Peanut Oral Immunotherapy in Children Evaluated via Real World Study

Children who underwent real-world peanut oral immunotherapy (P-OIT) at a large tertiary referral academic center tolerated the treatment well, but older children required more dose reductions when being desensitized to high-dose maintenance therapy. These were among findings presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2022 Annual Meeting, held in Phoenix, Arizona, February 25 to 28.

In the current study, investigators seeking to evaluate the effectiveness of P-OIT conducted a real-world, retrospective review of patients who underwent P-OIT at an academic tertiary referral center between 2018 and 2020. All participants were sensitized to low-dose (ie, 300 to  500 mg) or high-dose (ie, 1500 to 2000 mg) daily peanut protein (PP), according to tolerance and patient-centered treatment goals. Measures of effectiveness included the following: (1) proportion of patients who attained maintenance; and (2) tolerance of a 6000-mg PP challenge following 12 months of high-dose maintenance. All patients were stratified into 2 groups based on age: a younger group of children 72 months of age and younger (ie, preschool-aged) and an older group of children over 72 months of age.

A total of 85 patients underwent P-OIT, with 45 of them in the younger group (median age, 28.0 months; range, 18.0 to 50.0 months) and 40 of them in the older group (median age, 126.5 months; range, 106.8 to 151.0 months). Overall, 17 patients discontinued the study prior to maintenance and 11 withdrew because of adverse reactions. Maintenance was achieved in 80.0% (68 of 85) of the participants, and 69.4% (59 of 85) of patients achieved high-dose maintenance, regardless of age (younger group: 68.9% [31 of 45] vs older group: 72.5% [28 of 40]).

There were 6 patients in the younger group receiving high-dose maintenance who were reduced to low-dose maintenance because of adverse reactions and/or taste aversion; 1 patient in the older group discontinued. Of the 52 participants who remained on high-dose maintenance, 43 were eligible for the 12-month 6000-mg PP challenge, with 93.9% (31 of 33) of them tolerating the challenge without any adverse reactions. No significant differences were reported between the 2 age group cohorts with respect to either of the effectiveness measures.

The researchers concluded that children who continued high-dose maintenance for at least 12 months desensitize to high levels of PP exposure, which is consistent with the results of other clinical trials and real-world studies of P-OIT.

Reference  

Wilson B, Magier A, Andorf S, et al. Effectiveness of a real-world peanut oral immunotherapy at a large tertiary referral academic center. Presented at: American Academy of Allergy, Asthma & Immunology (AAAAI) 2022 Annual Meeting; February 25–28, 2022; Phoenix, AZ. Abstract 093.