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July 15, 2024
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Caregivers of infants, toddlers with peanut allergy show interest in oral immunotherapy

Fact checked byKristen Dowd
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Key takeaways:

  • The likelihood of remission for children that participated in peanut OIT was 83.3%
  • The most common reason for families not choosing OIT was their belief that it would not improve quality of life.

Families of children with peanut allergies that pursued oral immunotherapy cited remission and the potential for disease modification as their reason, according to a study published in The Journal of Allergy and Immunology: In Practice.

“Our previous study on real world adoption of FDA-approved peanut OIT with Palforzia yielded surprising results,” S. Shahzad Mustafa, MD, chief of allergy, immunology and rheumatology at Rochester Regional Health and clinical associate professor of medicine at the University of Rochester School of Medicine and Dentistry, told Healio.

Peanuts and Peanut Butter
Study findings suggest that families are more likely to pursue therapies that offer remission from peanut allergies compared with therapies that only increase the threshold dose. Image: Adobe Stock
S. Shahzad Mustafa

“We wanted to do a similar study to see the real world uptake and interest from patients and families in peanut OIT in infants and toddlers as young as 6 months of age,” he continued.

This study was conducted from January to December 2023 and recruited children aged 6 to 48 months with a peanut allergy diagnosis based on clinical history, skin prick testing or measurement of peanut specific IgE.

Caregivers of these children were given the treatment option of peanut oral immunotherapy, and their decision as well as the reasons for their decision were documented qualitatively.

 

The study included 97 participants (median age, 19 months; 61.9% boys; 85.6% white; 79.4% commercially insured). Among them, 74.2% had atopic dermatitis and 69.1% had another food allergy, with egg being the most common at 41.2%.

During peanut OIT, urticaria occurred in 67%, and 17.5% developed anaphylaxis. Medians included 10 mm (interquartile range [IQR], 5-12 mm) for SPT wheal, 4.7 kU/L (IQR, 1.1-11.9 kU/L) for peanut sIgE and 2.8 kU/L (IQR, 1-11.7 kU/L) for Ara h 2 IgE.

Peanut allergy was confirmed with an OFC for 34% of children. Among the 64 children with a peanut allergy diagnosis without an OFC, medians included 10 mm (IQR, 6-15 mm) for SPT wheal, 6.8 kU/L (IQR, 3.2-29.5 kU/L) for peanut sIgE and 5.2 kU/L (IQR 1.6, 25.6 kU/L) for Ara h 2 IgE. The entire cohort’s median likelihood of PA remission was 78% (IQR, 52%-85%).

Also, 67% of the cohort opted to pursue peanut OIT with the most common reason cited as increasing the likelihood of peanut allergy remission (92.3%). Researchers calculated the likelihood of remission for children that participated in peanut OIT as 83.3% (IQR, 70.8%-87%).

The most common reason why participants did not choose peanut OIT is that it would not improve quality of life (18.8%). The odds of remission in those that did not pursue peanut OIT was 50% (IQR, 23%-68%).

“The study highlights that food allergy therapies that offer potential disease modification, or the potential of facilitating resolution of a food allergy, are understandably far more attractive to families as compared to therapies aimed at decreasing risk of reactions due to accidental exposure,” Mustafa said.

He further explained that therapies that offer an allergy resolution are likely best accomplished in younger patients, starting as early as age 6 months.

“There is an urgent need for additional research and guidance on therapies for food allergy in infants and toddlers, and their role in facilitating resolution of food allergy,” Mustafa said.