First Real-World Effectiveness Analysis of Preschool Peanut Oral Immunotherapy

Abstract

RATIONALE: Peach tree (PT) pollen is entomophilous and therefore elicits allergy only in occupational exposure. METHODS: We report two cases of 12 y.o. girl and 15 y.o. boy living in an area of PT cultivars that in the past four-five years have developed rhinitis and, in the first case, also asthma. Symptoms appeared mainly on visits or stays in the family farms in the period of Peach tree (PT) flowering from late February to early June. RESULTS: Skin prick test (SPT) were positive to olive, grass, S kali and PT pollen in Case 1 and to S kali and PT pollen in Case 2. In both cases, SPT were negative to peach fruit and Pru p 3. SDS-PAGE immunoblotting showed one band recognized by rabbit polyclonal antisera to Ole e 6 and identified like Ole e 6-like allergen. We did SPT with Pru p 9, an already identified and registered allergen from PT pollen, plus Ole e 6-like having a positive response to both in Case 1 and only to Ole e 6 like in Case 2. Nasal challenges with PT pollen and Ole e 6 like were positive in both cases whereas with Pru p 9 and Olive tree pollen only in Case 1. CONCLUSIONS: These results show that PT pollen can induce symptoms in children living in an area of PT cultivars and children directly or indirectly exposed must be evaluated. We prove for the first time allergy to Ole e 6-like from PT pollen in children.

Food allergy and hypersensitivity reactions in children and adults—A review

“…Recently, an oral peanut immunotherapy drug was approved by the FDA and the EMA for patients between 5 and 17 years of age [100]. Furthermore, recent studies indicate an age gradient towards OIT being more successful and safer the younger the child is [101,102]. Similar studies have been conducted regarding wheat, egg, and milk [103–105], and new guidelines are being developed [106].…”

Managing food allergy: GA2LEN guideline 2022

“…There are similar data from a recent real-world study. 28 However, we make recommendations for allergen immunotherapy from 4 years of age based on the effectiveness evidence, the potential to outgrow the allergy, the logistics and potential harms. Clinicians may consider other age groups depending on individual circumstances.…”

Information needs of patients considering oral immunotherapy for food allergy

“…Future food allergy treatments may offer advantages over those available today, and waiting for these to become available is a reasonable option for some families 57,58 . However, waiting for future food allergy treatments must be balanced against short‐term deferral of the benefits of OIT as well as the potential diminished treatment response as children age 59,60 . Alternatives to OIT—although not typically available outside the context of clinical trials—should be discussed in the SDM process.…”