L’IMMUNOTERAPIA ORALE CONTRO L’ALLERGIA ALLE ARACHIDI NEI BAMBINI è POTENZIATA DALL’ASSUNZIONE DI UN CEPPO PROBIOTICO

L’immunoterapia orale contro le allergie alimentari permette in genere di tollerare l’alimento responsabile solamente durante il periodo di trattamento; la protezione cessa infatti abitualmente alla sospensione della terapia. In questa ricerca australiana, dal protocollo rigoroso (controllato contro placebo) si è per la prima volta dimostrato, in bambini di 1-10 anni allergici alle arachidi, che la contemporanea somministrazione di un ceppo probiotico (nello specifico il Lactobacillus rhamnosus) con l’immunoterapia orale ottiene una risposta potente e mantenuta anche dopo 2 e 5 settimane dopo la sospensione della somministrazione nell’89,7% dei bambini trattati con la combinazione probiotico-immunoterapia orale, contro il 7% osservato nel gruppo placebo. Anche i test cutanei di allergia sono migliorati, così come molti markers immunologici (soprattutto le IgE specifiche). La terapia si è rivelata, complessivamente, ben tollerata. Nonostante l’approccio terapeutico di questi autori necessiti di ulteriori conferme, i risultati ottenuti sono di notevole interesse, anche alla luce della crescente diffusione di patologie allergiche tra bambini e ragazzi in tutto il mondo.

Administration of a probiotic with peanut oral immunotherapy: A randomized trial.
Background: Coadministration of a bacterial adjuvant with oral immunotherapy (OIT) has been suggested as a potential treatment for food allergy.
Objective: To evaluate a combined therapy comprising a probiotic together with peanut OIT.
Methods: We performed a double-blind, placebo-controlled randomized trial of the probiotic Lactobacillus rhamnosus CGMCC 1.3724 and peanut OIT (probiotic and peanut oral immunotherapy [PPOIT]) in children (1-10 years) with peanut allergy. The primary outcome was induction of sustained unresponsiveness 2 to 5 weeks after discontinuation of treatment (referred to as possible sustained unresponsiveness). Secondary outcomes were desensitization, peanut skin prick test, and specific IgE and specific IgG4 measurements.
Results: Sixty-two children were randomized and stratified by age (<5 and >5 years) and peanut skin test wheal size (<10 and >10 mm); 56 reached the trial’s end. Baseline demographics were similar across groups. Possible sustained unresponsiveness was achieved in 82.1% receiving PPOIT and 3.6% receiving placebo (P < .001). Nine children need to be treated for 7 to achieve sustained unresponsiveness (number needed to treat, 1.27; 95% CI, 1.06-1.59). Of the subjects, 89.7% receiving PPOIT and 7.1% receiving placebo were desensitized (P < .001). PPOIT was associated with reduced peanut skin prick test responses and peanut-specific IgE levels and increased peanuts pecific IgG4 levels (all P < .001). PPOIT-treated participants reported a greater number of adverse events, mostly with maintenance home dosing.
Conclusion: This is the first randomized placebo-controlled trial evaluating the novel coadministration of a probiotic and peanut OIT and assessing sustained unresponsiveness in children with peanut allergy. PPOIT was effective in inducing possible sustained unresponsiveness and immune changes that suggest modulation of the peanut-specific immune response. Further work is required to confirm sustained unresponsiveness after a longer period of secondary peanut elimination and to clarify the relative contributions of probiotics versus OIT.