Probiotic-Food Oral Immunotherapy for The Treatment of Peanut Allergy
Mimi TANG
Allergic and Immune Deficiency Disorders / Murdoch Children’s Research Institute / Australia
Current management of food allergy relies on allergen avoidance and emergency of allergic reactions due to accidental ingestion. These measures minimise harm to patients but the need for constant vigilance and dietary restriction may have a major long term negative impact on quality of life. Research has focused on searching for a curative treatment that can modify the natural history of disease. Oral immunotherapy (OIT) has drawn greatest interest as a potential treatment for food allergy. OIT is effective at inducing desensitisation, however its ability to induce long-lasting tolerance or sustained unresponsiveness remains to be confirmed. The limited ability to induce long-lasting benefit and high rates of adverse reactions highlight a need for novel strategies to improve tolerance induction and safety. One such strategy is the use of an immune response modifying adjuvant together with food immunotherapy to modulate established allergic responses.
We evaluated a novel combination therapy comprising the probiotic L rhamnosus CGMCC 1.3724 and peanut oral immunotherapy (PPOIT) for the treatment of peanut allergy. In a proof of concept randomised trial involving 62 children with peanut allergy, 82% of PPOIT-treated participants compared with 3.6% of placebo-treated participants attained sustained unresponsiveness1. Follow-up of participants 4 years after treatment was completed revealed that 67% (16/24) of PPOIT-treated participants as compared to 4% (1/24) of placebo participants (p<0·001) had continuing peanut intake, and 58% (7/12) of PPOIT vs 7% (1/15) of placebo participants had persistent 8-week SU (p=0·012)2. Acquisition of sustained unresponsiveness was associated with improved quality of life3. These findings demonstrate that PPOIT provides long-lasting clinical benefit with persistent suppression of the allergic immune response to peanut. It remains unclear whether these beneficial effects relate to the addition of probiotic L rhamnosus CGMCC 1.3724 to peanut OIT as there was no peanut OIT only intervention for comparison. A multicenter randomized trial comparing PPOIT with peanut OIT and placebo is underway to clarify this. The use of bacterial immune modifying adjuvants may offer a promising means of enhancing OIT-induced sustained responsiveness and evaluation of the combination probiotic-food oral immunotherapy approach for treatment of other food allergies is warranted4.
1. Tang ML, Ponsonby AL, Orsini F, et al. Administration of a probiotic with peanut oral immunotherapy: A randomized trial. J Allergy Clin Immunol 2015; 135(3): 737-44 e8.
2. Hsiao KC, Ponsonby AL, Axelrad C, Pitkin S, Tang MLK, team Ps. Long-term clinical and immunological effects of probiotic and peanut oral immunotherapy after treatment cessation: 4-year follow-up of a randomised, double-blind, placebo-controlled trial. Lancet Child Adol Health 2017; 1(2): 97-105.
3. Dunn Galvin A, McMahon S, Ponsonby AL, Hsiao KC, Tang MLK, team Ps. The longitudinal impact of Probiotic and Peanut Oral Immunotherapy (PPOIT) on health related quality of life (HRQL). Allergy 2017.
