Peanut oral immunotherapy in a pediatric allergy clinic: patient factors associated with clinical outcomes
Guarnieri KM, Slack IF, Gadoury-Lévesque V, Eapen AA, Andorf S, and Lierl MB. Peanut oral immunotherapy in a pediatric allergy clinic: patient factors associated with clinical outcomes. Ann Allergy Asthma Immunol 2021.
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
BACKGROUND: Additional information is needed to inform optimal patient selection, expected outcomes, and treatment endpoints for clinical peanut oral immunotherapy (OIT).
OBJECTIVE: We analyzed a real-world peanut OIT cohort to provide insight into these questions.
METHODS: Records were reviewed for 174 children undergoing peanut OIT at a pediatric allergy clinic. Patient age, peanut skin prick test, peanut-specific IgE (sIgE) results, and inclusion of additional foods in OIT were analyzed for correlations with OIT outcomes.
RESULTS: To date, 144 patients have achieved maintenance dosing, 50 of whom transitioned to ad lib twice-weekly peanut ingestion. Thirty discontinued OIT. Fortyseven patients who underwent multi-food OIT had no significant difference in reactions or time to reach maintenance compared to those on peanut OIT alone. Age at initiation inversely correlated with achievement of maintenance: 92% of patients 0.5-<5 >years, 81% of those 5-<11 >years, and 70% of those 11-(P=0.013). Baseline peanut-sIgE level positively correlated with number of reactions during updosing (P=0.0004) and maintenance (P=0.0048), though was not significantly different in patients achieving successful maintenance versus those who discontinued OIT (P=0.098). Sixty-six percent of patients experienced ≥1 adverse reaction during OIT. Of those on ad lib peanut ingestion, 2 reported mild reactions after lapses in peanut consumption.
CONCLUSION: Clinical peanut OIT has similar outcomes to research protocols. OIT can be successful in older children and those with high peanut-sIgE levels, though these factors impact outcomes. Clinical and laboratory criteria can guide successful transition to intermittent ad lib peanut consumption.
ePub ahead of print