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Low dose Multi-Nut Oral Immunotherapy (OIT) in Preschoolers (LMNOP) Pilot Study

AIFA Ann Kupa Food Allergy Research Grant 2020 

A/Prof Kirsten Perrett, Murdoch Children's Research Institute, Victoria.

Low dose Multi-Nut Oral Immunotherapy in Preschoolers (LMNOP) Pilot Study.  

AProf Kirsten Perrett

Food allergy is a major public health problem, affecting 1 in 10 Australian infants. There is no cure, and management relies on food avoidance, with the ever-present risk of life-threatening reactions due to accidental ingestion. The significant mental, physical and financial burdens of food allergy are even greater for those with allergies to multiple foods. Nut (peanut and tree nut) allergies are the most common food allergies in children, are usually life-long and are the most frequent cause of anaphylaxis and food allergy death.

Oral immunotherapy (OIT) is a promising experimental treatment for food allergy, but there are concerns that the benefits may not be permanent and may be outweighed by safety risks. The LMNOP trial has been specifically designed to harness the unique immune ‘flexibility’ of young children to achieve lasting benefits, using low dose OIT to improve safety. This novel trial targets those with multi-nut allergy who are at highest risk of anaphylaxis and lifelong burden. Participants (children aged 18-36 months of age with multiple nut allergies) will be randomly assigned to receive either personalised multi-nut OIT or standard care (nut allergen avoidance). The primary outcome is the proportion of children achieving long-term induced tolerance (sustained unresponsiveness, the first measurable indicator of permanent cure) after 18 months of treatment.

The LMNOP trial will provide the first definitive evidence for early intervention with low dose, multi-nut OIT – and seeks to address the most significant unmet need in food allergy – the provision of a safe and effective cure in order to rescue young children from a lifetime of food allergy. LMNOP will form the cornerstone of a program of research with the aim of eradicating food allergy before school age.

This study may be the first step toward achieving the vision of eradicating food allergy before school age.

 AIFA is grateful to Professor Ann Kupa for the support of this grant.