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Long‐term outcome of peanut oral immunotherapy—Real‐life experience
Author(s) -
Nachshon Liat,
Goldberg Michael R.,
Katz Yitzhak,
Levy Michael B.,
Elizur Ar
Publication year - 2018
Publication title -
pediatric allergy and immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.269
H-Index - 89
eISSN - 1399-3038
pISSN - 0905-6157
DOI - 10.1111/pai.12914
Subject(s) - medicine , oral immunotherapy , peanut allergy , maintenance dose , allergy , surgery , food allergy , immunology
Background Oral immunotherapy ( OIT ) is currently recommended as a treatment option for peanut‐allergic patients. Data regarding its long‐term compliance and efficacy in real life are required. Methods Peanut‐allergic patients aged ≥4 years were enrolled in a single‐center clinical OIT program. Buildup to 3000 mg peanut protein was performed. Patients reaching this dose before or after 12/2014 were instructed to consume 3000 or 1200 mg daily, respectively. Patients were followed ≥6 months after reaching maintenance and rechallenged to 3000 mg. Results Of the 145 patients studied, 113 (77.9%) were fully desensitized to 3000 mg and 133 (91.7%) were desensitized to ≥300 mg. 21/145 patients (14.5%) required adrenaline for home‐dose reactions during buildup. Non‐anaphylactic gastrointestinal symptoms, experienced by 9 patients (6.2%), reversed with dose reduction. Of the 111 patients available for analysis 6 months after reaching 3000 mg, 97 (87.4%) continued regular peanut consumption. Only 2/111 patients (1.8%) required adrenaline over the long‐term (median, range; 18, 6‐75 months) follow‐up. Adherence to treatment was significantly higher in patients consuming 1200 mg (73/76, 96.1%) vs those consuming 3000 mg (24/35, 72.2%), ( P = .001). A higher maintenance dosage and home adrenaline requirement during buildup predicted adherence cessation ( OR 12.5, P = .001; and OR 7.8, P = .02, respectively). 63/64 patients (98.4%) consuming 1200 mg maintenance dose were successfully rechallenged to 3000 mg. Conclusions This real‐life experience demonstrates the efficacy of peanut OIT long‐term. A lower maintenance dose minimized treatment cessation while maintaining desensitization. OIT should be performed in qualified centers given the prevalence of adverse reactions, particularly during buildup.