***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND There are presently no available therapeutic options for patients with peanut allergy . OBJECTIVE We sought to investigate the safety , efficacy , and immunologic effects of peanut sublingual immunotherapy ( SLIT ) . METHODS After a baseline oral food challenge ( OFC ) of up to 2 g of peanut powder ( approximately 50 % protein ; median successfully consumed dose [ SCD ] , 46 mg ) , 40 subjects , aged 12 to 37 years ( median , 15 years ) , were r and omized 1:1 across 5 sites to daily peanut or placebo SLIT . A 5-g OFC was performed after 44 weeks , followed by unblinding ; placebo-treated subjects then crossed over to higher dose peanut SLIT , followed by a subsequent crossover Week 44 5-g OFC . Week 44 OFCs from both groups were compared with baseline OFCs ; subjects successfully consuming 5 g or at least 10-fold more peanut powder than the baseline OFC threshold were considered responders . RESULTS After 44 weeks of SLIT , 14 ( 70 % ) of 20 subjects receiving peanut SLIT were responders compared with 3 ( 15 % ) of 20 subjects receiving placebo ( P < .001 ) . In peanut SLIT responders , median SCD increased from 3.5 to 496 mg . After 68 weeks of SLIT , median SCD significantly increased to 996 mg ( compared with Week 44 , P = .05 ) . The median SCD at the Week 44 Crossover OFC was significantly higher than baseline ( 603 vs 71 mg , P = .02 ) . Seven ( 44 % ) of 16 crossover subjects were responders ; median SCD increased from 21 to 496 mg among responders . Of 10,855 peanut doses through the Week 44 OFCs , 63.1 % were symptom free ; excluding oral-pharyngeal symptoms , 95.2 % were symptom free . CONCLUSIONS Peanut SLIT safely induced a modest level of desensitization in a majority of subjects compared with placebo . Longer duration of therapy showed statistically significant increases in the SCD BACKGROUND Open-label oral immunotherapy ( OIT ) protocol s have been used to treat small numbers of patients with peanut allergy .  Peanut OIT has not been evaluated in double-blind , placebo-controlled trials . OBJECTIVE To investigate the safety and effectiveness of OIT for peanut allergy in a double-blind , placebo-controlled study . METHODS In this multicenter study , children ages 1 to 16 years with peanut allergy received  OIT with peanut flour or placebo . Initial escalation , build-up , and maintenance phases were followed by an oral food challenge ( OFC ) at approximately 1 year . Titrated skin prick tests ( SPTs ) and laboratory studies were performed at regular intervals . RESULTS Twenty-eight subjects were enrolled in the study . Three peanut OIT subjects withdrew early in the study because of allergic side effects . During the double-blind , placebo-controlled food challenge , all remaining peanut OIT subjects ( n = 16 ) ingested the maximum cumulative dose of 5000 mg ( approximately 20 peanuts ) , whereas placebo subjects ( n = 9 ) ingested a median cumulative dose of 280 mg ( range , 0 - 1900 mg ; P < .001 ) . In contrast with the placebo group , the peanut OIT group showed reductions in SPT size ( P < .001 ) , IL-5 ( P = .01 ) , and IL-13 ( P = .02 ) and increases in peanut-specific IgG(4 ) ( P < .001 ) . Peanut OIT subjects had initial increases in peanut-specific IgE ( P < .01 ) but did not show significant change from baseline by the time of OFC . The ratio of forkhead box protein 3 (FoxP3)(hi ) : FoxP3(intermediate ) CD4 + CD25 + T cells increased at the time of OFC ( P = .04 ) in peanut OIT subjects . CONCLUSION These results conclusively demonstrate that peanut OIT induces desensitization and concurrent immune modulation . The current study continues and is evaluating the hypothesis that peanut OIT causes long-term immune tolerance BACKGROUND There are no treatments currently available for peanut allergy . Sublingual immunotherapy ( SLIT ) is a novel approach to the treatment of peanut allergy . OBJECTIVE We sought to investigate the safety , clinical effectiveness , and immunologic changes with SLIT in children with peanut allergy . METHODS In this double-blind , placebo-controlled study subjects underwent 6 months of dose escalation and 6 months of maintenance dosing followed by a double-blind , placebo-controlled food challenge . RESULTS Eighteen children aged 1 to 11 years completed 12 months of dosing and the food challenge . Dosing side effects were primarily oropharyngeal and uncommonly required treatment . During the double-blind , placebo-controlled food challenge , the treatment group safely ingested 20 times more peanut protein than the placebo group ( median , 1,710 vs 85 mg ; P = .011 ) . Mechanistic studies demonstrated a decrease in skin prick test wheal size ( P = .020 ) and decreased basophil responsiveness after stimulation with 10(-2 ) μg/mL ( P = .009 ) and 10(-3 ) μg/mL ( P = .009 ) of peanut . Peanut-specific IgE levels increased over the initial 4 months ( P = .002 ) and then steadily decreased over the remaining 8 months ( P = .003 ) , whereas peanut-specific IgG4 levels increased during the 12 months ( P = .014 ) . Lastly , IL-5 levels decreased after 12 months ( P = .015 ) . No statistically significant changes were found in IL-13 levels , the percentage of regulatory T cells , or IL-10 and IFN-γ production . CONCLUSION Peanut SLIT is able to safely induce clinical desensitization in children with peanut allergy , with evidence of immunologic changes suggesting a significant change in the allergic response . Further study is required to determine whether continued peanut SLIT is able to induce long-term immune tolerance BACKGROUND Immediate hypersensitivity to peanuts is a frequent cause of anaphylactic reactions and deaths in children and adults . Currently , preventive treatment consists of avoidance , which is difficult because of the widespread and often disguised use of peanuts in the food industry . METHODS Twelve patients with immediate hypersensitivity to ingestion of peanuts were recruited . Half were treated with injections of peanut extract : a maintenance level of tolerance was first achieved by a rush protocol , then maintained with weekly injections for at least 1 year . The other six were untreated control subjects . All patients underwent double-blind , placebo-controlled , oral peanut challenges initially , after approximately 