Peanut oral immunotherapy plus omalizumab positively impacts adolescents’ quality of life
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Adolescents with severe peanut allergy experienced clinically relevant improvements in health-related quality of life with oral immunotherapy and omalizumab, according to a letter published in Clinical and Translational Allergy.
Led by researcher Maria Ödling, MSc, of the department of clinical science and education at Södersjukhuset and Karolinska Institutet, the study involved 11 patients (mean age, 15.8 years; 9 girls).
Comorbidities in this population included asthma (n = 10), allergic rhinitis (n = 8), eczema (n = 3), allergy to furry pets (n = 10) and allergy to pollen (n = 8).
Patients were treated with omalizumab (Xolair; Genentech, Novartis) for a mean of 93 weeks (range, 46-163) and peanut OIT.
Peanut OIT began with doses of 280 mg of peanut protein that increased over 8 weeks to reach a maintenance dose of 2,800 mg, at which point omalizumab doses were decreased in an individualized and stepwise approach. Patients continued peanut OIT for 12 weeks after the withdrawal of omalizumab treatment, followed by an open peanut challenge and peanut-specific basophils activation tests.
Patients also completed the Food Allergy Quality of Life Questionnaire-Teenager Form (FAQLQ-TF) at the beginning and at the end of the study. The questionnaire comprises 28 questions in three domains: allergen avoidance and dietary restrictions, emotional impact and risk for accidental exposure.
Mean scores in each individual domain all significantly decreased by the end of peanut OIT, the researchers found, as did the mean for total scores.
At the end of treatment, the clinical minimal important difference was 1.7 points lower for allergen avoidance and dietary restrictions (P < .01), 1.6 points lower for emotional impact (P < .01) and 1.4 points lower for risk for accidental exposure (P = .02). Also, there was a 1.7-point clinical minimal important difference in total scores (P < .01).
The researchers called the change in the domain pertaining to allergen avoidance and dietary restrictions interesting, as adolescents typically spend more time outside of the home, where they need to take responsibility for their food choices.
Also, the researchers attributed the change in scores pertaining to the emotional impact domain to adolescents getting to know their disease and feeling more mature in dealing with allergic reactions after long treatment with OIT and simply getting older.
Further, the researchers wrote that changes in the scores for risk for accidental exposure may indicate increased tolerance to peanuts due to OIT as adolescents feel they can participate more in social events and become more liberal in their diet.
However, the researchers cautioned that OIT can be slow and burdensome and that it may need to be continued indefinitely, so clinicians should share its benefits and downsides with patients during shared decision-making about treatment.
Perspective
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Ödling and colleagues report improvements in health-related quality of life among 11 adolescents following treatment with peanut OIT. Existing psychosocial literature has largely focused on young children with food allergy and their caregivers, with a relative lack of attention given to the unique experiences of adolescents with food allergy.
However, this is a particularly important developmental period to examine, given that adolescents must manage their food allergy in the context of greater independence, heightened social reward and propensities toward both taking risks and fitting in.
The vigilance and responsibility imposed by food allergy may conflict with these developmental trends, posing daily challenges for adolescents with food allergies and likely contributing to the increased risk for fatal reactions among this population. Strengths of this study include the dedicated focus on adolescence and the use of self-reported (as opposed to caregiver-proxy) quality-of-life measures.
Conclusions are limited due to the small sample size, but the clinically meaningful differences across all three health-related quality-of-life subscales are encouraging. It will be important to continue examining adolescent-reported psychosocial outcomes in future studies with larger, more representative samples.
Aside from health-related quality of life, it may also be beneficial to study food allergy-related knowledge, anxiety and illness intrusiveness. It would be ideal to expand beyond the pre- and post-treatment measures that this study employs to also examine trajectories in psychosocial outcomes throughout treatment.
Finally, it is important to measure these same processes and outcomes in adolescents who begin OIT but later drop out or fail treatment, which in this study was more than half of the original population of 23 patients. A greater understanding of common trajectories throughout the OIT treatment may aid allergists in shared decision-making with adolescent patients and their families.
References:
Engel ML, et al. Clin Pract Pediatr Psychol. 2023;doi:10.1037/cpp0000475.
Rotter NS, et al. Food allergies and the teenager. Stukus DR. In: Allergies and Adolescents: Transitioning Towards Independent Living. Springer; 2018:153-168.
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