Community Private Practice Clinical Experience with Peanut Oral Immunotherapy

Area of Science:

• Allergy and Immunology
• Clinical Medicine
• Pediatrics

Background:

• Peanut oral immunotherapy (OIT) effectively desensitizes patients with peanut allergy.
• However, the frequency of adverse reactions during OIT has limited its widespread adoption.
• Understanding these reactions is crucial for optimizing OIT protocols.

Purpose of the Study:

• To determine the frequency of adverse reactions in peanut-allergic patients undergoing OIT during build-up and maintenance phases.
• To identify patient-specific factors associated with the occurrence of adverse events during OIT.

Main Methods:

• A retrospective chart review was conducted on 783 children and adults with peanut allergy receiving OIT.
• Data collected included patient demographics, allergy profiles, and details of adverse reactions during OIT build-up and maintenance.
• Systemic reactions were defined by specific symptom criteria, including gastrointestinal, cutaneous, respiratory, or severe systemic involvement.

Main Results:

• During build-up, 10% experienced systemic reactions, while 4% required epinephrine. Gastrointestinal (84%) and cutaneous (47%) events were most frequent.
• During maintenance, 19% experienced systemic reactions, and 11% required epinephrine. Gastrointestinal (27%) and cutaneous (15%) events remained common.
• Increasing pretreatment peanut-specific IgE levels correlated with systemic reactions during build-up. Age, IgE levels, and prior build-up reactions predicted maintenance reactions.

Conclusions:

• Peanut OIT can be an effective and safe treatment option for carefully selected peanut-allergic individuals.
• Experienced providers are essential for managing OIT and its associated adverse events.
• Predictive patient and immunologic factors can help identify individuals at higher risk for adverse reactions during OIT.