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Infant and Toddler Peanut Oral Immunotherapy: Initiation Before Age 2 Increases Ad Libitum Peanut Consumption
S Shahzad Mustafa1, Peter Capucilli1, Linh-An Tuong2
1Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Rochester Regional Health, Rochester, NY; Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
Insights
High-dose peanut oral immunotherapy (POIT) is safe and effective for children aged 6 months to 4 years, enabling ad libitum peanut consumption, particularly when started before age two.
Area of Science:
- Allergy and Immunology
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Peanut oral immunotherapy (POIT) shows promise for disease modification in peanut allergy.
- Limited data exists on high-dose POIT, especially in young children (6 months to 4 years).
- Ad libitum (ad lib) consumption of peanut products is a key goal for POIT success.
Purpose of the Study:
- Evaluate real-world outcomes of high-dose POIT in infants and toddlers.
- Assess adverse events, achievement of ad lib peanut consumption, and age-related impacts.
- Determine the feasibility of high-dose POIT in a pediatric population.
Main Methods:
- Enrolled children aged 6 months to 4 years with a peanut allergy diagnosis.
- Administered POIT with a target dose of 3000 mg daily.
- Collected demographic and clinical outcome data at 6 months post-POIT.
Main Results:
- 85% of children completed high-dose POIT, achieving ad lib peanut consumption.
- Adverse reactions occurred in 26.7% of participants during treatment.
- Initiating POIT before 24 months significantly increased the odds of ad lib consumption (OR 11.69).
Conclusions:
- High-dose POIT is well-tolerated in infants and toddlers.
- POIT can lead to successful introduction of dietary peanut products.
- Early initiation of POIT (before age 2) enhances the likelihood of achieving ad lib consumption.
Background:
Peanut oral immunotherapy (POIT) has promising potential of disease modification, but there are no studies to date evaluating high-dose POIT, leading to ad libitum (ad lib) consumption of peanut products, especially in children 6 months to 4 years of age.
Objective:
To report real-world outcomes of high-dose POIT in children 6 months to 4 years of age, including adverse events, achievement of ad lib consumption, and the impact of age on these outcome measures.
Methods:
Patients 6 months to 4 years of age with a diagnosis of peanut allergy were enrolled in a POIT protocol with a goal dose of 3000 mg. Demographics along with POIT and clinical outcomes 6 months after POIT are reported.
Results:
Sixty children, with a median age of 16 months, started POIT. Three (5%) were lost to follow-up, and 6 (10%) discontinued POIT because of recurrent adverse events or the inability to consume daily peanut protein. Fifty-one (85%) children completed POIT in a median of 7 months and were consuming ad lib peanut products for a duration of 6 months after completion of the POIT protocol. Sixteen (26.7%) children experienced a total of 22 adverse reactions during POIT. Initiating POIT before 24 months of age increased the likelihood of ad lib peanut consumption by an odds ratio of 11.69 (1.19-114.31, P = .035).
Conclusions:
Our study demonstrates that high-dose POIT in infants and toddlers is well tolerated and can lead to ad lib introduction of dietary peanut products into the diet, especially if initiated before 2 years of age.
