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Peanut oral immunotherapy (OIT) helps reduce peanut allergy in many children, but it also triggers frequent reactions, especially during dose escalation.
Children with high allergic sensitivity or existing allergic conditions face more frequent AEs during peanut oral immunotherapy, underscoring the need for personalized monitoring and support to ensure safe, effective treatment.
Peanut oral immunotherapy (OIT) helps reduce peanut allergy in many children, but it also triggers frequent reactions, especially during dose escalation. Children with greater allergic sensitivity or conditions such as asthma, allergic rhinitis, or a history of anaphylaxis appear more vulnerable, and early results suggest that probiotics may slightly improve safety in younger patients.
Hence, Melanie Lloyd et al. aimed to identify which baseline factors heighten the risk of treatment-related reactions during OIT dose escalation and to examine how withdrawal patterns and common cofactors contribute to these events.
The probiotic peanut oral immunotherapy (PPOIT)-003 randomized trial included 201 children aged 1–10 years with confirmed peanut allergy, randomly assigned to receive PPOIT, peanut OIT alone (OIT), or placebo. Researchers used exposure-adjusted incidence rates (EAIR) to measure how often treatment-related reactions occurred and applied multivariable Poisson regression to examine how each child’s baseline traits influenced their risk during treatment.
The analysis showed that both PPOIT and OIT produced a threefold higher rate of treatment-related adverse events (AEs) compared with placebo, with no meaningful difference between the two active treatments (Table 1).
Older children (aged ≥6 years) and girls showed higher rates of treatment-related reactions across all groups. Strong allergic sensitivity and existing allergic conditions also increased the risk. Children with large skin prick test wheals (≥15 mm), high peanut-specific IgE levels (≥40 kU/L), low reaction thresholds (<320 mg of peanut protein), or a history of asthma, allergic rhinitis, or anaphylaxis were more likely to experience frequent AEs during PPOIT or OIT.
Baseline allergic sensitivity and comorbidities significantly influence the risk of AEs during peanut OIT. Identifying higher-risk children allows clinicians to implement tailored monitoring and support, optimizing safety and improving treatment outcomes.
The Journal of Allergy and Clinical Immunology: In Practice
Impact of Participant Baseline Factors on Exposure-Adjusted Incidence of Treatment-Related Adverse Events During Peanut Oral Immunotherapy
Melanie Lloyd et al.
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