January 20, 2022

expert reaction to genetic study looking at peanut oral immunotherapy in peanut-allergic children

A study published in The Lancet looks at the efficacy and safety of oral immunotherapy in children aged 1 to 3 with a peanut allergy.

Dr Andrew Clark, Consultant Paediatric Allergist, Cambridge Peanut Allergy Clinic, Cambridge University Hospitals NHS Foundation Trust, said:

“The press release gives a fair description of the study results, though the safety issues deserve highlighting. 20/96 (22%) actively treated participants received a dose of epinephrine IM for treatment of an adverse event, this is a higher proportion than is seen in studies of oral immunotherapy in older children (e.g.14% in Palisade, a Phase III registration trial for Palforzia), which may be explained partly by the longer duration of this study, but still worthy of discussion as peanut avoidance in this age group is straightforward and anaphylaxis from standard of care (peanut avoidance)  is extremely rare.

“This was a robustly designed clinical trial run by experts in the field (a US consortium) using appropriate methods and efforts were made to minimise bias (e.g. randozmization, blinding and using a matched placebo). This study suggests that peanut oral immunotherapy is successful at inducing desensitisation in very young children, and if confirmed by other studies may expand the range of ages amenable to treatment to 1-3y. However, the age distribution was weighted towards the older end of the age group (only 12% were 12-23m old), so limited inferences can be made for very young children in this study.

“The authors have mostly accounted for confounders and the conclusions are fairly stated, although they seem to have not included the industry standard of having a ‘blinded’ assessor perform the primary endpoint challenge.This is offset to some degree by the use of randomised active / placebo food challenges.”

‘Efficacy and safety of oral immunotherapy in children aged 1–3 years with peanut allergy (the Immune Tolerance Network IMPACT trial): a randomised placebo-controlled Study’ by Stacie Jones et al. was published in The Lancet at 23:30 UK time on Thursday 20 January 2022.

Declared interests

Dr Andrew Clark: “I am Chief Medical Officer and shareholder in Camallergy, who are developing peanut immunotherapy products.”