Oral peanut immunotherapy in children with peanut anaphylaxis

The only treatment option for peanut allergy is strict avoidance. However, accidental ingestion followed by allergic reactions is common because of the widespread use of peanuts. As reported in this issue of the Journal, Blumchen et al investigated the efficacy and safety of oral immunotherapy (OIT) in children with peanut anaphylaxis. Twenty-three children with IgE-mediated peanut allergy confirmed by positive double-blind, placebo-controlled food challenges (DBPCFCs) were recruited. After receiving OIT following a 7-day-Rush protocol with roasted peanut, most of the children did not tolerate a protective dose of at least 500 mg of peanut. After continuation with a long-term protocol with daily peanut intake and biweekly dose increases, 14 of the 23 patients finally reached the protective dose; however, mild to moderate side effects were common. OIT was discontinued in 4 patients because of adverse events. As shown in the Figure, threshold levels at final DBPCFC were increased significantly in comparison to DBPCFC before OIT. In general, a long-term protocol for OIT seems to be a quite safe and effective treatment to protect many peanut-allergic patients against accidental reactions. However, until the risk-benefit ratio has been further evaluated in larger controlled studies, OIT for peanut-allergic patients cannot be considered as a therapeutic strategy for routine clinical practice.


“Oral peanut immunotherapy in children with peanut anaphylaxis” Remarks by Beyer et al. (JACI July 2010 / Volume 126, No. 1)

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