Study: Large Majority of Children on Peanut OIT Achieve Maintenance Dose Including Older Kids

In a recent study published in the journal Annals of Allergy, Asthma and Immunology, researchers sought to gain insights into the optimal patient selection, expected outcomes, and treatment endpoints for clinical peanut oral immunotherapy (OIT) by analyzing a real-world peanut OIT cohort.

OIT involves taking minute quantities of an allergen which are gradually increased over time, known as updosing. The goal of OIT is to desensitize the patient to inadvertent exposure to the allergen and thus prevent reactions and anaphylaxis. At the endpoint of the therapy, the patient is placed on a maintenance dose of the allergen to ensure they maintain the desensitization they have built up over time.

In this study, records of 174 children undergoing peanut OIT at a pediatric allergy clinic were analyzed. Patient age, peanut skin prick test results, and peanut-specific immunoglobulin E (sIgE) results were analyzed for correlations with therapy outcomes, including whether the patient was simultaneously being treated with multifood OIT for other allergens.

Here’s what they found:

• To date, of those 174 study subjects, 144 patients have achieved maintenance dosing. 50 of those went on to twice-weekly ad-lib peanut consumption;
• 30 patients discontinued OIT, most often during updosing due to an aversion to peanuts or gastrointestinal symptoms;
• Of the 47 patients who underwent multifood OIT, there was no significant difference in reactions or time-to-reach maintenance compared with those on peanut OIT alone;
• Age at initiation did inversely correlate with achievement of maintenance:
  • 92% of patients 0.5 to less than 5 years
  • 81% of those 5 to less than 11 years, and
  • 70% of those 11 to less than 18 years reached and continued maintenance;
• Baseline peanut-sIgE level positively correlated with number of reactions during updosing and maintenance, though it was not significantly different in patients achieving successful maintenance vs those who discontinued OIT;
• 66% of patients experienced greater than or equal to 1 adverse reaction during OIT. Of those on ad lib peanut ingestion, 2 reported mild reactions after lapses in peanut consumption.

Although some two-thirds of patients experienced at least one adverse reaction, these were generally mild involving gastric pain or nausea and responded to treatment with H₂ blockers (oral antihistamines.)

The researchers concluded that OIT can be successful in older children and those with high peanut-sIgE levels, though these factors do affect outcomes. They also determined that clinical and laboratory criteria can guide the successful transition to intermittent ad-lib peanut consumption.