Title: Optimising immunotherapy for peanut allergy in the UK to improve patient safety
Funder: Action Medical Research

Abstract: Background_x000D_ Peanut allergy affects around 1 in 50 children, and is the commonest cause of potentially life-threatening allergic reactions (anaphylaxis) in this age group. Oral immunotherapy (OIT) is an emerging treatment, where small, increasing doses of peanut are used to induce a state of desensitisation such that patients no longer react to peanut products. However, frequent mild allergic reactions (and occasionally, anaphylaxis) are side effects, with some children unable to tolerate the treatment. Furthermore, there are few data to predict whether children remain desensitised to peanuts once OIT is stopped. _x000D_ _x000D_ Boiling peanuts results in a less allergenic product which can be used for OIT. In the Boiled Oral Peanut Immunotherapy (BOPI) study at Imperial College London, boiled peanut was successfully used to desensitise peanut-allergic children with fewer side effects than reported with conventional OIT using roasted peanut flour. Children were able to tolerate around six to eight peanuts after one year of treatment, with over half maintaining the effect after stopping desensitisation treatment for a month._x000D_ _x000D_ The research project_x000D_ This project will follow-up participants in the original BOPI study and compare outcomes in these children to a new group of patients in the BOPI-2 study, in order to: _x000D_ 1) Compare the effectiveness and safety of boiled peanut OIT with conventional OIT (using roasted peanut flour). _x000D_ 2) Describe the immune changes associated with the persistence or loss of desensitisation in children undergoing up to three years of OIT for peanut allergy. _x000D_ 3) Identify factors which predict longer-term efficacy of desensitisation that could be used to develop a personalised approach to OIT. _x000D_ _x000D_ This study will help doctors better advise children (and their families) as to whether unrestricted peanut consumption is likely to be possible after immunotherapy - arguably the most important outcome for allergic children and their families. The researchers will generate a unique database relating to duration of OIT and treatment success. By using these data to personalise OIT treatment, they hope to maximise safe and successful outcomes for children with potentially life-threatening peanut allergy. _x000D_ _x000D_ Supported by a generous donation from The Rosetrees Trust.

Lay abstract: Background_x000D_ Peanut allergy affects around 1 in 50 children, and is the commonest cause of potentially life-threatening allergic reactions (anaphylaxis) in this age group. Oral immunotherapy (OIT) is an emerging treatment, where small, increasing doses of peanut are used to induce a state of desensitisation such that patients no longer react to peanut products. However, frequent mild allergic reactions (and occasionally, anaphylaxis) are side effects, with some children unable to tolerate the treatment. Furthermore, there are few data to predict whether children remain desensitised to peanuts once OIT is stopped. _x000D_ _x000D_ Boiling peanuts results in a less allergenic product which can be used for OIT. In the Boiled Oral Peanut Immunotherapy (BOPI) study at Imperial College London, boiled peanut was successfully used to desensitise peanut-allergic children with fewer side effects than reported with conventional OIT using roasted peanut flour. Children were able to tolerate around six to eight peanuts after one year of treatment, with over half maintaining the effect after stopping desensitisation treatment for a month._x000D_ _x000D_ The research project_x000D_ This project will follow-up participants in the original BOPI study and compare outcomes in these children to a new group of patients in the BOPI-2 study, in order to: _x000D_ 1) Compare the effectiveness and safety of boiled peanut OIT with conventional OIT (using roasted peanut flour). _x000D_ 2) Describe the immune changes associated with the persistence or loss of desensitisation in children undergoing up to three years of OIT for peanut allergy. _x000D_ 3) Identify factors which predict longer-term efficacy of desensitisation that could be used to develop a personalised approach to OIT. _x000D_ _x000D_ This study will help doctors better advise children (and their families) as to whether unrestricted peanut consumption is likely to be possible after immunotherapy - arguably the most important outcome for allergic children and their families. The researchers will generate a unique database relating to duration of OIT and treatment success. By using these data to personalise OIT treatment, they hope to maximise safe and successful outcomes for children with potentially life-threatening peanut allergy. _x000D_ _x000D_ Supported by a generous donation from The Rosetrees Trust.

Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;6.1 PHARMACEUTICALS
Health categories: INFLAMMATORY AND IMMUNE SYSTEM