Real World Experience With Peanut Oral Immunotherapy: Lessons Learned From 270 Patients

Publication date: Available online 30 May 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Richard L. Wasserman, Angela R. Hague, Deanna M. Pence, Robert W. Sugerman, Stacy K. Silvers, Joanna G. Rolen, Morley Herbert
BackgroundPeanut allergy (PA) is a significant and increasing problem, interfering with psychological development and family life. The standard recommendation to avoid peanut products and have access to injectable epinephrine is often inadequate. Oral immunotherapy for PA has been formally studied. Clinical observations of allergen immunotherapy have repeatedly enhanced patient care.ObjectiveThe purpose of this study is to report observations on the treatment of 270 PA patients over 8.5 years.MethodsThis is a retrospective record review of patients beginning peanut oral immunotherapy between January 1, 2009 and June 1, 2017 approved by the North Texas Institutional Review Board.Results270 patients aged 4 to 18 years comprising 107 girls and 163 boys were treated. 214/270 patients (79%) completed immunotherapy escalation. Age (p<0.001) and peanut IgE (p<0.001) correlate inversely with completing dose escalation. Epinephrine treated reactions in 63 and isolated gastrointestinal symptoms in 101 patients respectively were the most common adverse reactions to treatment but did not preclude success. Peanut IgE decreased by 65% after 3 years of maintenance treatment and 14/214 patients (6.5%) were able to achieve sustained unresponsiveness.ConclusionsIn an allergy office practice setting, 79% of patients are able to complete a peanut desensitization protocol and maintain the desensitized state indefinitely with daily dosing. With appropriate planning and precautions, peanut oral immunotherapy may be performed in an allergy office. Careful observations of clinical treatment can contribute to the development of effective treatment strategies.