Peanut Challenge May Reveal No Need for OIT After All

TOPLINE:

Nearly 70% of children with low-risk peanut allergy tolerated a peanut oral food challenge, negating the need for allergy treatment, data from one center showed.

METHODOLOGY:

Researchers sought to determine how many children with a previously diagnosed low-risk peanut allergy could tolerate a full peanut oral food challenge during initial dose escalation for peanut oral immunotherapy (OIT).
Of 76 patients aged less than 4 years participating in peanut OIT, 19 were considered low-risk candidates for an accelerated initial dose escalation based on a history of allergic reaction to peanut without anaphylaxis, a wheal diameter of < 8 mm on a skin prick test, and a peanut serum immunoglobulin E level of < 5 kU/L.
Sixteen children participated in the accelerated initial dose escalation (mean age, 20.3 months; 56% boys). The parents of the other three children chose not to participate because of associated risks.

TAKEAWAY:

Among the 16 children who underwent accelerated initial dose escalation, 11 (68.8%) showed resolution of peanut allergy by tolerating the full dose.
The other five patients had mild reactions during the initial dose escalation, including rash, localized hives, and rhinorrhea. These patients began peanut OIT at a significantly higher mean dose (450 mg vs 25 mg peanut protein) and reached maintenance dosing with fewer clinic visits (mean difference, 4.5 visits) than patients following the standard protocol, the researchers reported.

IN PRACTICE:

“Low-risk peanut-allergic children as defined by age, clinical history, and allergy testing should be offered a peanut oral food challenge before starting oral immunotherapy because most of them tolerate peanut,” the authors wrote.

SOURCE:

Kelly M. O’Shea, MD, with the University of Michigan, Ann Arbor, Michigan, was the corresponding author of the study, which was published online on February 18 and is scheduled to appear in the May issue of Journal of Allergy and Clinical Immunology: Global.

LIMITATIONS:

Data were from a small cohort with limited racial and ethnic diversity. More research is needed to verify the safety of the accelerated approach, according to the authors of the study.

DISCLOSURES:

Some of the researchers have received grant support from the National Institutes of Health and from pharmaceutical companies, including Aimmune, DBV Technologies, Novartis Pharmaceuticals, Alladapt Immunotherapeutics, ALK-Abelló, and Siolta Therapeutics.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.