Peanut oral immunotherapy in peanut allergy: symptoms more likely during initial escalation day

Oral immunotherapy (OIT) offers a promising therapeutic option for peanut allergy. Given that during OIT an allergic patient ingests an allergen that could potentially cause a serious reaction, the safety of OIT is of particular concern.

In this study of 20 patients, most symptoms were noted during the initial escalation day:

- upper respiratory tract symptoms (79%)
- abdominal symptoms (68%)

The risk of mild wheezing during the initial escalation day was 18%. The probability of having any symptoms after a buildup phase dose was 46%.

The risk of reaction with any home dose was 3.5%. Upper respiratory tract (1.2%) and skin (1.1%) symptoms were the most likely after home doses. Two subjects received epinephrine after 1 home dose each.

The authors concluded that subjects were more likely to have significant allergic symptoms during the initial escalation day when they were (and must be) in a closely monitored setting.

Allergic reactions with home doses were rare but yet, 2 out of 20 patients needed to use EpiPen.

Eight top allergens account for 90 percent of all food allergies. See more Allergy and Immunology mind maps here.

Safety of a peanut oral immunotherapy protocol in children with peanut allergy. Hofmann AM, Scurlock AM, Jones SM, Palmer KP, Lokhnygina Y, Steele PH, Kamilaris J, Burks AW. J Allergy Clin Immunol. 2009 May 26. [Epub ahead of print]
Oral tolerance induction in peanut allergy
Food Allergy
Adverse reactions during peanut oral immunotherapy home dosing. JACI, Volume 124, Issue 6, Pages 1351-1352 (December 2009).
Specific oral tolerance (SOTI) cannot be recommended for routine clinical practice for food allergy treatment yet - JACI
Peanut oral immunotherapy is not ready for clinical use - From the experts in the field. JACI, 2010
Office-based oral immunotherapy for food allergy is safe and effective - according to Texas allergist group that use it
Therapies for peanut allergy: Sustained oral tolerance over desensitization is the goal, we are not there yet.
Peanut oral immunotherapy (20 peanuts) induces desensitization, however questions about long-term tolerance remain. JACI, 2011.
Oral immunotherapy for peanut allergy - interview with Dr. Wesley Burks: clearly 15-20% will not tolerate the treatment
Sublingual and oral immunotherapy for milk allergy. Desensitization was lost in some cases within 1 week off therapy. JACI, 2011.
The place of oral desensitization in the practice of allergy at this time is in flux - see why: 
Image source: Roasted peanuts as snack food, Wikipedia, public domain.

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