Parents and peanut desensitization therapy: one size doesn’t fit all

Published online: September 1, 2021

In the United States, peanut allergy is the most common food allergy in children. Management strategies include avoidance of peanuts and emergency medications in case of accidental exposure, but such strategies can be burdensome to parents. The first oral peanut desensitization therapy was approved in 2020 and other peanut desensitization treatments are in development.  Peanut desensitization therapy can reduce the future risk of allergic reaction to accidental exposure, but since the therapy uses progressive exposures to peanut protein in peanut-allergic individuals, desensitization therapy itself can cause allergic reactions, leading to discontinuation.  Understanding which of these benefits and risks are most important to parents, how much risk parents are willing to accept, and how this varies among parents is important to help inform treatment decisions.

In The Journal of Allergy and Clinical Immunology: In Practice, Hung, Gonzalez, Yang, Hass, Kim, and Johnson reported parent preferences on peanut desensitization therapy based on a discrete-choice experiment survey. The survey was administered to a national sample of 500 parents in the United States with at least 1 peanut-allergic child aged 4 to 17 years. The survey asked parents to choose among varying treatment options that differed in four aspects: (1) mode of administration, (2) average amount of peanut tolerated after one year of treatment, (3) how many stopped treatment by one year because of side effects, and (4) cost.

Of the 500 parents, 4 preference groups were identified: (1) Cost-Sensitive, (2) Pro-Treatment (but Side Effect-Averse), (3) Trader, and (4) Inconsistent. Cost-Sensitive parents were most concerned about costs. Pro-Treatment (but Side Effect-Averse) parents were most concerned about the discontinuation rate due to side effects, but almost always chose treatment over no treatment. Trader parents found efficacy, discontinuation, and costs to be similarly important.  Inconsistent parents tended to fail consistency tests included in the survey. Pro-Treatment (but Side Effect-Averse) parents were willing to accept a maximum discontinuation rate of 22% for a treatment that would allow their children to tolerate 1000 mg of peanut protein after one year of treatment, while the other three preference groups were willing to accept twice as high discontinuation rates. Characteristics associated with belonging to a given preference group included parent age, child age, income, parent perception of child risk and ability to manage allergic reactions, past history of allergy reactions, and change in precautionary behaviors after therapy.  

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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