First Real-World Effectiveness Analysis of Preschool Peanut Oral Immunotherapy.

The journal of allergy and clinical immunology. In practice 2021 Mar

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We previously described safety of preschool peanut oral immunotherapy (P-OIT) in a real-world setting; 0.4% of patients experienced a severe reaction, and 4.1% received epinephrine, during build-up. To determine the effectiveness of preschool P-OIT after 1 year of maintenance. Preschoolers (9-70 months) with at least 1 objective reaction to peanut (during baseline oral food challenge (OFC) or P-OIT build-up) received a follow-up OFC to cumulative 4000 mg protein after 1 year on 300 mg peanut daily maintenance. Effectiveness of desensitization was defined as proportion of patients with a negative follow-up OFC. Symptoms and treatment at follow-up OFC were recorded. Of the 117 patients who successfully completed 1 year of P-OIT and subsequently underwent a cumulative 4000-mg follow-up OFC, 92 (78.6%) had a negative OFC and 115 (98.3%) tolerated a cumulative dose of greater than or equal to 1000 mg. For the 25 (21.4%) who reacted, their threshold increased by 3376 mg (95% CI, 2884-3868) from baseline to follow-up; 17 (14.5%) patients experienced grade 1 reactions, 7 (6.00%) grade 2, and 1 (0.85%) grade 3. Two patients (1.71%) received epinephrine associated with P-OIT, and 1 (0.85%) went to the emergency department. Our data demonstrate that real-world preschool P-OIT is effective after 1 year of maintenance for those who received a follow-up OFC. For those who reacted, their threshold increased sufficiently to protect against accidental exposures. P-OIT should be considered for preschoolers as an alternative to current recommendations to avoid peanut. Copyright © 2020 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Citation

Lianne Soller, Elissa M Abrams, Stuart Carr, Sandeep Kapur, Gregory A Rex, Sara Leo, Mary McHenry, Timothy K Vander Leek, Joanne Yeung, Victoria E Cook, Tiffany Wong, Kyla J Hildebrand, Raymond Mak, Thomas V Gerstner, Scott B Cameron, Edmond S Chan. First Real-World Effectiveness Analysis of Preschool Peanut Oral Immunotherapy. The journal of allergy and clinical immunology. In practice. 2021 Mar;9(3):1349-1356.e1