Peanut oral immunotherapy in toddlers is safe and effective
Published: February 28, 2024
The prevalence of peanut allergy is about 2% and the allergy is typically lifelong. Studies of oral immunotherapy (OIT) with peanut, a daily oral intake of an initially low and then increasing dose of peanut, often show problematic side effects. However, there are indications of better safety and efficacy in younger children compared with older children and adults.
In this study published in The Journal of Allergy and Clinical Immunology: In Practice, a Swedish research group enrolled children between one to three years of age with peanut allergy. Among 75 children who reacted at the baseline oral peanut challenge to up to 250 mg of peanut protein (approximately 1 peanut), 50 children were randomized to treatment with peanut OIT and 25 to continued avoidance. OIT was performed using a slow up-dosing strategy, every 4 to 6 weeks, and a low maintenance dose (285 mg peanut protein) with a peanut-coated corn puff containing 50% peanut. The maintenance dose was 3 puffs a day for a total of three years. In this paper the authors present the results after one year of OIT. The authors investigated the outcome of tolerating at least 750 mg peanut protein after one year.
The median age of the participating children at enrollment was 31 months. After one year of peanut OIT or continued avoidance, a peanut challenge was performed. In the OIT group, 43 out of 50, and in the avoidance group, 20 out of 25, children performed the 1-year oral peanut challenge. Among children in the OIT group, the median tolerated dose was 2750 mg peanut protein, and 72% (36/50) tolerated 750 mg peanut protein (approximately 3 peanuts). Children in the avoidance group tolerated a median of 2.8 mg peanut protein and 4% (1/25) tolerated 750 mg peanut protein. Of the 15466 doses administered at home during the first year of OIT, 1.4% resulted in adverse effects. Most of the adverse effects were mild, skin symptoms and oral symptoms such as mouth itch, and mostly occurred during the first week of treatment. Twelve of the OIT treated participants (27%) had no adverse effects at all.
The authors conclude that OIT for peanut allergy in toddlers seems to be effective and safe.
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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