Oral immunotherapy for peanut allergy: a systematic review and meta-analysis

Food allergy, particularly peanut allergy, is a significant and growing health concern, especially in high-income countries. Affecting 2% of children and 1% of adults, peanut allergy is a chronic condition that severely impacts quality of life. The standard treatment remains allergen avoidance, though oral immunotherapy (OIT) has emerged as a potential strategy for desensitization. This systematic review and meta-analysis aims to evaluate the efficacy and safety of peanut oral immunotherapy (POIT) based on randomized controlled trials (RCTs).

A systematic review and meta-analyses were conducted following PRISMA guidelines. Eligible studies included double-blind RCTs evaluating POIT versus placebo or avoidance. Databases such as PubMed, Google Scholar, Cochrane-Controlled Register of Trials, and ClinicalTrials.gov were searched. Risk of bias was assessed using the Cochrane Risk of Bias tool (ROB2), and statistical analysis was performed using the RevMan software.

A total of 20 studies with 2161 participants (median age: 8.6 years) were included. POIT demonstrated a significant increase in desensitization rates (RR = 7.25, 95% CI: 2.66-19.79, P = 0.0001). However, POIT was also associated with increased risks of anaphylaxis (RR = 2.27, 95% CI: 1.48-3.47, P = 0.0002) and epinephrine use (RR = 2.05, 95% CI: 1.35-3.12, P = 0.0008). Adverse effects such as gastrointestinal symptoms, respiratory events, and skin abnormalities were more frequent in the POIT group, leading to a higher treatment discontinuation rate (RR = 2.50, 95% CI: 1.20-5.21, P = 0.01).

POIT is effective in inducing desensitization in peanut-allergic individuals but carries significant risks, including an increased likelihood of anaphylaxis and adverse events. These findings reinforce previous meta-analyses and highlight the need for individualized risk-benefit assessments in clinical practice. Further research is required to optimize treatment protocols and improve patient safety.