Boiled Tree Nut for Oral Immunotherapy in Food-allergic Children

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE2

Total Enrollment

75 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-06-01

Study Completion Date

2026-12-31

Brief Summary

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As the global prevalence of food allergy steadily increases, tree nut (TN) becomes one of the main triggers of food-allergic reactions and food anaphylaxis. Since there is no effective cure, TN-allergic patients and their families must continue to live with this chronic, disabling condition while avoiding allergens and responding to allergic reactions with emergency treatment. An emerging experimental treatment for food allergy is oral immunotherapy (OIT). Tree nut OIT appears promising in preliminary studies but there are concerns about the high risk of adverse reactions to TNs used in the treatment. The rate of remission with TN OIT is also lacking. Identification of OIT regimes with increased efficacy and safety is urgently needed. The investigators revealed that boiled cashews had lower allergenic potential but retained mast cell reactivity. The aim of this proposed study is to investigate the efficacy and safety of a novel treatment strategy for TN-allergic individuals, whereby the investigators hypothesized that consuming increasing quantities of boiled cashews can induce desensitization/ remission to roasted tree nuts in children with cashew allergies.

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Detailed Description

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This will be a two-arm, parallel-design, double-blind, randomized controlled trial. Participants aged 3-17 years of age with double blind placebo-controlled food challenge-confirmed cashew allergy will be randomised into either the active or placebo arm. The active and placebo participants will consume daily dose of cashew and placebo, respectively, for 52 weeks. Participants will undergo an initial escalation and build-up phase until they reach a maintenance dose of cashew or placebo. Participants will return at 6 months for a safety and compliance check and at 12 months (T1) and 14 months (T2) for endpoint oral food challenges. Level of cross-desensitization to pistachio will be examined at T1. Immunological changes, including sIgE and IgG4, will be examined.

Conditions

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Food Allergy in Children Food Allergy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Cashew Oral Immunotherapy

Oral immunotherapy with boiled cashews followed by roasted cashews taken daily for 12 months

Group Type ACTIVE_COMPARATOR

Cashew oral immunotherapy

Intervention Type OTHER

Cashew Flour (boiled/ roasted) that is prepared under food manufacturing regulations

Placebo Oral Immunotherapy

Placebo oral immunotherapy taken daily for 12 months

Group Type PLACEBO_COMPARATOR

Placebo oral immunotherapy

Intervention Type OTHER

Placebo oral immunotherapy consists of corn flour with food colouring that has similar appearance, taste and smell to the active product

Interventions

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Cashew oral immunotherapy

Cashew Flour (boiled/ roasted) that is prepared under food manufacturing regulations

Intervention Type OTHER

Placebo oral immunotherapy

Placebo oral immunotherapy consists of corn flour with food colouring that has similar appearance, taste and smell to the active product

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Aged between 3 year and 17 years of age;
* Either sex, and of any race and ethnicity;
* \>7kg (the weight considered safe for the administration of an adrenaline autoinjector) (e.g. Jext);
* Confirmed diagnosis of cashew nut allergy as defined by a failed DBPCFC with cashew nut and a positive SPT (\>=3mm than control) or sIgE to cashew nut (of at least 0.35 kUA) at screening.
* Subject's parent and/ or guardian must be able to understand and provide informed consent.

Exclusion Criteria

* History of severe anaphylaxis (as defined by persistent hypotension, collapse, loss of consciousness, persistent hypoxia or ever needing more than three (3) doses of intramuscular adrenaline or an intravenous adrenaline infusion for management of an allergic reaction)
* Severe anaphylaxis during the study entry DBPCFC (defined as persistent hypotension, collapse, loss of consciousness, persistent hypoxia, or requiring more than 3 doses of intramuscular adrenaline or an intravenous adrenaline infusion for management of an allergic reaction)
* Any disorder in which adrenaline is contraindicated (such as hypertension or cardiac rhythm disorders)
* Reacting to the placebo component during the study entry DBPCFC
* FEV1 \<85% at rest and FEV1/FVC ≤ 85% at rest or ongoing chronic persistent asthma (as per Australian Asthma Foundation guidelines)
* Underlying medical conditions (e.g. cardiac disease) that increase the risks associated with anaphylaxis
* Use of beta-blockers, ACE inhibitors or calcium channel blockers
* Inflammatory intestinal conditions, indwelling catheters, gastrostomies, immune-compromised states, post-cardiac and/or gastrointestinal tract surgery, critically-ill and those requiring prolonged hospitalisation or other conditions that may increase the risks of probiotic associated sepsis
* Have received other food immunotherapy treatment in the preceding 6 months
* Currently taking immunomodulatory therapy (including allergen immunotherapy)
* Therapy with anti-IgE or other biologics within 1 year of enrolment
* Past or current major illness that in the opinion of the Site Investigator may affect the subject's ability to participate in the study e.g. increased risk to the participant
* History of suspected or biopsy-confirmed eosinophilic oesophagitis (EoE)
* Subjects who in the opinion of the Site Investigator are unable to follow the protocol NOTE: participants with other food allergies are NOT excluded from participating in this trial.

Minimum Eligible Age

3 Years

Maximum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No