Boiled Peanut Immunotherapy for the Treatment of Peanut Allergy

Summary

Peanut allergy is the most common cause of severe allergic reactions to food. Onset is common in childhood, but in contrast to other food allergies such as cow's milk and egg, peanut allergy tends to persist into adulthood. It is associated with a significant impact on quality of life, both for the affected individual and their family.

There is no current cure for peanut allergy. Oral peanut immunotherapy (OIT) using defatted, roasted peanut flour has been demonstrated to offer potential in this regard, but is associated with significant and frequent reactions and can cause life-threatening allergic symptoms.

The investigators have previously demonstrated that the processing of peanuts through boiling results in a relatively hypoallergenic product due to the loss of key allergenic components from peanut into the water. This has been tested in a recently-completed Phase 2b/3 trial (The BOPI Study, Clinicaltrials.gov NCT02149719; HRA reference 15/LO/0287): 47 children/ young people with peanut allergy confirmed at double-blind, placebo-controlled food challenge (DBPCFC) were randomised (2:1) to receive either oral immunotherapy (updosing using boiled peanut for \~6 months, followed by maintenance with roasted peanut) or standard treatment (allergen avoidance). Participants underwent repeat DBPCFC at 12 months to assess response, following which peanut OIT was stopped and sustained unresponsiveness assessed after 4 weeks (4SU). 24/32 participants (100% per protocol) achieved the primary outcome of desensitisation to \>1.44g peanut protein (approximately 6-8 peanuts, p\<0.0001); of those 14 tolerated \>4.4g peanut protein. 13/24 participants achieved 4SU. There was no significant change in threshold in the control group (p\>0.05). Boiled peanut OIT had a favourable safety profile, with under 2% of doses associated with gastrointestinal symptoms.

The BOPI-2 study is a non-inferiority study to demonstrate that boiled peanut is at least as effective as peanut flour in treating children with peanut allergy. The study will compare the rate of adverse events and other safety outcomes between these two interventions, and assess the immunological mechanisms involved, a secondary aim being to develop clinically-useful predictors for identifying individuals likely to undergo successful desensitisation.

Conditions

• IgE Mediated Peanut Allergy
• Peanut Hypersensitivity

Interventions

OTHER

Boiled peanut

Desensitisation using boiled peanut for induction and initial updosing

OTHER

Defatted roasted peanut flour

Desensitisation using defatted peanut flour for induction and initial updosing

Sponsors & Collaborators

• University College Cork

  collaborator OTHER

• Imperial College London

  lead OTHER

Principal Investigators

• Paul J Turner, FRACP PhD · Imperial College London

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

7 Years

Max Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2019-04-29

Primary Completion

2024-05-31

Completion

2027-05-31

Countries

• United Kingdom

Study Locations