Oral Immunotherapy for Peanut Allergy: It Works, But...

Abstract

Research Article| August 01 2019 Oral Immunotherapy for Peanut Allergy: It Works, But... AAP Grand Rounds (2019) 42 (2): 20. https://doi.org/10.1542/gr.42-2-20 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Oral Immunotherapy for Peanut Allergy: It Works, But.... AAP Grand Rounds August 2019; 42 (2): 20. https://doi.org/10.1542/gr.42-2-20 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: immunotherapy, peanut hypersensitivity, adverse event Source: Chu DK, Wood RA, French S, et al. Oral immunotherapy for peanut allergy (PACE): a systematic review and meta-analysis of efficacy and safety. Lancet. 2019; 393(10187): 2222– 2232; doi: https://doi.org/10.1016/S0140-6736(19)30420-9Google Scholar Investigators from multiple institutions conducted a meta-analysis to assess the safety and efficacy of oral immunotherapy for peanut allergy. Investigators searched MEDLINE, Embase, the Cochrane Controlled Register of Trials, and databases at the US Food and Drug Administration and European Medicines Agency from inception to 2018 to identify published and unpublished randomized controlled trials (RCTs) comparing oral immunotherapy with placebo or allergen avoidance for the treatment of peanut allergy. The investigators pooled data among included studies for several outcomes, including (a) peanut-induced anaphylaxis, defined as involvement of ≥2 organ systems after possible allergen exposure; (b) epinephrine use; (c) serious adverse events; and (d) proportion of patients who passed a supervised in-clinic oral food challenge. The investigators analyzed these outcomes according to intention to treat. Risk ratios or incidence rate ratios for these outcomes among participants receiving oral immunotherapy (vs placebo or allergen avoidance) were determined. Among 1,624 records identified, 12 RCTs were included involving 1,041 participants with a median age of 8.7 years. In all trials, peanut oral immunotherapy involved defatted peanut flour, paste, or extract. Patients who received oral immunotherapy (vs no immunotherapy) had a significantly increased likelihood of passing a supervised in-clinic oral challenge (risk ratio [RR], 12.42; 95% CI, 6.82–22.61). However, compared to those who received no immunotherapy, participants who received oral immunotherapy had a significantly greater risk of anaphylaxis (RR, 3.12; 95% CI, 1.76–5.55), epinephrine use (RR, 2.21; 95% CI, 1.27–3.83), and serious adverse events (RR, 1.92; 95% CI, 1.00–3.66). The investigators conclude that although oral immunotherapy effectively induces desensitization, it comes at considerable expense, with increased serious adverse events and anaphylactic reactions. Dr Rosenthal has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Peanut allergy can be life-threatening. Desensitization with trace amounts of peanut protein gradually increased over time can be used to overcome lifelong avoidance of peanuts.1 This method has an efficacy of 67.2%, but how safe is this approach? (See AAP Grand Rounds. 2019;4[3]:32.1 ) The current study reports on a meta-analysis of the safety and efficacy of oral immunotherapy for peanut allergy. Compared to those who received no immunotherapy, children who received oral peanut immunotherapy had a significantly increased risk of anaphylaxis, epinephrine use, and serious adverse events. What can be done to avoid these serious adverse events? Do not forget that prevention of peanut allergy can be achieved with early introduction of peanut protein in children. (See AAP Grand Rounds. 2015;33[6]:61.2 ) The Learning Early About Peanut Allergy (LEAP) study tested the theory that the very low rates of peanut allergy in Israeli children were a result of... You do not currently have access to this content.