Is Oral Immunotherapy for Peanut Allergy Safe?

Although peanut oral immunotherapy regimens have been shown to effectively induce desensitization in patients with peanut allergy, they are also associated with significantly increased allergic and anaphylactic reactions compared with avoidance, according to the results of a recent study.

In order to further explore the harms and benefits of peanut oral immunotherapy, researchers conducted a systematic review and meta-analysis including 12 trials and 1041 participants.

Overall, they found that oral immunotherapy was associated with increased risk of anaphylaxis (risk ratio [RR] 3.12), increased anaphylaxis frequency (incidence rate ratio [IRR] 2.72), and increased epinephrine use (RR 2.21) compared with no oral immunotherapy.

Further, oral immunotherapy was associated with increased risk of serious adverse events (RR 1.92) and non-anaphylactic reactions, including vomiting, angioedema, and upper and lower respiratory tract reactions.

“In patients with peanut allergy, high-certainty evidence shows that available peanut oral immunotherapy regimens considerably increase allergic and anaphylactic reactions over avoidance or placebo, despite effectively inducing desensitization. Safer peanut allergy treatment approaches and rigorous randomized controlled trials that evaluate patient-important outcomes are needed,” the researchers concluded.

—Michael Potts

Reference:

Chu DK, Wood RA, French S, et al. Oral immunotherapy for peanut allergy (PACE): a systematic review and meta-analysis of efficacy and safety [published online April 25, 2019]. DOI:https://doi.org/10.1016/S0140-6736(19)30420-9.