Children, adolescents demonstrate high rates of adherence to peanut oral immunotherapy
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Key takeaways:
- Ten of the 12 patients in the study ingested at least 300 mg of peanut protein each day an average of 26 months after the up-dosing phase.
- Eleven of the 12 patients carried an epinephrine autoinjector.
SAN ANTONIO — Children and adolescents had high adherence rates to their and autoinjector protocols for peanut allergy, according to data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.
“Oral immunotherapy remains a relatively novel treatment for food allergies,” Benjamin Lawson, clinical coordinator, Canadian Treatment Center for Obsessive Compulsive Disorders, told Healio.
“However, there are numerous knowledge gaps related to the best strategies to conduct OIT and regarding long-term outcomes,” he continued. “It is especially crucial to assess long-term adherence to OIT once the maintenance dose is achieved.”
Further, Lawson called immunotherapy an excellent management strategy, but he also noted that it is not a cure for allergy and that adherence is crucial in maintaining its efficacy.
The researchers recruited 12 children and adolescents (median age 13 years; 50% boys) who had been desensitized to peanuts at the Center for Innovative Medicine at Montreal Children’s Hospital. Each of these patients had completed the up-dosing phase of peanut OIT as well as an exit challenge.
Between 1 and 3 years later, with an average of 26 months, the parents of these patients completed a questionnaire that assessed their adherence to maintenance dosing and epinephrine autoinjector protocols.
A variety of peanut products was used in dosing adherence, including roasted or seasoned peanuts (18%), peanut M&M’s (64%), a combination of M&M’s and roasted or seasoned peanuts (9%) and other (9%).
Each day, 10 (83.33%) of the patients were taking 300 mg or more of peanut protein, and one (8.33%) of the patients was taking less than 300 mg of peanut protein. One (8.33%) patient stopped taking the maintenance doses due to the number of reactions.
Also, 11 (91.66%) of the patients were carrying an epinephrine autoinjector at follow-up. The remaining patient (8.33%) also carried an epinephrine autoinjector, but it had expired.
The researchers classified this adherence to OIT maintenance dosing and to autoinjector protocols as high. Lawson noted previous research that his group had conducted finding a lower rate of adherence among children and adolescents on OIT for milk allergies.
“It is possible that the higher adherence to peanut OIT is related to differences related to different protocols eg, higher quantity of milk allergens recommended peanut allergens or lower risk of adverse events during maintenance,” Lawson said.
Considering the limited sample in the current study, Lawson said, larger studies would be required to generalize and corroborate these findings.
“We intend for this study to be a first step in a broader line of research that will be able to more thoroughly examine these important questions,” he said. “The next step for this research would involve recruiting a larger sample of patients in different settings, over longer periods of time, and with different allergens.”
Meanwhile, providers with patients exhibiting adherence challenges can take steps to improve outcomes, Lawson continued.
“Better adherence is likely achieved with safer protocols associated with lower risk of side effects and with better educational programs for families emphasizing the importance of adherence to maintain desensitization,” he said.