Allergen-specific oral immunotherapy for peanut allergy

Area of Science:

• Allergy and Immunology
• Clinical Trials
• Food Hypersensitivity

Background:

• Peanut allergy is a prevalent food allergy, often persistent and linked to severe reactions.
• Current management relies on strict peanut avoidance.
• Oral immunotherapy (OIT) shows potential for desensitization and tolerance induction but requires further safety and efficacy evaluation.

Purpose of the Study:

• To assess the effectiveness and safety of allergen-specific OIT in individuals with IgE-mediated peanut allergy.
• To evaluate OIT's impact on symptom development following peanut ingestion.

Main Methods:

• A systematic search of multiple databases identified eligible randomized controlled trials (RCTs), quasi-RCTs, and controlled clinical trials.
• Studies included children and adults with IgE-mediated peanut allergy treated with OIT versus placebo or no treatment.
• Two reviewers independently assessed study eligibility, risk of bias, and extracted data.

Main Results:

• One small RCT (28 children) found OIT significantly increased the threshold dose of peanut allergen required to elicit a reaction.
• OIT participants tolerated a median cumulative dose of 5000 mg peanut protein, compared to 280 mg in the placebo group.
• OIT was associated with more adverse events, including reactions requiring antihistamines and epinephrine, though most were mild.

Conclusions:

• Allergen-specific peanut OIT demonstrated desensitization and immune modulation in children.
• The treatment approach carried a substantial risk of adverse events, limiting current recommendations.
• Larger RCTs are needed to explore long-term effectiveness, safety, and cost-effectiveness of OIT regimens.