Peanut Food Equivalents May Safely Maintain Desensitization After Immunotherapy

This article is part of Pulmonology Advisor‘s coverage of the American Academy of Allergy, Asthma & Immunology annual meeting, taking place in San Francisco, California. Our staff will report on medical research related to asthma, allergy, and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from AAAAI 2019.

SAN FRANCISCO — The majority of patients who had participated in prior peanut immunotherapy clinical trials were able to safely continue consuming peanuts, suggesting that food equivalents may be a safe option for maintaining desensitization, according to a study presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) held February 22-25 in San Francisco.

Researchers conducted a longitudinal observational study of 55 patients who had completed studies in oral or sublingual immunotherapy between 2010 and 2017. Peanut food equivalent dosing and associated reactions were evaluated. Participants who were desensitized to ≥300 mg of peanut were instructed to incorporate peanut into their diets. The follow-up from the clinical trial end dates ranged from 1 to 8 years.

A total of 49 patients continued to consume peanut after their participation in clinical trials ended, with 31 of these patients consuming peanuts daily. The median amount of peanut consumed was 600 mg (mean, 808 mg). Patients of older age tended to consume less peanut (r= –0.17). In addition, patients who had been part of sublingual immunotherapy trials consumed less peanut (median, 500 mg; mean, 543 mg) compared with patients who were part of oral immunotherapy trials (median, 600 mg; mean, 955 mg). However, more adverse reactions were reported with oral immunotherapy.

Adverse reactions in 10 patients included urticaria, gastrointestinal symptoms, and oropharyngeal pruritus, and 1 patient experienced eosinophilic esophagitis. Although 3 patients reported needing epinephrine, 1 patient decided to continue consuming peanuts after the event, the presenting author, Edwin Kim, MD, MS, University of North Carolina Chapel Hill in North Carolina, noted.

Dr Kim also pointed out that none of these treatments are a cure, but patients feel like they have some protection from possible accidental exposure. Furthermore, Dr Kim stressed the importance of standardized treatment and creating protocols to determine how long patients are able to maintain their tolerance.

Reference

Cook Q, Yang L, Hamad A, et al. Dosing and safety of peanut food equivalents after immunotherapy trials. Presented at: American Academy of Allergy, Asthma & Immunology annual meeting 2019; February 22-25, 2019; San Francisco, CA. Abstract 740.

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