Update on peanut allergy: Prevention and immunotherapy

Background: The prevalence of food allergy is steadily increasing, and the burden of food allergy has become significant. However, treatments for food allergy remain experimental. Objective: To review advances in the past 18 months for the prevention and treatment of food allergies, with a particular focus on peanut allergy. Methods: Recently published trials on the use of oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT) as well as updates on the implementation of the early introduction of peanut guidelines were identified. Results: To address the slow implementation of the early introduction of peanut guidelines, addendum guidelines were published by the National Institute of Allergy and Infectious Diseases, which provide broader and more practical guidelines across a wider range of patients. Well-known studies of OIT have supported its efficacy. Recent studies have shown the potential for sustained unresponsiveness (SU) in up to 50% of subjects after peanut OIT and an even higher proportion in toddlers who received peanut OIT. Adjustments in the protocol to address practicality and safety have shown potential for lower maintenance doses and faster buildups. Longer durations of peanut SLIT have shown successful desensitization to moderate amounts of peanut and may also show the potential for SU. EPIT has maintained an excellent safety profile with statistically significant response rates in children <11 years of age. Conclusion: Advances in food immunotherapy have continued to push the field forward and provided a better understanding of the safety and efficacy of OIT, SLIT, and EPIT. These treatments remain experimental, although phase III studies are currently underway.