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A Practical, Stepwise Approach to Peanut Oral Immunotherapy in Clinical Practice: Benefits and Risks

Authors Anagnostou A

Received 26 January 2021

Accepted for publication 1 March 2021

Published 25 March 2021 Volume 2021:14 Pages 277—285


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Amrita Dosanjh

Aikaterini Anagnostou1,2

1Baylor College of Medicine, Section of Pediatric Immunology, Allergy and Rheumatology, Houston, TX, USA; 2Texas Children’s Hospital, Department of Pediatrics, Section of Immunology, Allergy and Rheumatology, Houston, TX, USA

Correspondence: Aikaterini Anagnostou
Baylor College of Medicine, Section of Pediatric Immunology, Allergy and Rheumatology, 1102 Bates Avenue Ste 330, Houston, TX 77030, USA
Tel +1 832-824-1319
Fax +1 832-825-1260
Email [email protected]

Abstract: Food allergies are common, affecting 6– 8% of the children in the United States. There is a significant burden on the quality of life of allergic children and their caregivers, due to multiple dietary, social and psychological restrictions. Peanut allergy affects approximately 2– 5% of the school-age children. Despite the recommended dietary avoidance, reactions tend to occur due to unintentional exposures and the fear of accidental ingestions potentially resulting in anaphylaxis and death, which creates a lot of anxiety in peanut-allergic individuals. Peanut oral immunotherapy (POIT) has emerged as a form of active treatment and has shown high efficacy in research trials with the majority of participants achieving desensitization and protection from trace exposures. An improved quality of life has also been noted following successful POIT. The risks of POIT should be balanced against the benefits resulting from successful treatment for each individual. Rates of allergic reactions and anaphylaxis are reported to be higher in individuals pursuing therapy, but most subjects will experience mild or moderate reactions during treatment. The landscape of peanut allergy management is changing and the future offers more options for patients than were previously available. Shared decision-making, which is the process of how to choose between different available options, becomes an ongoing discussion between the clinician and the patient, which will ensure achievement of the best possible outcome for the peanut-allergic child. This is a multistep process that evaluates the benefits and risks of therapy or no therapy, as well as patient and family preferences and we review it in detail in this manuscript with the aim to provide clinicians with a practical approach.

Keywords: food allergy, anaphylaxis, children, epinephrine, peanut, food challenge, oral immunotherapy, desensitization, sustained unresponsiveness, shared decision-making, decision aids

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