Adverse events associated with peanut oral immunotherapy in children - a systematic review and meta-analysis

Area of Science:

• Allergy and Immunology
• Pediatric Medicine
• Clinical Research

Background:

• Peanut oral immunotherapy (POIT) shows promise for treating childhood peanut allergies.
• Safety concerns and adverse events are significant barriers to POIT's widespread clinical use.
• Systematic assessment of POIT's safety profile is crucial for optimizing treatment protocols.

Purpose of the Study:

• To systematically evaluate the risk and frequency of adverse events during POIT in children.
• To identify study-level characteristics associated with the occurrence and severity of POIT-related adverse events.
• To explore potential modifications to POIT protocols that could enhance safety and efficacy.

Main Methods:

• A systematic literature search was conducted across MEDLINE, EMBASE, and Web of Science up to April 2019.
• Included were controlled and non-controlled studies evaluating POIT in pediatric populations.
• Data from 27 studies involving 1488 subjects were analyzed to assess adverse event rates and influencing factors.

Main Results:

• Adverse events were frequent, leading to treatment discontinuation in 6.6% of children.
• Epinephrine was required for 7.6% of participants, at a rate of 2.0 per 10,000 doses.
• Rush treatment phases and higher maintenance doses correlated with increased epinephrine use; co-treatments reduced discontinuation risk.

Conclusions:

• Adverse events are common in pediatric peanut oral immunotherapy.
• Modifications such as co-treatments may reduce treatment discontinuation.
• Further research into optimizing POIT protocols can improve safety and patient outcomes for peanut allergy management.