Peanut Oral Immunotherapy in Children Evaluated via Real World Study

Peanut allergy
Peanut allergy
Is peanut oral immunotherapy well-tolerated by children in the real world, and does tolerance vary by age or by peanut protein dosage?

The following article is a part of conference coverage from the American Academy of Allergy, Asthma & Immunology Annual Meeting, being held in Phoenix, Arizona, from February 25 to 28, 2022. The team at Pulmonology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the AAAAI 2022 Virtual Annual Meeting.

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.


Visit Pulmonology Advisor’s conference section for complete coverage of the AAAAI 2022 Annual Meeting.



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.