Oral immunotherapy safe for children allergic to peanuts

A recent study has claimed that oral immunotherapy given as routine treatment is safe for preschoolers allergic to peanuts. Oral immunotherapy (OIT) is a treatment protocol in which a patient consumes small amounts of the allergenic food.

“Although there have been many clinical trials of peanut oral immunotherapy in older children and one trial in preschoolers, there has been a lack of real-world data due to safety concerns of offering this treatment to preschoolers outside of a research setting,” said Lianne Soller, the lead author of the study which was published in Journal of Allergy and Clinical Immunology.

Children were seen by a pediatric allergist every two weeks, where they were fed a peanut dose that gradually increases in every visit. Parents also gave children the same daily dose at home, between clinic visits, until they reached a maintenance dose of 300 mg of peanut protein.

Symptoms and treatment of allergic reactions at clinic visits and at home, including epinephrine use, were recorded in the patient’s medical chart.

Parents were given instructions on how to manage at-home allergic reactions, when to administer epinephrine, and when to hold off on an OIT dose, such as during severe cold or flu.

“The goal of our project was to confirm the safety of preschool peanut OIT in a much larger sample of patients in the real world,” said Dr. Edmond Chan, senior author.

The researchers found that 243 children (90%) reached the maintenance stage successfully, while 27 children, or 10 per cent, dropped out.

It took an average duration of 22 weeks of oral immunotherapy for patients to reach the maintenance stage.

“Many allergists do not believe OIT should be offered outside of research settings, and have not routinely offered it as a therapy for peanut allergy in their clinics due to safety concerns. We hope that our data demonstrates that the treatment is safe in preschoolers, and could be offered to families of preschool children with peanut allergy who ask for it. There appears to be a big difference in outcomes in preschoolers compared to older children,” he said.

The group now hopes to investigate the long-term safety and efficacy of peanut OIT desensitisation and sustained unresponsiveness for patients who choose to stop daily peanut OIT.

“He hopes the findings provide guidance to health-care practitioners treating preschool children in their clinics,” said Chan.

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First Published:
Apr 21, 2019 15:17 IST

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