First Real-World Effectiveness Analysis of Preschool Peanut Oral Immunotherapy

Lianne Soller; Elissa M Abrams; Stuart Carr; Sandeep Kapur; Gregory A Rex; Sara Leo; Mary McHenry; Timothy K Vander Leek; Joanne Yeung; Victoria E Cook; Tiffany Wong; Kyla J Hildebrand; Raymond Mak; Thomas V Gerstner; Scott B Cameron; Edmond S Chan

doi:10.1016/j.jaip.2020.10.045

First Real-World Effectiveness Analysis of Preschool Peanut Oral Immunotherapy

J Allergy Clin Immunol Pract. 2021 Mar;9(3):1349-1356.e1. doi: 10.1016/j.jaip.2020.10.045. Epub 2020 Nov 19.

Authors

Lianne Soller¹, Elissa M Abrams², Stuart Carr³, Sandeep Kapur⁴, Gregory A Rex⁴, Sara Leo⁵, Mary McHenry⁴, Timothy K Vander Leek⁶, Joanne Yeung⁷, Victoria E Cook⁸, Tiffany Wong⁹, Kyla J Hildebrand⁹, Raymond Mak¹⁰, Thomas V Gerstner¹¹, Scott B Cameron⁸, Edmond S Chan⁹

Affiliations

¹ British Columbia Children's Hospital, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada. Electronic address: lsoller@bcchr.ca.
² Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Meadowood Medical Center, Winnipeg, MB, Canada.
³ Pediatric Allergy & Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
⁴ Division of Allergy, Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, NS, Canada; Halifax Allergy & Asthma Associates, Halifax, NS, Canada.
⁵ Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; West Coast Allergy and Immunology Clinic, Vancouver, BC, Canada.
⁶ Pediatric Allergy & Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Pediatric Allergy & Immunology, Edmonton, AB, Canada.
⁷ Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Vancouver Pediatric and Allergy Centre, Vancouver, BC, Canada.
⁸ Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Community Allergy Clinic, Victoria, BC, Canada.
⁹ British Columbia Children's Hospital, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
¹⁰ Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
¹¹ Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Meadowood Medical Center, Winnipeg, MB, Canada.

PMID: 33221274
DOI: 10.1016/j.jaip.2020.10.045

Abstract

Background: We previously described safety of preschool peanut oral immunotherapy (P-OIT) in a real-world setting; 0.4% of patients experienced a severe reaction, and 4.1% received epinephrine, during build-up.

Objective: To determine the effectiveness of preschool P-OIT after 1 year of maintenance.

Methods: Preschoolers (9-70 months) with at least 1 objective reaction to peanut (during baseline oral food challenge (OFC) or P-OIT build-up) received a follow-up OFC to cumulative 4000 mg protein after 1 year on 300 mg peanut daily maintenance. Effectiveness of desensitization was defined as proportion of patients with a negative follow-up OFC. Symptoms and treatment at follow-up OFC were recorded.

Results: Of the 117 patients who successfully completed 1 year of P-OIT and subsequently underwent a cumulative 4000-mg follow-up OFC, 92 (78.6%) had a negative OFC and 115 (98.3%) tolerated a cumulative dose of greater than or equal to 1000 mg. For the 25 (21.4%) who reacted, their threshold increased by 3376 mg (95% CI, 2884-3868) from baseline to follow-up; 17 (14.5%) patients experienced grade 1 reactions, 7 (6.00%) grade 2, and 1 (0.85%) grade 3. Two patients (1.71%) received epinephrine associated with P-OIT, and 1 (0.85%) went to the emergency department.

Conclusions: Our data demonstrate that real-world preschool P-OIT is effective after 1 year of maintenance for those who received a follow-up OFC. For those who reacted, their threshold increased sufficiently to protect against accidental exposures. P-OIT should be considered for preschoolers as an alternative to current recommendations to avoid peanut.

Keywords: Effectiveness; Oral immunotherapy; Peanut allergy; Preschool; Real-world.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Administration, Oral
Allergens
Arachis*
Child, Preschool
Desensitization, Immunologic
Epinephrine / therapeutic use
Humans
Peanut Hypersensitivity* / therapy

Substances

Allergens
Epinephrine