Abstract
While peanut oral immunotherapy (POIT) represents a promising treatment for peanut allergies in children, safety concerns remain a common barrier to widespread adoption. We aimed to systematically assess available evidence to determine the risk and frequency of adverse events occurring during POIT, and examine study-level characteristics associated with their occurrence and severity. A systematic search of MEDLINE, EMBASE, and Web of Science was conducted through April 2019. Controlled and non-controlled studies evaluating POIT were eligible. Twenty-seven studies, involving 1488 subjects, were included. Adverse events to POIT were common and led to treatment discontinuation in 6.6% of children (95% CI 4.4–9.0; 27 studies, I2 = 48.7%). Adverse events requiring treatment with epinephrine occurred among 7.6% (4.5–11.4; 26 studies, I2 = 75.5%) of participants, at a rate of 2.0 per 10,000 doses (0.8–3.7; 15 studies, I2 = 64.4). Use of a rush treatment phase and targeting a higher maintenance dose were associated with a higher risk and frequency of epinephrine use, while using co-treatments in addition to POIT was associated with a lower risk of treatment discontinuation due to adverse events. While adverse events to POIT are common, this study provides promising explorative evidence that certain modifications to existing treatment protocols could significantly improve treatment outcomes.
Highlights
While peanut oral immunotherapy (POIT) represents a promising treatment for peanut allergies in children, safety concerns remain a common barrier to widespread adoption
While recent systematic reviews have demonstrated the effectiveness of POIT in achieving the immunological goal of desensitisation to peanut allergy, they have raised significant concerns regarding potential risks associated with treatment[12,13]
We sought to quantify the risk of adverse events occurring during POIT for peanut allergy in allergic children, and examine study and patient level characteristics associated with their occurrence
Summary
While peanut oral immunotherapy (POIT) represents a promising treatment for peanut allergies in children, safety concerns remain a common barrier to widespread adoption. While recent systematic reviews have demonstrated the effectiveness of POIT in achieving the immunological goal of desensitisation to peanut allergy, they have raised significant concerns regarding potential risks associated with treatment[12,13]. This has led to caution regarding the adoption of POIT in clinical practice outside of the trial setting. We sought to quantify the risk of adverse events occurring during POIT for peanut allergy in allergic children, and examine study and patient level characteristics associated with their occurrence
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