Oral immunotherapy for peanut allergy: multipractice experience with epinephrine-treated reactions. 2014

Oral Immunotherapy for Peanut Allergy: Multipractice Experience With Epinephrine-treated Reactions


Richard L. Wasserman, MD, PhDa , Jeffrey M. Factor, MDb , James W. Baker, MDc , Lyndon E. Mansfield, MDd , Yitzhak Katz, MDe , Angela R. Hague, PA-Cf , Marianne M. Paul, BSc , Robert W. Sugerman, MDa , Jason O. Lee, MDb , Mitchell R. Lester, MDb , Louis M. Mendelson, MDb , Liat Nacshon, MDg , Michael B. Levy, MDg , Michael R. Goldberg, MD, PhDg , and Arnon Elizur, MDe Dallas and El Paso, Tex; West Hartford, Conn; Portland, Ore; and Tel Aviv and Zerifin, Israel

  • What is already known about this topic? Oral immunotherapy for IgE-mediated food allergy has been reported for decades but is seldom performed in allergy practices.
  • What does this article add to our knowledge? This report demonstrates, in 352 patients who received more than 240,000 doses of peanut, that oral immunotherapy for peanut allergy can be performed in a practice setting with a manageable rate of epinephrine-treated reactions.
  • How does this study impact current management guidelines? This study suggests that some allergists may be able to offer oral immunotherapy for peanut allergy to patients with peanut allergy, in recognizing that mild and serious reactions occur and that long-term efficacy is unproven.

BACKGROUND: Peanut allergy creates the risk of life threatening anaphylaxis that can disrupt psychosocial development and family life. The avoidance management strategy often fails to prevent anaphylaxis and may contribute to social dysfunction. Peanut oral immunotherapy may address these problems, but there are safety concerns regarding implementation in clinical practice.

OBJECTIVE: The purpose of this report is to communicate observations about the frequency of epinephrine-treated reactions during peanut oral immunotherapy in 5 different allergy/immunology practices.

METHODS: Retrospective chart review of peanut oral immunotherapy performed in 5 clinical allergy practices.

RESULTS: A total of 352 treated patients received 240,351 doses of peanut, peanut butter, or peanut flour, and experienced 95 reactions that were treated with epinephrine. Only 3 patients received 2 doses of epinephrine, and no patient required more intensive treatment. A total of 298 patients achieved the target maintenance dose for a success rate of 85%. CONCLUSION: Peanut oral immunotherapy carries a risk of systemic reactions. In the context of oral immunotherapy, those reactions were recognized and treated promptly. Peanut oral immunotherapy may be a suitable therapy for patients managed by qualified allergists/immunologists.

LINK TO: Oral immunotherapy for peanut allergy: multipractice experience with epinephrine-treated reactions. J Allergy Clin Immunol Pract. 2014 Jan-Feb;2(1):91-6.

This article was considered the “PRO” article, and a “CON” article arguing against OIT being done in private practice was in this same issue, by Dr. Hugh Sampson and Dr. Robert Wood


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