Oral immunotherapy for egg, peanut allergy appears safe for children with asthma

Oral immunotherapy for egg or peanut allergy appeared safe for children on asthma medication despite greater bronchial hyperresponsiveness in this population, according to a study published in Clinical and Translational Allergy.

To evaluate whether OIT affects asthma control, Janne Burman, MD, of the division of allergology at Helsinki University Central Hospital, and colleagues analyzed 39 children (56% boys; mean age, 9.4 years) with peanut allergy, 50 children (46% boys; mean age, 11.2 years) with egg allergy and 80 healthy control children (55% boys; mean age, 10.4 years). Forty of the children (45%) with peanut or egg allergy and none of the healthy controls had asthma.

OIT led to desensitization for 44 (88%) of the children with egg allergy and 28 (72%) of the children with peanut allergy for an overall rate of 81%, with 17 children discontinuing treatment.

Lung function

The children underwent methacholine challenge testing and exhaled nitric oxide testing at baseline and after 6 to 12 months of OIT.

Based on the former, significantly more children with egg allergy (58%) and peanut allergy (38%) had significant bronchial hyperresponsiveness (BHR) than the controls (7.5%; P < .001). Median cumulative provocative doses of methacholine that caused a 20% fall (PD20) in FEV₁ included 1,009 µg for the egg group and 1,104 µg for the peanut group compared with 2,068 µg for the control group (P < .001).

Among the 44 children from the allergy groups with BHR, 19 (43%) had asthma and 25 (57%) had asymptomatic BHR.

Compared with the 7.5% rate of BHR in the control group, significantly more of the 49 children in the allergy groups who did not have asthma had BHR (51%; P < .001), with a significantly lower cumulative methacholine dose in the allergy group as well (655 µg vs. 2,601 µg; P < .001).

There were no significant differences in FeNO levels (29.3 ppb vs. 26.7 ppb) or in the proportion of children with a FeNO greater than 35 ppb (32% vs. 26%) between the egg and peanut groups.

Similarly, there were no differences in lung function, the presence of BHR, PD20FEV₁ or FeNO levels between the children who achieved desensitization and those who discontinued OIT.

Children with allergic rhinitis and food allergy had more frequent BHR than those children who only had allergic rhinitis (PD20FEV₁, 670 µg vs. 2,100 µg; P = .03).

After reviewing medical records, the researchers found that OIT did not have any impact on asthma control among the 40 children who used regular asthma medication, nor did these children have any difference in FEV₁ (94.9% vs. 93.1%), FeNO (22.7 ppb vs. 22.5 ppb) or BHR (PD20FEV, 855 µg vs. 975 µg) from baseline to 6 to 12 months of OIT.

Conclusions, recommendations

The researchers concluded that children with persistent egg and peanut allergy experience BHR more frequently than those who do not have any food allergies. Also, they continued, lung function and BHR remain stable during OIT and do not impact its outcomes.

Based on these findings, the researchers determined that OIT is safe for children on medication for asthma and they did not recommend BHR assessments for children who do not have asthma who are about to start OIT.