Lianne Soller1, Elissa M Abrams2, Stuart Carr3, Sandeep Kapur4, Gregory A Rex4, Sara Leo5, Mary McHenry4, Timothy K Vander Leek6, Joanne Yeung7, Victoria E Cook8, Tiffany Wong9, Kyla J Hildebrand9, Raymond Mak10, Thomas V Gerstner11, Scott B Cameron8, Edmond S Chan9. 1. British Columbia Children's Hospital, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada. Electronic address: lsoller@bcchr.ca. 2. Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Meadowood Medical Center, Winnipeg, MB, Canada. 3. Pediatric Allergy & Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. 4. Division of Allergy, Department of Pediatrics, Dalhousie University/IWK Health Centre, Halifax, NS, Canada; Halifax Allergy & Asthma Associates, Halifax, NS, Canada. 5. Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; West Coast Allergy and Immunology Clinic, Vancouver, BC, Canada. 6. Pediatric Allergy & Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Pediatric Allergy & Immunology, Edmonton, AB, Canada. 7. Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Vancouver Pediatric and Allergy Centre, Vancouver, BC, Canada. 8. Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Community Allergy Clinic, Victoria, BC, Canada. 9. British Columbia Children's Hospital, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada. 10. Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada. 11. Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Meadowood Medical Center, Winnipeg, MB, Canada.
Abstract
BACKGROUND: We previously described safety of preschool peanut oral immunotherapy (P-OIT) in a real-world setting; 0.4% of patients experienced a severe reaction, and 4.1% received epinephrine, during build-up. OBJECTIVE: To determine the effectiveness of preschool P-OIT after 1 year of maintenance. METHODS: Preschoolers (9-70 months) with at least 1 objective reaction to peanut (during baseline oral food challenge (OFC) or P-OIT build-up) received a follow-up OFC to cumulative 4000 mg protein after 1 year on 300 mg peanut daily maintenance. Effectiveness of desensitization was defined as proportion of patients with a negative follow-up OFC. Symptoms and treatment at follow-up OFC were recorded. RESULTS: Of the 117 patients who successfully completed 1 year of P-OIT and subsequently underwent a cumulative 4000-mg follow-up OFC, 92 (78.6%) had a negative OFC and 115 (98.3%) tolerated a cumulative dose of greater than or equal to 1000 mg. For the 25 (21.4%) who reacted, their threshold increased by 3376 mg (95% CI, 2884-3868) from baseline to follow-up; 17 (14.5%) patients experienced grade 1 reactions, 7 (6.00%) grade 2, and 1 (0.85%) grade 3. Two patients (1.71%) received epinephrine associated with P-OIT, and 1 (0.85%) went to the emergency department. CONCLUSIONS: Our data demonstrate that real-world preschool P-OIT is effective after 1 year of maintenance for those who received a follow-up OFC. For those who reacted, their threshold increased sufficiently to protect against accidental exposures. P-OIT should be considered for preschoolers as an alternative to current recommendations to avoid peanut.
BACKGROUND: We previously described safety of preschool peanut oral immunotherapy (P-OIT) in a real-world setting; 0.4% of patients experienced a severe reaction, and 4.1% received epinephrine, during build-up. OBJECTIVE: To determine the effectiveness of preschool P-OIT after 1 year of maintenance. METHODS: Preschoolers (9-70 months) with at least 1 objective reaction to peanut (during baseline oral food challenge (OFC) or P-OIT build-up) received a follow-up OFC to cumulative 4000 mg protein after 1 year on 300 mg peanut daily maintenance. Effectiveness of desensitization was defined as proportion of patients with a negative follow-up OFC. Symptoms and treatment at follow-up OFC were recorded. RESULTS: Of the 117 patients who successfully completed 1 year of P-OIT and subsequently underwent a cumulative 4000-mg follow-up OFC, 92 (78.6%) had a negative OFC and 115 (98.3%) tolerated a cumulative dose of greater than or equal to 1000 mg. For the 25 (21.4%) who reacted, their threshold increased by 3376 mg (95% CI, 2884-3868) from baseline to follow-up; 17 (14.5%) patients experienced grade 1 reactions, 7 (6.00%) grade 2, and 1 (0.85%) grade 3. Two patients (1.71%) received epinephrine associated with P-OIT, and 1 (0.85%) went to the emergency department. CONCLUSIONS: Our data demonstrate that real-world preschool P-OIT is effective after 1 year of maintenance for those who received a follow-up OFC. For those who reacted, their threshold increased sufficiently to protect against accidental exposures. P-OIT should be considered for preschoolers as an alternative to current recommendations to avoid peanut.
Authors: Gilbert T Chua; Edmond S Chan; Joanne Yeung; Scott B Cameron; Lianne Soller; Brock A Williams; Alanna Chomyn; Timothy K Vander Leek; Elissa M Abrams; Raymond Mak; Tiffany Wong Journal: Allergy Asthma Clin Immunol Date: 2022-06-12 Impact factor: 3.373
Authors: Mona I Kidon; Soad Haj Yahia; Diti Machnes-Maayan; Yael Levy; Shirli Frizinsky; Ramit Maoz-Segal; Irena Offenganden; Ron S Kenett; Nancy Agmon-Levin; Ran Hovav Journal: Front Pediatr Date: 2021-11-30 Impact factor: 3.418
Authors: Antonella Muraro; Debra de Silva; Susanne Halken; Margitta Worm; Ekaterina Khaleva; Stefania Arasi; Audrey Dunn-Galvin; Bright I Nwaru; Nicolette W De Jong; Pablo Rodríguez Del Río; Paul J Turner; Pete Smith; Philippe Begin; Elizabeth Angier; Hasan Arshad; Barbara Ballmer-Weber; Kirsten Beyer; Carsten Bindslev-Jensen; Antonella Cianferoni; Céline Demoulin; Antoine Deschildre; Motohiro Ebisawa; Maria Montserrat Fernandez-Rivas; Alessandro Fiocchi; Bertine Flokstra-de Blok; Jennifer Gerdts; Josefine Gradman; Kate Grimshaw; Carla Jones; Susanne Lau; Richard Loh; Montserrat Alvaro Lozano; Mika Makela; Mary Jane Marchisotto; Rosan Meyer; Clare Mills; Caroline Nilsson; Anna Nowak-Wegrzyn; Ulugbek Nurmatov; Giovanni Pajno; Marcia Podestà; Lars K Poulsen; Hugh A Sampson; Angel Sanchez; Sabine Schnadt; Hania Szajewska; Ronald Van Ree; Carina Venter; Berber Vlieg-Boerstra; Amena Warner; Gary Wong; Robert Wood; Torsten Zuberbier; Graham Roberts Journal: World Allergy Organ J Date: 2022-09-07 Impact factor: 5.516