Long‐term outcome of peanut oral immunotherapy—Real‐life experience. Issue 5 (5th June 2018)

• Record Type: Journal Article
• Authors: Nachshon, Liat; Goldberg, Michael R.; Katz, Yitzhak; Levy, Michael B.; Elizur, Arnon
• Is Part Of: Pediatric allergy and immunology. Volume 29:Issue 5(2018)
• Page Start: 519
• Page End: 526
• Publication Date: 2018-06-05
• Subjects: adverse reactions -- desensitization -- food aversion -- maintenance dose -- peanuts allergy; Allergy in children -- Periodicals; Immunologic diseases in children -- Periodicals; 617
• DOI: 10.1111/pai.12914
• Languages: English
• ISSNs: 0905-6157

Abstract

Abstract: Background: Oral immunotherapy (OIT) is currently recommended as a treatment option for peanut‐allergic patients. Data regarding its long‐term compliance and efficacy in real life are required. Methods: Peanut‐allergic patients aged ≥4 years were enrolled in a single‐center clinical OIT program. Buildup to 3000 mg peanut protein was performed. Patients reaching this dose before or after 12/2014 were instructed to consume 3000 or 1200 mg daily, respectively. Patients were followed ≥6 months after reaching maintenance and rechallenged to 3000 mg. Results: Of the 145 patients studied, 113 (77.9%) were fully desensitized to 3000 mg and 133 (91.7%) were desensitized to ≥300 mg. 21/145 patients (14.5%) required adrenaline for home‐dose reactions during buildup. Non‐anaphylactic gastrointestinal symptoms, experienced by 9 patients (6.2%), reversed with dose reduction. Of the 111 patients available for analysis 6 months after reaching 3000 mg, 97 (87.4%) continued regular peanut consumption. Only 2/111 patients (1.8%) required adrenaline over the long‐term (median, range; 18, 6‐75 months) follow‐up. Adherence to treatment was significantly higher in patients consuming 1200 mg (73/76, 96.1%) vs those consuming 3000 mg (24/35, 72.2%), ( P = .001). A higher maintenance dosage and home adrenaline requirement during buildup predicted adherence cessation (OR 12.5, P = .001; and OR 7.8, P = .02, respectively). 63/64 patients (98.4%) consuming 1200 mg maintenance dose were successfully rechallenged to 3000 mg. Conclusions: This real‐life experience demonstrates the efficacy of peanut OIT long‐term. A lower maintenance dose minimized treatment cessation while maintaining desensitization. OIT should be performed in qualified centers given the prevalence of adverse reactions, particularly during buildup. Abstract :