Adding a Probiotic to Peanut Oral Immunotherapy in Children

For children with peanut allergy, the addition of a probiotic to peanut oral immunotherapy (OIT) may improve safety and tolerability of OIT, according to a study published in The Lancet Child & Adolescent Health.

While peanut OIT has been shown to be effective at inducing desensitization to allergens, it has also been associated with treatment-related reactions. The addition of immune response modifiers (probiotics or Toll-like receptor agonists) has been suggested to improve the effectiveness or safety of OIT.

Researchers investigated whether addition of a probiotic adjuvant improved the efficacy or safety of peanut OIT in children aged 1 to10 years in a phase 2b trial conducted in 3 hospitals in Australia. A total of 201 participants were randomly assigned to receive probiotic and peanut oral immunotherapy (PPOIT group; n = 79), placebo probiotic and peanut OIT (OIT group; n = 83), or placebo probiotic and placebo OIT (placebo group; n = 39) for 18 months.

The researchers found that 36 (46%) of 79 children in the PPOIT group and 42 (51%) of 83 children in the OIT group achieved sustained unresponsiveness compared with 2 (5%) of 39 children in the placebo group (P<.0001), with no significant difference between PPOIT and OIT (P=.52). In addition, treatment-related adverse events were reported in 72 (91%) of 79 children in the PPOIT group, 73 (88%) of 83 children in the OIT group, and 28 (72%) of 39 children in the placebo group. Twelve months post-treatment, 60 (85%) of 71 participants in the PPOIT group, 60 (86%) of 70 participants in the OIT group, and 6 (18%) of 34 participants in the placebo group were eating peanut, with rescue epinephrine being used infrequently. Researchers also found that children aged 1-5 years had higher rates of sustained unresponsiveness to peanut allergens.


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“Both PPOIT and OIT were effective at inducing sustained unresponsiveness,” the  researchers concluded.  “Addition of probiotic did not improve efficacy of OIT but might provide a meaningful safety benefit, particularly for children aged 1–5 years, by reducing the burden of gastrointestinal symptoms and systemic reactions,” they added.

Disclosure: This research was supported by National Health and Medical Research Council Australia and Prota Therapeutics. Please see the original reference for a full list of disclosures.

Reference

Loke P, Orsini F, Lozinsky AC, et al; PPOIT-003 study group. Probiotic peanut oral immunotherapy versus oral immunotherapy and placebo in children with peanut allergy in Australia (PPOIT-003): a multicentre, randomised, phase 2b trial. Lancet Child Adolesc Health. Published online February 3, 2022. doi:10.1016/S2352-4642(22)00006-2

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General Pediatrics