Peanut Oral Immunotherapy Side Effects, Including Anaphylaxis, Common

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 — Peanut oral immunotherapy (POIT) can be a safe and effective treatment for most patients with a peanut allergy, although side effects are common, according to research presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting, held February 22-25, 2019, in San Francisco, California.

POIT has proven effective in desensitizing patients with peanut allergies, however, it has had limited clinical use due to a relatively high frequency of adverse events reported. 

Investigators conducted a retrospective chart review of 595 patients to determine the frequency of adverse effects POIT patients experienced at a food allergy treatment center. The participants were aged 3 to 48 years (mean age, 9 years), had a peanut allergy, and had received POIT over the previous 8 years. Investigators analyzed the percentage of patients who experienced adverse effects during the build-up and maintenance phases (tolerating ≥ 2.5 peanuts per day) of POIT.

During the build-up phase, 85% of patients experienced ≥1 episode of gastrointestinal (GI)-related symptoms, which were mostly mild and included abdominal pain (68%) and oral itch (50%). Up to 46% of patients experienced cutaneous symptoms, 20% experienced respiratory symptoms, and 9% had ≥1 episode of anaphylaxis also during the build-up phase. A total of 87% of patients reached the maintenance phase. These patients experienced fewer gastrointestinal (24%), cutaneous (14%), and respiratory (6%) symptoms.

However, 17% of patients experienced ≥1 episode of anaphylaxis during the maintenance phase. Of those patients who experienced anaphylaxis, 20% experienced exercise-induced anaphylaxis. None of the patients were hospitalized and no patients died. A total of 8 patients (1.3%) developed eosinophilic esophagitis during the immunotherapy treatment. 

The researchers concluded that although POIT may be safe and effective in most patients with peanut allergies, mild gastrointestinal and cutaneous symptoms were common and anaphylaxis occurred in build-up and maintenance stages. Physicians should be aware of the possible adverse effects of POIT in patients with peanut allergies and discuss this information with patients considering POIT. 

Reference

Rubin TN, Patel S, Lee JO, et al. Frequency of allergic symptoms during build-up and maintenance phases of peanut oral immunotherapy. Presented at: American Academy of Allergy, Asthma & Immunology Annual Meeting 2019; February 22-25, 2019; San Francisco, CA. Abstract 808.

Visit Pulmonology Advisor‘s conference section for continuous coverage from AAAAI 2019