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Peanut Oral Immunotherapy May Up Allergic Reaction Risk

FRIDAY, April 26, 2019 -- Current peanut oral immunotherapy approaches are associated with increased risk and frequency of allergic reactions, including anaphylaxis, according to a review published online April 25 in The Lancet.

Derek K. Chu, Ph.D., from McMaster University in Hamilton, Ontario, Canada, and colleagues conducted a systematic review to examine the efficacy and safety of oral immunotherapy versus allergen avoidance or placebo for peanut allergy. Studies were screened, data were extracted, and the risk for bias was assessed independently in duplicate.

The researchers found that in 12 trials with 1,041 patients, compared with no oral immunotherapy, oral immunotherapy was associated with increased anaphylaxis risk (risk ratio, 3.12), anaphylaxis frequency (incidence rate ratio, 2.72), and epinephrine use (risk ratio, 2.21) similarly during build-up and maintenance. Oral immunotherapy correlated with increased serious adverse events (risk ratio, 1.92) and nonanaphylactic reactions (vomiting, angioedema, upper-tract respiratory reactions, and lower-tract respiratory reactions: risk ratios, 1.79, 2.25, 1.36, and 1.55, respectively). The likelihood of passing a supervised challenge, which was a surrogate for preventing out-of-clinic reactions, was higher with oral immunotherapy (risk ratio, 12.42). Quality of life did not differ between the groups.

"Considering the current view of peanut allergy oral immunotherapy as a model for other food allergies combined with the rising global prevalence of food allergy, these findings are significant and important to the ongoing development of food allergy therapeutics and improved patient outcomes," the authors write.

Several authors disclosed financial ties to the biopharmaceutical industry.

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Posted: April 2019

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