Most oral immunotherapy patients prefer dietary peanut product for maintenance treatment
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Nearly all the patients on peanut OIT chose dietary peanut products instead of protein powder to continue treatment upon reaching maintenance dosing, according to a letter published in Annals of Allergy, Asthma & Immunology.
Taste and convenience were the primary drivers behind these choices, Syed Shahzad Mustafa, MD, clinical associate professor of allergy, immunology and rheumatology at Rochester Regional Health in New York, and colleagues wrote.
The study involved 44 patients aged 4 to 17 years (median age at enrollment, 9 years; 65.9% boys) with an allergist-confirmed peanut allergy diagnosis who had successfully reached maintenance dosing of peanut OIT for at least 2 weeks.
The researchers asked the patients if they would like to continue taking peanut (Arachis hypogaea) allergen powder-dnfp (Palforzia, Aimmune Therapeutics) or transition to a dietary peanut product for their maintenance dosing. Dietary peanut products included a single peanut M&M, a whole peanut or a smoothie with peanut butter.
“Many allergists are transitioning individuals with peanut allergy to dietary peanut products after using Palforzia for buildup dosing, so we wanted to capture this in a systematic way, and better understand the reasons to switch or decline to switch,” Mustafa said.
The patients who chose the dietary peanut product received the first dose in the office with 1-hour monitoring. Also, these patients had access to an on-call physician and in-person follow-up visits every 3 to 6 months. These patients reported any adverse events they experienced.
According to the researchers, 40 (90.9%) patients chose to transition to a dietary peanut product, including 75% who chose a single peanut M&M, 22.5% who chose a whole peanut and 2.5% who chose a smoothie with peanut butter.
Three of the four patients who chose to continue with Palforzia said they did so because they were familiar with its routine. The fourth was afraid of having an allergic reaction to a dietary peanut product.
The most common reasons for switching to a dietary peanut product included taste (45%) and increased convenience (42.5%). Four of those who switched (10%) said they had experienced nonspecific abdominal discomfort with Palforzia and hoped they would tolerate the dietary peanut product better. One patient (2.5%) indicated that the switch was due to cost savings.
During follow-up visits, the researchers asked these patients if they had achieved their goal in switching to a dietary peanut product. The four patients who said they had experienced abdominal discomfort with Palforzia all later said their tolerance improved with the dietary peanut product. Also, 72.2% of those who switched because of taste said that the dietary peanut product tasted better. All of the patients who switched because of convenience said the dietary peanut product was more convenient than Palforzia.
There were no systemic allergic reactions among the patients who switched on their first day of the new treatment, nor were there any reactions among the patients who switched or among those who did not during a median follow-up of 7 months (IQR, 5-12).
None of the patients who switched to a dietary peanut product asked to switch back to Palforzia.
“The results were not surprising, but they reinforce the importance of continuing to improve techniques for peanut oral immunotherapy, such as addressing taste aversion, and making this indefinite therapy more logistically feasible,” Mustafa said.
Additional drawbacks for peanut OIT include insurance approval, out-of-pocket costs and cold storage requirements, reinforcing the importance of convenience in treatment options, the researchers continued.
Finally, the researchers noted the role that shared decision-making played during routine clinical care, reinforcing its importance in managing patients with peanut allergy.
“The report will hopefully provide real-world data for allergists to confidently switch peanut-allergic patients from Palforzia to dietary peanut products once they reach maintenance dosing,” Mustafa said, adding that more research is necessary.
“We still need more real-world data on Palforzia and peanut immunotherapy, since real-world practice is likely to be different than the clinical trial experiences,” he said.
For more information:
Syed Shahzad Mustafa, MD, can be reached at shahzad.mustafa@rochesterregional.org.