Safety of epicutaneous immunotherapy for the treatment of peanut allergy: A phase 1 study using the Viaskin patch

To the Editor: Peanut allergy (PA) affects approximately 1% to 1.5% of children and adults living in westernized society1 and is considered a life-long allergy in the vast majority of subjects.2,3 Additionally, peanuts and tree nuts account for 90% of all cases of fatal and near-fatal anaphylaxis to foods.4 Strict dietary avoidance and availability of injectable epinephrine are key management tools in the current food allergy guidelines,2 and the quest for effective allergen immunotherapy for PA is ongoing.5 Epicutaneous immunotherapy (EPIT) has shown promise in animal studies6-8 and in a single pilot study9 as a novel future treatment for food allergy. Preclinical studies indicate that allergen applied through EPIT to intact skin does not cross into the circulation but rather activates dendritic cells in the dermal layer of the skin to affect immune activation.5 The findings presented in this letter expand the data presented in abstract form10 to include a comprehensive analysis of the phase 1 study.