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First Real-World Effectiveness Analysis of Preschool Peanut Oral Immunotherapy
Lianne Soller1, Elissa M Abrams2, Stuart Carr3
1British Columbia Children's Hospital, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
Insights
Preschool peanut oral immunotherapy (P-OIT) is effective, with 78.6% of children tolerating a high dose after one year. This treatment offers protection against accidental peanut exposure for young children.
Area of Science:
- Allergy and Immunology
- Pediatric Gastroenterology
- Clinical Therapeutics
Background:
- Previous studies established the safety of preschool peanut oral immunotherapy (P-OIT) in real-world settings.
- During the build-up phase, severe reactions occurred in 0.4% of patients, and 4.1% required epinephrine.
Purpose of the Study:
- To evaluate the effectiveness of preschool peanut oral immunotherapy (P-OIT) after one year of maintenance therapy.
- To assess the degree of desensitization achieved in young children undergoing P-OIT.
Main Methods:
- Preschoolers (9-70 months) with a history of peanut reaction underwent a follow-up oral food challenge (OFC) after one year of daily maintenance P-OIT.
- Effectiveness was determined by the proportion of patients achieving a negative OFC to a cumulative dose of 4000 mg peanut protein.
- Symptoms and treatments during the follow-up OFC were meticulously recorded.
Main Results:
- Of 117 patients completing one year of P-OIT, 78.6% (92/117) had a negative follow-up OFC.
- 98.3% (115/117) tolerated a cumulative dose of at least 1000 mg peanut protein.
- For the 21.4% (25/117) who reacted, their peanut tolerance threshold significantly increased by a mean of 3376 mg.
Conclusions:
- Real-world preschool peanut oral immunotherapy (P-OIT) demonstrates significant effectiveness after one year of maintenance.
- The increased tolerance threshold provides protection against accidental peanut exposures.
- P-OIT presents a viable alternative to strict peanut avoidance for preschoolers.
Background:
We previously described safety of preschool peanut oral immunotherapy (P-OIT) in a real-world setting; 0.4% of patients experienced a severe reaction, and 4.1% received epinephrine, during build-up.
Objective:
To determine the effectiveness of preschool P-OIT after 1 year of maintenance.
Methods:
Preschoolers (9-70 months) with at least 1 objective reaction to peanut (during baseline oral food challenge (OFC) or P-OIT build-up) received a follow-up OFC to cumulative 4000 mg protein after 1 year on 300 mg peanut daily maintenance. Effectiveness of desensitization was defined as proportion of patients with a negative follow-up OFC. Symptoms and treatment at follow-up OFC were recorded.
Results:
Of the 117 patients who successfully completed 1 year of P-OIT and subsequently underwent a cumulative 4000-mg follow-up OFC, 92 (78.6%) had a negative OFC and 115 (98.3%) tolerated a cumulative dose of greater than or equal to 1000 mg. For the 25 (21.4%) who reacted, their threshold increased by 3376 mg (95% CI, 2884-3868) from baseline to follow-up; 17 (14.5%) patients experienced grade 1 reactions, 7 (6.00%) grade 2, and 1 (0.85%) grade 3. Two patients (1.71%) received epinephrine associated with P-OIT, and 1 (0.85%) went to the emergency department.
Conclusions:
Our data demonstrate that real-world preschool P-OIT is effective after 1 year of maintenance for those who received a follow-up OFC. For those who reacted, their threshold increased sufficiently to protect against accidental exposures. P-OIT should be considered for preschoolers as an alternative to current recommendations to avoid peanut.