6 weeks , and after 1 year . RESULTS All treated patients achieved the maintenance dose of 0.5 ml of 1:100 wt/vol peanut extract by the rush injection protocol . All experienced increased tolerance to double-blind , placebo-controlled peanut challenge and decreased sensitivity on titrated skin prick testing with peanut extract , whereas the threshold to oral peanut challenge and cutaneous reactivity to peanut extract were unchanged in the untreated control subjects . Systemic reactions were common in the treated group both during rush immunotherapy and with maintenance injections . Only three patients remained tolerant of the full maintenance dose . The increased tolerance to oral peanut challenge was maintained in the three subjects who received full maintenance doses , but there was partial ( n = 2 ) or complete ( n = 1 ) loss of protection in the patients who required dose reduction because of systemic reactions . CONCLUSIONS Injections of peanut extract increase the tolerance of patients with peanut allergy to oral ingestion of peanuts . Injections result in repeated systemic reactions in most patients , even during maintenance injections . For clinical application of this method of treatment , a modified peanut extract is needed Peanut and peanut products are a common food in the diet . Peanuts are also one of the most common foods responsible for food-induced anaphylaxis . Patients rarely lose sensitivity to peanuts . Although the ideal treatment is avoidance , this is often not possible because of hidden exposures ; therefore , a more effective treatment is needed . Subjects with confirmed peanut allergy were treated in a double-blind , placebo-controlled study with peanut immunotherapy or placebo . Objective measures of efficacy included changes in symptom score during double-blind placebo-controlled peanut challenge ( DBPCPC ) and titrated end point prick skin tests ( PST ) .  Three subjects treated with peanut immunotherapy  completed the study . These subjects displayed a 67 % to 100 % decrease in symptoms induced by DBPCPC . Subjects also had a 2- to 5-log reduction in end point PST reactivity to peanut extract . One placebo-treated subject completed the study . This subject had essentially no change in DBPCPC symptom scores or PST sensitivity to peanut . Two other placebo-treated subjects underwent a second PST session . These subjects had a 1- to 2-log increase in skin test sensitivity to peanut . All peanut-treated subjects were able to reach maintenance dose , and in no case did an anaphylactic reaction occur secondary to the peanut immunotherapy . The current study provides preliminary data demonstrating the efficacy of injection therapy with peanut extract and provides a future line of clinical investigation for the treatment of this potentially lethal disease . It should be noted , however , that the rate of systemic reactions with rush immunotherapy was 13.3 % . ( ABSTRACT TRUNCATED AT 250 WORDS Food oral immunotherapy ( OIT ) is an investigational peanut allergy treatment aim ed to achieve specific oral tolerance induction . Allergic children are given titrated oral ( or sublingual ) doses of their allergen on a daily basis , unlike in subcutaneous immunotherapy ( SCIT ) . OIT is theorized to cause a shift from a Th2 to a Th1 regulatory environment , reflected by increases in food-specific IgG4/IgE , and the production of FoxP3 . Peanut OIT holds special promise because peanut allergy has an unfavorable natural history and is rarely outgrown . A high percentage of the participants experience symptoms during peanut OIT , including anaphylaxis , warranting epinephrine and /or discontinuation of therapy . This is a concerning fact given that the studies have mostly targeted only older children , with less historical reactivity for enrollment . The h and ful of peanut OIT studies have shown that some participants can be desensitized to peanut , but none have shown that long-term tolerance can be reestablished . Factors predictive of which patients are most likely to succeed and become desensitized through OIT are unknown . Some private practice s have begun offering peanut OIT as a therapy . Such practice is potentially dangerous given the safety and efficacy of OIT in r and omized controlled clinical trials is still not well established . Therefore , until further investigation emerges that conclusively demonstrates OIT is safe , intermediate and long-term outcomes are better established , the number of participants that experience symptoms is reduced , and proof of concept established in patients of all ages , ( irrespective of past reaction severity ) , OIT is not ready for use in the general allergy practice * The UK incidence of anaphylactic reactions is increasing . * Patients who have an anaphylactic reaction have life-threatening airway and , or breathing and , or circulation problems usually associated with skin or mucosal changes . * Patients having an anaphylactic reaction should be treated using the Airway , Breathing , Circulation , Disability , Exposure ( ABCDE ) approach . * Anaphylactic reactions are not easy to study with r and omised controlled trials . There are , however , systematic review s of the available evidence and a wealth of clinical experience to help formulate guidelines . * The exact treatment will depend on the patient 's location , the equipment and drugs available , and the skills of those treating the anaphylactic reaction . * Early treatment with intramuscular adrenaline is the treatment of choice for patients having an anaphylactic reaction . * Despite previous guidelines , there is still confusion about the indications , dose and route of adrenaline . * Intravenous adrenaline must only be used in certain specialist setting s and only by those skilled and experienced in its use . * All those who are suspected of having had an anaphylactic reaction should be referred to a specialist in allergy . * Individuals who are at high risk of an anaphylactic reaction should carry an adrenaline auto-injector and receive training and support in its use . * There is a need for further research about the diagnosis , treatment and prevention of anaphylactic reactions 
    Output:
    
This study showed a statistically significant benefit of peanut immunotherapy in patients with peanut allergy .