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Peanut oral immunotherapy (OIT) in clinical practice

Published online: May 30, 2018

Peanut allergy is a serious public health problem that disrupts family life, subjects children to bullying, results in thousands of emergency department visits, and even causes death. Peanut allergy treatment has been extensively studied in academic settings but the standard of care in North America is to avoid peanut and be prepared to treat reactions with epinephrine.

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Wasserman, et. al. reported the treatment of peanut allergic patients using oral immunotherapy. The report was based on a record review of 270 consecutively treated patients in a single private allergy practice. Patients were treated using a protocol based on the strategy used for allergy shots except that patients were treated orally. Treatment began with a dose of about 1/125,000th of a peanut that was increased over time to 12 peanuts.

Approximately 80% of treated patient were able to reach the 12 peanut target. The average time to OIT escalation was six months. While the severity of prior reactions did not predict success, younger age and lower peanut specific allergic antibody did. Nevertheless, some teenage patients with very high peanut antibody levels were able to complete OIT escalation. Although some patients had reactions that required epinephrine, 77% completed OIT escalation without an epinephrine treated reaction. Significant gastrointestinal side effects delayed treatment in 13.7% of patients and caused some patients to discontinue. The authors concluded that peanut oral immunotherapy, in a clinical setting, successfully treated most children regardless of their reaction history or level of peanut allergic antibody.

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

Real-World Experience with Peanut Oral Immunotherapy: Lessons Learned From 270 Patients
By Richard L. Wasserman, Angela R. Hague, Deanna M. Pence, Robert W. Sugerman, Stacy K. Silvers, Joanna G. Rolen, Morley Herbert