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.
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.
Authors: Hanneke P M van der Kleij; Hans J M Warmenhoven; Ronald van Ree; Serge A Versteeg; Raymond H H Pieters; Stephen C Dreskin; André C Knulst; Els van Hoffen; Dirk Jan E Opstelten; Stef J Koppelman; Joost J Smit Journal: Allergy Date: 2018-12-27 Impact factor: 13.146
Authors: J-L Fauquert; E Michaud; B Pereira; L Bernard; N Gourdon-Dubois; P-O Rouzaire; E Rochette; E Merlin; B Evrard Journal: Clin Exp Allergy Date: 2018-05-29 Impact factor: 5.018
Authors: J L Brożek; L Terracciano; J Hsu; J Kreis; E Compalati; N Santesso; A Fiocchi; H J Schünemann Journal: Clin Exp Allergy Date: 2012-03 Impact factor: 5.018
Authors: George Du Toit; Graham Roberts; Peter H Sayre; Henry T Bahnson; Suzana Radulovic; Alexandra F Santos; Helen A Brough; Deborah Phippard; Monica Basting; Mary Feeney; Victor Turcanu; Michelle L Sever; Margarita Gomez Lorenzo; Marshall Plaut; Gideon Lack Journal: N Engl J Med Date: 2015-02-23 Impact factor: 91.245
Authors: Ruchi S Gupta; Christopher M Warren; Bridget M Smith; Jialing Jiang; Jesse A Blumenstock; Matthew M Davis; Robert P Schleimer; Kari C Nadeau Journal: JAMA Netw Open Date: 2019-01-04