Predictors improve peanut OIT safety for preschoolers

PHOENIX — Researchers identified predictive factors of grade 2 or worse reactions during peanut OIT in preschoolers, according to an abstract presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

“Previous literature has shown that patient factors, such as age, gender, baseline specific IgE levels and atopic comorbidities have been shown to impact the safety of OIT for other food allergies and in older patients,” Edmond S. Chan, MD, FRCPC, FCSACI, FAAAAI, a clinical investigator at the University of British Columbia Children’s Hospital Research Institute, told Healio. “However, no data exists on which factors predict safety of peanut OIT in preschool populations.”

Researchers analyzed data obtained from the Canadian Food Allergy Immunotherapy Registry on 672 preschoolers (median age at OIT entry, 24 months).

According to Chan, the build-up phase of OIT involved administering increased amounts of peanut doses approximately every 2 weeks. Symptoms were documented and classified using a modified World Allergy Organization Subcutaneous Immunotherapy Reaction Grading System.

Overall, 35.7% of the preschoolers had grade 2 or higher reactions and 1.19% had grade 4 reactions during OIT.

A multivariate logistic regression model showed predictors such as older age (OR = 1.027; 95% CI, 1.009-1.044), higher baseline sIgE (OR = 1.029; 95% CI, 1.017-1.041), pre-OIT grade 2 or higher reaction (OR = 2.42; 95% CI, 1.433-4.088) and lower eliciting dose (OR = 0.988; 95% CI, 0.983-0.993) predicted grade 2 or higher reactions during OIT.

Chan suggested that clinicians should consider all predictive factors before beginning preschool peanut OIT.

“However, since preschool OIT is overall so much safer than OIT in older children, we would use these predictors to decide who to offer a more cautious build-up phase rather than for deciding who to exclude from OIT,” Chan said. “Actual exclusion criteria for immunotherapy have already been well-established in guidelines, such as patients with uncontrolled asthma.”

Chan concluded that the next step of this research is to evaluate this model as a clinical tool and its impact on OIT delivery.

“Two of the factors that we identified as predictive of decreased OIT safety were a reaction of grade 2 or higher prior to OIT start and lower eliciting dose,” Chan said. “Limited research has explored these predictive factors and is an area that can be further researched.”