Oral immunotherapy for peanut allergy: The con argument

Abstract

Background: In some countries of the world, peanut allergy represents an important source of anaphylactic reactions. Traditionally treated with the avoidance of responsible allergens, this condition can also be targeted by oral peanut immunotherapy. Methods: In this study, we review the beneficial and side effects of currently available forms of peanut oral immunotherapy (POIT). We report the discussions resulting from the publication of a meta-analysis that brought to light the downsides of oral immunotherapy for peanuts. Results: In some clinical situations, the risk-benefit ratio can favor peanut oral immunotherapy over avoidance. In many other situations, this is not the case. The decision must be based on the values and preferences of clinicians and patients. Those not ready to accept serious adverse effects from POIT are likely to continue the elimination diet; those motivated to achieving desensitization, and prepared to accept serious adverse effects, may choose to undergo POIT. Conclusions: Without being prejudiced against peanut oral immunotherapy, we indicate the possible evolution of treatment for this condition is in a rapidly evolving broader scenario. Among the future options, sublingual immunotherapy, parenteral immunotherapy with modified allergens, transcutaneous immunotherapy, and the use of biologics will become important options.

Omalizumab in Ige-Mediated Food Allergy: A Systematic Review and Meta-Analysis

“…51,56 In line with previous clinical experience, OMA showed no major safety concerns in patients with IgE-mediated FA. In OIT protocols, safety is a major concern 64,65 ; however, reductions in adverse reactions were noted in subjects receiving OMA during OIT dose escalation, dose-related reactions necessitating treatment, and doses needed to achieve maintenance. 16 Studies have indicated that OMA can decrease episodes of anaphylaxis in patients with recurrent and/or unprovoked anaphylactic reactions, 47 reiterating a potential benefit, especially in patients at a high risk of FA-related severe anaphylaxis.…”

The use of biologics in food allergy

“…In its phase 1, an Omalizumab/placebo comparison will assess among patients allergic to peanuts and other foods the ability to reach a full‐serving size threshold at DBPCFC after 16–20 weeks of treatment. A further 24‐weeks extension will evaluate if a prolonged Omalizumab treatment increases the probability of patients to introduce foods 102 …”

Transcriptome changes during peanut oral immunotherapy and omalizumab treatment

“…Specifically, peanut oral immunotherapy (pOIT) is able to induce tolerance/desensitization. 3 While the pathogenesis of food allergy is relatively well-studied, 4 mechanisms of OIT-induced tolerance are not well understood. Omalizumab (anti-IgE), which is used as treatment for severe allergic asthma and other IgE-driven allergies, can also facilitate OIT initiation 5 ; however, little is known about the involved mechanisms, including possible changes at the transcriptional level.…”

“…Simon Kebede Merid 1 David Brodin 2 Josef Brandström 3,4 Fredrik Fagerström-Billai 2 Marieke van der Heiden 5 Jon R. Konradsen 4 Michael Kabesch 6 Cornelis M. van Drunen 7 Korneliusz Golebski 8,9 Anke H. Maitland-van der Zee 9 Uroš Potočnik 10,11 Susanne J. H. Vijverberg 9 Anna Nopp 1,12 Caroline Nilsson 1,12 Erik Melén…”