Public Defence: Tonje Reier-Nilsen
Cand.med. Tonje Reier-Nilsen at Institute of Clinical Medicine will be defending the thesis “High-dose oral immunotherapy in children with anaphylaxis to peanut” for the degree of PhD (Philosophiae Doctor).
Trial Lecture – time and place
See Trial Lecture.
- First opponent: Senior Consultant Katharina Blümchen, University Hospital Frankfurt
- Second opponent: Associate Professor Caroline Nilsson, Karolinska Institutet
- Third member and chair of the evaluation committee: Associate Professor Torild Skrivarhaug, University of Oslo
Chair of the Defence
Adjunct Professor Drude Fugelseth, University of Oslo
Senior Consultant Geir Håland, Oslo University Hospital
Peanut allergy is common, and the main cause of life-threatening allergic reactions among children in the Western world. Concern for accidental exposure may reduce quality of life (QoL).
In allergen specific immunotherapy, initial exposure of a very low allergen dose is followed by incremental amounts of the culprit allergen until a maintenance dose is reached. Trials of oral immunotherapy (OIT) report successful desensitization (increased reactivity threshold to the allergen during treatment) with acceptable safety profiles. Paradoxically, children with severe peanut allergy, thought to benefit the most from a successful treatment, are often excluded from trials due to the risk of anaphylaxis.
The main objective of the present thesis was to determine the feasibility and effect of two years’ OIT in children with anaphylaxis to peanut.
In the prospective, open labelled 4-year high-dose peanut OIT TAKE-AWAY trial, 57 children were randomized to OIT and 20 to observation only. Immunological tests, QoL-questionnaires and food challenge were performed at inclusion and after two years of treatment.
In children with anaphylaxis to peanut, 24.6 % were deemed ineligible to OIT due to very low reactivity thresholds. Up-dosing was completed by 75.5 % with maintenance doses ranging from 250 to 5000 mg peanut protein (ppt), while 21.1 % only reached the pre-defined maximum maintenance dose (MMD) of 5000 mg ppt. The main reason for not reaching MMD was distaste for peanuts, followed by adverse events.
Every fifth child experienced an anaphylactic adverse event, questioning the feasibility and safety of high-dose OIT in these patients.
After two years of OIT, desensitization to 7500 mg ppt was confirmed in 94.6 % of the children. The QoL in children improved as reported by the parents, but not by the children. Hence, parents’ apparent over estimation of their child’s improvement in QoL by OIT, should be considered if such treatment is to be offered for peanut allergy.
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