT protocol. We will study the basophil/mast cell reactivity, antigen-specific T cell responses and mucosal and systemic humoral immune responses in these subjects. We are combining the expertise of scientific investigators from the fields of allergy, immunology and pathology and the resources of our NIH-funded GCRC for our studies. Our specific aims are: (1) Determine if allergen-specific SLIT will cause clinical desensitization and tolerance to develop in peanut allergic young children, (2) Determine if the development of the desensitized state to peanut is associated with the down-regulation of mast cells and basophils, (3) Determine if the development of clinical tolerance to peanuts is associated with an increase in the T regulatory phenotype of antigen-activated peripheral CD4+ T cells and (4) Determine the effect of peanut-specific mucosal and systemic humoral immune responses in SLIT on desensitization and oral tolerance. Completion of the studies will provide new information regarding the cellular and molecular mechanisms of action of oral tolerance and allergen-specific SLIT and provide the foundation for the development of novel treatments for food allergy. PUBLIC HEALTH RELEVANCE - PROJECT NARRATIVE: The project is designed to develop a treatment for food allergy. Food allergy effect 6% - 8% of young children and 4% of adults and there are no current preventive treatment available. The development of a treatment and understanding the mechanism of how it works is important for the future treatment of patients with food allergy.